The Economist USA 03.28.2020

TheEconomistMarch 28th 2020 53

1

“W

e are tryingto fly the plane while

we are building it.” That is how

Richard Hunt from America’s department

of health described caring for patients seri-

ously ill with covid-19 in a training session

on the subject on March 24th. The session

was webcast to almost 2,000 people in 39

countries (most were in America). The

questions sent in advance filled 25 pages,

said Mr Hunt.

The thirst for clinical guidance is des-

perate. Three months after doctors in the

Chinese city of Wuhan encountered the

world’s first covid-19 patients, medics in

more than 150 countries are treating grow-

ing numbers. British scientists reckon that

4.4% of those infected will need hospitali-

sation; about one in three of those requires

treatment in an intensive-care unit (icu).

Doctors in icus treat severe pneumonia,

the hallmark of a serious case of covid-19,

all the time. But with this new disease they

do not yet know which changes in a pa-

tient’s symptoms, blood tests or vital signs

are critical ones. Some may point to im-

provements, while others suggest deterio-

ration and the need for more intensive

care, such as a ventilator.

Knowing when and for how long to put

someone on a ventilator is not just crucial

for that patient, says Mark Caridi-Scheible

of the Emory Critical Care Centre in Atlan-

ta, one of the instructors on the webinar; it

is also important for the sake of the next

patient who needs the machine. As hospi-

tals around the world brace for more co-

vid-19 patients than they have ventilators

for, that question is at the top of their list.

While the disease spreads, the World

Health Organisation (who) is crowdsourc-

ing what hospitals are learning. It has

asked doctors to submit anonymised co-

vid-19 patient records to its global data-

base, listing the drugs prescribed, proce-

dures carried out and outcomes. But it has

received fewer contributions than hoped,

says Soumya Swaminathan, the who’s

chief scientist. Talking to doctors directly

seems to work better. Clinicians who treat

covid-19 patients in 30 countries chime in

at a twice-weekly virtual gathering run by

the who. Their input, plus the clinical

studies that are being published at a steady

clip, are distilled into the who’s standards

of care. Knowledge is evolving so quickly

that these standards have been revised five

times in less than two months.

Meanwhile, veterans from the earliest

battles of the pandemic are taking their

knowledge to others. On March 12th eight

Chinese doctors, led by Liang Zongang, a

professor of cardiopulmonary reanima-

tion, arrived in Italy on a charter flight that

brought medical equipment supplied by

the Chinese Red Cross. They were followed

on March 18th by around 300 Chinese in-

tensive-care doctors.

Online learning about covid-19 is gath-

ering speed, especially in developing coun-

tries. Around the world, clinicians already

gather online to learn and share their expe-

rience on such topics as hiv/aids, tubercu-

losis, cancer and mental health. The echo

Project, based at the University of New

Mexico, has trained and supports hun-

dreds of such groups in 39 countries, most-

ly in Africa and Asia. Many are now using

The pandemic

Stop, collaborate and listen

The race to learn how to treat covid-19

International

54 Hospitalventilators

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