These guidelines acknowledge an important limitation of the healthcare system that is difficult to understand if you have never worked in a hospital: ICU beds. If you have never worked in a hospital, you may imagine a hospital works like a movie theater, waiting for patrons to fill its seats. If you have worked in a hospital, you know that healthcare economics have pushed our hospitals to capacity. Our ICUs, in particular, are already filled with critically ill patients; if those numbers double in the next several months, we may have nowhere to put those patients. In the past month, we have heard much about the challenges associated with ramping up the production of N95 masks and other critical supplies. Those challenges are dwarfed by the complexities associated with creating new ICU beds, and training the staff needed to attend to those beds.
How, precisely, patients who require immunosuppression may be affected by COVID-19 is hard to say. Investigators at the University of North Carolina at Chapel Hill and the Icahn School of Medicine at Mt. Sinai, New York, have taken the first stab at trying to define the risk among immunosuppressed patients by creating a registry for patients with inflammatory bowel disease who have been infected with COVID-19.
The Secure-IBD Registry collects basic information on patient epidemiology, co-morbid conditions and immunosuppression; because it has a head start, this group may provide us with the first glimpse into how our immunosuppressed patients may fare. But we rheumatologists are hard on their heels. An effort to create a similar registry for patients with rheumatic disease is being spearheaded by Philip Robinson, a rheumatologist and associate professor at the University of Queensland, Australia, and Jinoos Yazdany, chief of the Division of Rheumatology at Zuckerberg San Francisco General Hospital and the Alice Betts Endowed Professor of Medicine at the University of California, San Francisco, with the support of the ACR.
Social Distancing
Basketball, in the U.S., is like a form of religion; you know things are getting serious when it affects March Madness. The National Collegiate Athletic Association’s (NCAA) Division I Basketball Tournament has been canceled. That’s as unthinkable as canceling Christmas. Major American music festivals, including South by Southwest (SXSW) and Coachella, have been cancelled or postponed. Altogether, over 25% of all Americans have been ordered to stay at home as much as possible to stem the spread of this disease.
This seems dramatic until you compare these actions to what is taking place in other countries. In Europe, Italy, Greece, France and Spain have essentially shut down their entire nations until further notice. Germany may rapidly follow suit.
