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Rising to the Challenge of COVID-19: Advice for Pulmonary and Critical Care and an Agenda for Research

2020; American Thoracic Society; Volume: 201; Issue: 9 Linguagem: Inglês

10.1164/rccm.202003-0741ed

1535-4970

Michael S. Niederman, Luca Richeldi, Sanjay H. Chotirmall, Chunxue Bai,

COVID-19 and healthcare impacts

The explosion of coronavirus disease , the illness related to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had worldwide health implications, but it is a particular challenge to those of us who practice Pulmonary and Critical Care Medicine (PCCM) because of the high rate of respiratory tract involvement, the frequent presence of pneumonia in these patients, and the high mortality rate for those with respiratory failure, particularly in the ICU (1, 2).In China, although 80% had mild illness, approximately one quarter of those who were hospitalized for COVID-19 needed ICU care.For those in the ICU, mortality was 49%, whereas those with Acute Respiratory Distress Syndrome (ARDS) had a mortality of 52.4% (1, 3).As has become clear, many countries have not been able to contain COVID-19 spread because of unavailability of early widespread testing, undertesting of those at risk, failing to trace all contacts of infected patients, and in some overcrowded settings, nosocomial spread of the infection.There is concern about a shortage of ICU beds and ventilators, trained medical staff, adequate personal protective equipment (PPE), and everchanging recommendations about management and supportive care, at a time when no definitive therapy for COVID-19 is available.All of these factors put great strain on PCCM clinicians, and we need to have a plan for meeting these challenges.In this editorial, we provide suggestions based on our experiences with this epidemic to guide our colleagues.We adhere to Benjamin Franklin's assessment that "by failing to prepare, you are preparing to fail."Some important basic facts about COVID-19 are still being determined, most importantly the mortality rate.While some series report mortality rates as high as 3-4%, the rates vary widely by age, comorbidity, and severity of illness on presentation (4).Predictors of mortality have included older age, elevated D-dimer on admission, and higher degree of initial organ dysfunction (4).However, the calculated mortality rate is also a reflection of the degree of widespread diagnostic testing, because many infected individuals have minimal symptoms and may not be routinely evaluated.In South Korea, efforts have been made to test the broad population, and when a more accurate number of infected individuals is included, the overall mortality rate may be ,1%.However, this makes COVID-19 more deadly than seasonal influenza, which has a 0.1% mortality rate; this may reflect not only