WEBVTT - Virus Treatment Is Changing

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<v Speaker 1>Welcome to Prognosis. I'm Francesco Levi. Laura Carlson is out.

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<v Speaker 1>It's day one hundred nine since coronavirus was declared a

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<v Speaker 1>global pandemic. Today's main story. The virus still plagues many countries,

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<v Speaker 1>but in the six months or so since it first

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<v Speaker 1>emerged in humans, we have learned a lot about how

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<v Speaker 1>to treat it. That knowledge may help us save many

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<v Speaker 1>more lives than in the early days of the pandemic.

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<v Speaker 1>But first, here's what happened in virus news today. US

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<v Speaker 1>President Donald Trump is amping up pressure to send kids

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<v Speaker 1>back to school, regardless of the safety risks. Today he

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<v Speaker 1>blasted the Centers for Disease Control and Prevention atter they

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<v Speaker 1>set guidelines for reopening schools. In a tweet, Trump called

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<v Speaker 1>the guidelines quote very tough and expensive, and said he

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<v Speaker 1>would meet with the CDC earlier. Trump said he may

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<v Speaker 1>cut funding if schools do not open before the November election,

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<v Speaker 1>saying keeping them closed benefits the Democrats. The country's largest

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<v Speaker 1>public school system, New York City, announced today that students

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<v Speaker 1>would probably return to physical schools part time this fall.

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<v Speaker 1>Mayor build A Blasio said he anticipates a blended learning

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<v Speaker 1>program with students in class two to three days a week.

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<v Speaker 1>New York State Governor Andrew Cuomo said a decision on

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<v Speaker 1>schools would be announced the first week of August. Melbourne,

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<v Speaker 1>Australia's second largest city, goes into lockdown today for the

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<v Speaker 1>second time in four months. The country's missteps in handling

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<v Speaker 1>travelers returning from overseas and the complacency of a few

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<v Speaker 1>neighborhoods tipped the city back into the danger zone. Melbourne

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<v Speaker 1>is now responsible for the vast majority of Australia's new

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<v Speaker 1>COVID nineteen cases in the past month. Even as life

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<v Speaker 1>in most of the nation returns to normal, Melbourne's five

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<v Speaker 1>million people will be back under stay at home orders

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<v Speaker 1>that were first imposed in March, and finally, Brooks Brothers

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<v Speaker 1>filed for bankruptcy. The company was the latest victim of

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<v Speaker 1>the pandemics hit to clothing sales. Neiman Marcus Group, Jay

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<v Speaker 1>Crew Group and John Varvados Enterprises have all filed for

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<v Speaker 1>bankruptcy since the virus took hold. And now for today's

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<v Speaker 1>main story. Almost two hundred days after the first coronavirus

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<v Speaker 1>cases were reported in Central China, health workers and researchers

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<v Speaker 1>have raced to learn more about the brand new pathogen.

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<v Speaker 1>As many as one thousand COVID related research papers are

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<v Speaker 1>being released daily. Bloomberg Senior editor Jason Gale reports that

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<v Speaker 1>that research and the experience of frontline healthcare workers is

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<v Speaker 1>informing better ways to diagnose, prevent, and treat the disease,

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<v Speaker 1>and it's helping to save more lives. On April six,

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<v Speaker 1>in New York, for a personal experience, I think that

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<v Speaker 1>was the worst day hospital wise. That's Associate Professor Sonya Yellow,

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<v Speaker 1>an eighteen year veteran critical care doctor currently working at

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<v Speaker 1>the Columbia University of a Medical Center. We were really,

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<v Speaker 1>really very busy, and the hospital was full of patients

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<v Speaker 1>with with COVID, and I was working in the intermediate

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<v Speaker 1>care unit or step down unit, which normally has eight

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<v Speaker 1>to tend patients, and that day we had a more

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<v Speaker 1>than sixty patient. At some point we had sixty eight patients,

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<v Speaker 1>so that's approximately eightfold increased. Many patients struggled to breathe.

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<v Speaker 1>The most critical we transferred to a pop up intensive

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<v Speaker 1>care unit, but others also required more invasive respiratory support.

