TheEconomistMarch 28th 2020 531“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 signsare 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 usingThe pandemicStop, collaborate and listen
The race to learn how to treat covid-19International
54 HospitalventilatorsAlso in this section