Emergency Room Doctor: Getting Best COVID-19 Treatment Ideas Via WhatsApp
The excellent podcast Radiolab has been running some shorter (from its normal fare) “dispatches” from the pandemic that have been quite interesting, but I wanted to take a quick look at one recent such episode that is mostly a discussion between host Jad Abumrad and ER doctor Avir Mitra, who, in a prior life, had interned at Radiolab, in which Mitra plays some of the voice memos he’s been recording for himself as he deals with being an ER doctor on the frontlines in a hospital in NYC, where the largest number of COVID-19 cases are happening.
The whole episode is quite interesting, and they get into discussions about how doctors are recognizing that COVID-19 is not acting like other respiratory diseases, and they’re finding all sorts of oddities — like patients who should be passed out due to low blood oxygen levels acting like there’s nothing wrong at all:
AVIR MITRA: The biggest thing that struck me is patient comes in, you measure their oxygen level with a pulse ox. And to take a step back, the pulse ox is that little thing you put on your finger with a laser light.
JAD: It shines a laser through your finger and reads the color of your blood. And from that …
AVIR MITRA: It tells you your oxygen concentration. If normal is, you know, 97 to 100 percent, you know, we’re seeing patients that are at 60, 70 percent routinely. Normally, if someone’s oxygen saturation is anything close to 70 percent, they’re not awake. They’re — they’re out of it completely. They’re grasping at anything, trying to get oxygen. But these patients we’re seeing routinely that are looking at us, talking to us, they’re wide awake, texting on their phone, and their oxygen saturations are at these super low levels.
JAD: I remember you sent me a text message of somebody who had a — an oxygen saturation reading of, like, in the 50s and they were on their phone.
AVIR MITRA: Exactly. That one got circulated around because we were all seeing the same thing and it’s like you look at someone with a 54, that’s a person that you’re like, “Okay ma’am, you’re gonna be taking a long nap. You know, you’re going on a ventilator.” And they may be like, “Well, can I just finish posting on Instagram first?” You know, it’s just so surreal.
But what struck me about the story — and which made it worth posting about here — is that Mitra discusses how he and other doctors are all using WhatsAspp to discuss theories and possible treatments. In a voice memo he recorded, Mitra first discusses how doctors are all communicating and sharing info through WhatsAspp:
AVIR MITRA: April 10, 2020. I’ve never in my short career seen people spreading information amongst ER doctors and ICU doctors literally by WhatsApp, texting each other images of charts that people have written, kind of really just figuring it out as it goes, which is kind of incredible because in medicine in general, we’re very cautious. We’ll sit in journal club meetings and debate whether we should give somebody 162 milligrams of aspirin or 325 milligrams of aspirin. We’ll — we’ll literally debate that for hours.
JAD: Hmm.
AVIR MITRA: But — but right now we’re just trying different things out almost on a whim.
JAD: So these WhatsApp groups you were telling me about where you’re …
AVIR MITRA: Yeah.
JAD: … you’re exchanging information with doctors in Italy and China.
AVIR MITRA: Yeah. And a lot from Washington also.
JAD: Washington state, right.
AVIR MITRA: Their outbreak started, I don’t know. What was it? A week or two before ours?
And later in the episode, Mitra and others start exploring a completely different approach to treatment, again based on their discussions on WhatsApp:
JAD: One of the things he says that’s been puzzling is just the crazy array of symptoms he’s seeing in people with COVID. There’s the usual cough, fever, breathing issues, but you also have people reporting neurological issues. Some people, including a few folks that I work with, lost their sense of taste and smell for a while. Others are reporting skin issues on their fingers and toes. Migraines.
AVIR MITRA: Trying to understand what’s going on and more importantly what to do about it. So one hypothesis that has been kind of floating around, and I’ve been thinking about and a lot of people have been thinking about is this idea of a coagulopathy.
JAD: He said the idea started again on a WhatsApp group.
AVIR MITRA: I first heard about it from Washington. It may have gone back even to Italy or China, I’m not sure.
JAD: Doctor on one of these groups says, “Hey, I’m seeing these weird lab values in my COVID patients. I’m not sure what it means.” Avir and his colleagues start to investigate, and ultimately notice that COVID patients often seem to have very high levels of this one enzyme in their blood. It’s an enzyme that’s often associated with clotting.
AVIR MITRA: If someone’s making clots and breaking down clots and just going through that clotting process. So that kind of brought up this theory of could it be that this virus is somehow inducing little clots all over the body?
JAD: Thousands and thousands of these micro-clots that might be jamming up the highways and preventing the oxygen in the blood from getting where it needs to go.
AVIR MITRA: And it also could potentially explain why we’re seeing heart damage, because the blood that’s supposed to go to the heart is getting clotted before it can get there. Same thing with the brain. And as a matter of fact, we see problems with the kidneys. We’re seeing problems with every end organ. Maybe it’s not a problem with the organ, maybe it’s a problem with the blood supply that should be getting to the organ.
As the story makes clear, they don’t know any of this for sure, and some of the early tests around this haven’t worked out, but it’s given them a path to explore, which might have some potential.
There were a few key points that struck me about this. First is that it’s yet another example of how the internet has been incredibly useful to doctors on the frontlines. A few weeks back we wrote about how oncologists were getting their best info from Twitter in how to deal with cancer patients with COVID-19, and now we hear about ER doctors on the frontlines using WhatsApp, and getting ideas and real time info from other doctors around the world (some of whom are a little further ahead in making their way through the pandemic).
The second thing that struck me about this was that for the past few years, all we’ve been hearing about WhatsApp have been stories about people wanting to blame the app for violence in India and elsewhere after groups spread misinformation that may have contributed to physical attacks. This, of course, is the nature of a tool that allows for communication (especially encrypted communications). Some of that communication can be for a good purpose, and some of it may be the ongoing flow of disinformation. And when we’re focusing on how to deal with the latter, we should be pretty damn careful that it not cut off the possibility of the former.
The third thing that I found notable about this is how quickly these informal networks seem to have sprung up. There are, already in existence, a bunch of professional organizations and “established” channels of communication to share medical research and ideas… and none of those seem to be as useful or effective in the short term as jumping onto these social media and messaging apps to establish informal networks of experts in a hurry. That’s really quite amazing and worth celebrating. For all the complaints and anger over the negative and problematic uses of social media and messaging apps, we shouldn’t forget how absolutely vital they’ve been for many people working hard to actually save lives.