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<v Speaker 1>Despite all our efforts, we were stuck with the several

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<v Speaker 1>patients who needed to be incubated, but there was no

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<v Speaker 1>way Sonia and a colleagues could incubate all of them

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<v Speaker 1>at once. She had to buy time, so she made

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<v Speaker 1>the decision to do something unorthodox, something for which there

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<v Speaker 1>are no guidelines or protocols. We've been hearing about this

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<v Speaker 1>technique in the beginning of April from friends and some

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<v Speaker 1>colleagues about this prawning, which means putting people to lay

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<v Speaker 1>on their stomach among patients who are not intubated, that

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<v Speaker 1>means they are not on a respiration or not on

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<v Speaker 1>a mechanical ventilation, and that's an unconventional treatment. There are

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<v Speaker 1>no guidelines on such therapy and non intubrated patients. Feeling

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<v Speaker 1>she had nothing to lose, Sunny went ahead anyway. Laying

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<v Speaker 1>on the stomach improves blood circulation in the upper portion

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<v Speaker 1>of the lung, increasing the volume of oxygen and carbon

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<v Speaker 1>dioxide that can be exchanged. It also decreases pressure around

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<v Speaker 1>the lung and can help clear secretions from the airways.

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<v Speaker 1>So we tried that and the first few patients I

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<v Speaker 1>remember first three patients really had a dramatic improvement in

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<v Speaker 1>their oxygen nation, which is measured from a finger by

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<v Speaker 1>pulse of symmetry. That's a small clip like device that

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<v Speaker 1>attaches to the patient finger. But we were very encouraged

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<v Speaker 1>by that and also the clinical stuff. Nurses and nurse

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<v Speaker 1>practitioners as well as hospital is they really surprised how

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<v Speaker 1>well this works. So we said, okay, let's just see

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<v Speaker 1>who else is needing the most oxygen. So we decided

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<v Speaker 1>to do this promposition only in those most severe cases

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<v Speaker 1>who would otherwise be integrated. Immediately, Sonya got approval to

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<v Speaker 1>attract these patients and report what happened to them in

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<v Speaker 1>a study. Her paper was published last month and the

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<v Speaker 1>Journal of the American Medical Association. She and a colleagues

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<v Speaker 1>founded if they were able to get patients blood oxygen

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<v Speaker 1>levels back into the acceptable or normal range, then there

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<v Speaker 1>was a forty six percent reduction in the probability of

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<v Speaker 1>them being intubated. We were hoping that this would be

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<v Speaker 1>helpful to other health care providers dread and COVID patients.

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<v Speaker 1>The approach hasn't yet been tested in a large randomized

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<v Speaker 1>control old trial, but it's a reminder that necessity is

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<v Speaker 1>the mother of invention in the absence of a cure.

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<v Speaker 1>Doctors like Sonia are left relying in part on trial

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<v Speaker 1>and error, but months into the most destructive pandemic in

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<v Speaker 1>a century, their collective experience is starting to build a

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<v Speaker 1>framework of how best to cope with coronavirus patients. In April,

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<v Speaker 1>Gilead's anti viral Rhamdavia, now approved with the brand name Vecklery,

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<v Speaker 1>were shown to speed recovery time and COVID patients. Last month,

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<v Speaker 1>the inexpensive corticosteroid decks of methad zone was found to

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<v Speaker 1>reduce debts by a third among patients receiving mechanical ventilation.

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<v Speaker 1>Doctors are also routinely administering heprin, another anti coagulants to

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<v Speaker 1>prevent dangerous blood clots from forming in the veins of

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<v Speaker 1>the critically ill or. COVID nineteen is a respiratory disease.

