In the past year and a half we’ve done a 180 on a lot of medical concepts.
We used to think intubating people really early in the course of Covid was good…we now know its bad, they are more likely to die. Save intubation for when we’ve tried everything else.
We used to keep people on high oxygen levels and high PEEP …not anymore.
We stopped recommending ventilations and chest compressions cause they were said to be Aerosol Generating Procedures…now we know these are trivial compared to patients simply coughing.
We used to recommend bleach injections (no, kidding, that was only Dr Trump). But we did recommend lots of different meds…and found resounding benefit for only one: steroids (dexamethasone or similar) in hypoxic patients.
We did discover things that work, that were important: checking blood oxygen levels (there are so many people who feel OK, but whose blood oxygen levels are dangerously low…and need oxygen); letting mildly hypoxic patients go home with pulse oximetry followup in the community or at home; lying patients prone, even before they became severely ill, to utilise more of their lungs in oxygen exchange. Nasal prong oxygen, CPAP, high-flow oxygen. These are all methods that took us from mortality rates of 10% initially in some health systems, to less than 1% overall in most wealthy countries even prior to vaccination.
Good lessons that the simplest interventions are what will save you: oxygen, masks, vaccinations, and physical distancing. Not fancy expensive medications, ECMO, or ventilators.
This was a good warm-up run for when the next Covid variant blossoms, or when pandemic influenza comes back.