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<v Speaker 1>We now know that it has the capacity to cause

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<v Speaker 1>diverse manifestations um but little by legion, we discovered the

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<v Speaker 1>new sign new symptoms of the disease. This is Dr

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<v Speaker 1>Sylvie Bryant, the World Health Organization's Director for Global Infectious

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<v Speaker 1>Hazard Preparedness. Now we know that there is really a lot,

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<v Speaker 1>a lot of possibilities for these barns to attact the

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<v Speaker 1>human body. The quest is to create a toolbox that

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<v Speaker 1>will enable doctors to provide better care for the full

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<v Speaker 1>range of COVID patients aill we says. The w h

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<v Speaker 1>O is collating data from countries to identify the crucial

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<v Speaker 1>elements that reduce the proportion of COVID patients who die

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<v Speaker 1>from their illness. These include how health systems triage COVID patients,

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<v Speaker 1>how they protect those vulnerable to more serious complications, and

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<v Speaker 1>the speed with which they provide intensive care. It's not

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<v Speaker 1>only what you do. Sometimes at this level there is

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<v Speaker 1>a little different, but it's really how you do it.

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<v Speaker 1>What is the particular point that that makes the difference.

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<v Speaker 1>We are in the midst of our surge now, we

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<v Speaker 1>are are we have exponential growth in Arizona. The daily

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<v Speaker 1>case rates are going up, our hospital admissions are going up,

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<v Speaker 1>So we are in the midst of it right now.

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<v Speaker 1>The more COVID patients Dr. Jared Mosey A sees in

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<v Speaker 1>his hospital's intensive Kegan in Tucson, the more he says

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<v Speaker 1>he's convinced that saving lives comes down to protecting the

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<v Speaker 1>lungs of those with acute respiratory distress. Syndrome. It's an

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<v Speaker 1>inflammatory condition doctors refer to simply as a RDS. Most

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<v Speaker 1>patients need breathing support, but too little or too much

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<v Speaker 1>air pressure and volume can damage the lungs further. And

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<v Speaker 1>so I look at all of those things and tinker

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<v Speaker 1>with the ventilator for a good while every day to

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<v Speaker 1>try to find that balance, and to me, that is

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<v Speaker 1>the thing that will save the most lives in in

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<v Speaker 1>this disease is just excellent critical care management of a

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<v Speaker 1>r d S. Jared is also an associate professor of

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<v Speaker 1>emergency medicine at the University of Arizona. When I spoke

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<v Speaker 1>with him in late June, his hospital had just expanded

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<v Speaker 1>in intensive care facility to one beds, with plans for

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<v Speaker 1>more if needed. He says he's laid hands on more

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<v Speaker 1>than one hundred COVID patients over the past four months

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<v Speaker 1>or so. I asked him if he thought better treatments

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<v Speaker 1>we're leading to better survival. How do I hope? So?

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<v Speaker 1>I think I think that's the case, but it's very

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<v Speaker 1>hard to answer that question when you're in the thick

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<v Speaker 1>of it. I hope. So some days I think we're

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<v Speaker 1>actually getting pretty good at this and other days. I

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<v Speaker 1>think this is demoralizing. That's the humbling thing about the pandemic.

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<v Speaker 1>The more we know, the more we understand that there's

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<v Speaker 1>so much more we don't yet know well, such as

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<v Speaker 1>doctors and health authorities are racing to come up with

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<v Speaker 1>a better waste to find COVID nineteen in the absence

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<v Speaker 1>of an effected vaccine. The best way to find the

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<v Speaker 1>pandemic remains avoiding catching the coronavirus in the first place.

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<v Speaker 1>That was Jason Gale in Melbourne. And that's it for

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<v Speaker 1>our show. For coverage of the outbreak from one bureaus

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<v Speaker 1>around the world, visit bloomberg dot com slash coronavirus and

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<v Speaker 1>if you like the show, please leave us a review

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<v Speaker 1>and rating on Apple Podcasts or Spotify or wherever you listen.

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<v Speaker 1>It's the best way to help more listeners find our

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<v Speaker 1>global reporting. The Prognosis Daily edition is produced by Topor

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<v Speaker 1>foreheads Jordan Gospore, Magnus Hendrickson, and Laura Carlson. Today's main

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<v Speaker 1>story was reported by Jason Gale. Original all music by

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<v Speaker 1>Leo Sidran. Our editors are Rick Shine and me Francesco Levi,

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<v Speaker 1>Bloomberg's head of podcast is me,