Abu Dhabi: An American physician who has been on the frontlines against the coronavirus outbreak in the United States has called his visit to the UAE life-changing.
Speaking to Gulf News during his knowledge-sharing trip to Abu Dhabi, Dr Paul Stephens, intensivist at the Cleveland Clinic in Ohio, appeared impressed with the level of dedication and care on the part of healthcare workers and the government.
“Working here at Cleveland Clinic Abu Dhabi has been life changing, from the people I’ve met, to the patients I’ve cared for, to the passion I’ve seen caregivers provide. The love the nurses here display for their patients has just been phenomenal,” Dr Stephens said.
Awe-inspiring medical care
“[In addition], the UAE government seems to just be so passionate and caring about their people. To me, it seems like they’ve told [healthcare facilities] to do anything that is needed for patients and for me as a physician, that is awe inspiring,” he added.
The physician, who specialises in the care of critically ill patients, arrived in Abu Dhabi in May, with a 40-member team that also included other physicians, nurses and allied health professionals. He testified to the medical level of care in the UAE.
“What is [also] interesting about my experience here is that patients are being offered the same level of care as they could expect in the best health systems around the world. You could take a patient in the ICU here and in New York City, and the complications they’re facing [and level of treatment they’re receiving] would be the same,” Dr Stephens said.
The cardiac intensivist spent more than month in the capital, sharing key learnings about COVID-19 management in the United States, as well as receiving updates on the progress of testing and treatment in the UAE. Prior to it, Dr Stephens had also spent time in New York City as part of an effort by Cleveland Clinic in Ohio to support some of the hardest hit areas in the States, which helped make his insights of COVID-19 particularly incisive.
“COVID-19 is a very complex and new disease, so most of what we’re doing is based on small studies and findings from around the world. This means that while studies can point us in certain directions, we still need to determine what is 100 per cent effective and what isn’t,” Dr Stephens said.
“We really have to use our clinical judgement...so it really comes down to sound critical care, looking at every organ system and seeing if we can try and help each part of the body stay in its natural balance or as close to it as possible. Only [then] can we help the body heal itself,” he explained.
Critical care very important
This is the reason why critical care has become such an integral part of ensuring recovery from COVID-19.
“I think that I was lucky to go to New York and learn some of these things, but it really comes down to having board-certified intensivists doing what they do every day, taking care of these super sick patient. Having intensivists like they have here at Cleveland Clinic Abu Dhabi who are so good at critical care, I think they’re able to maximise [this process] better than any other physician in [another] field. It’s definitely impressive to see how well they’re doing it,” Dr Stephens said.
During this COVID-19 outbreak, medical professionals all over the world have been supporting efforts and sharing expertise across borders. In addition to the Cleveland Clinic team, the UAE itself has also cohorts of nurses coming down from India to support efforts here, and the Abu Dhabi Stem Cell Centre has achieved property rights so that its stem cell treatment can be shared.
Changing treatment guidelines
This kind of knowledge sharing has proved invaluable because COVID-19 is an incredibly new disease. Dr Stephens said treatment guidelines have continued to shift as the medical community learns more and more about the condition.
“Initially, the recommendation in the US was to intubate early; the thinking behind that was if we intubated patients early, we would have control of their airway, making them less prone to coughing and spreading the virus around, and also that patients [would be less likely to develop the low oxygen levels that could lead to respiratory arrest],” he said.
“Then we saw that the experience in Italy was that there were some patients that their oxygen level would get so that they never had any respiratory distress and that by just managing their oxygen aggressively, [doctors] were able to able to get patients through the entire acute phase of the disease without needing to intubate. This then guided thinking towards waiting to intubate patients as late as possible,” the doctor explained.
Developing medical therapies
Other changes have been seen in in the prescribed medicinal therapies used to treat COVID-19 patients.
“The World Health Organisation initially recommended against the use of steroids in patients. But looking at the data, the Society of Critical Care Medicine revised that guidance, saying that steroids could be used to try to control some of the dysregulation in the body caused by COVID-19. These have to be properly times to regulate inflammation in the body,” Dr Stephens said.
If the inflammation is not regulated, it causes the human body to make micro clots everywhere.
“This then causes problems with oxygenation and the lungs not working, requiring deep sedation so that patients can be put on ventilation. Once on ventilation, there’s a lot of care that needs to be taken to make sure that the body isn’t working too hard while ventilated,” the physician said.
At present, patients are intubated only when there is a clinical indication.
“We have also changed the way we intubate COVID-19 patients to reduce the risk they can spread the infection to their care team by employing indirect intubation methods that use a camera to help guide us,” Dr Stephen said.
Striking a fine balance
The care doesn’t stop even when the patient is again able to breath independently.
“It’s almost a vicious cycle where we have to take drastic measures to care for a patient through their very sick phase and then, once they’re past it, we have to help them with the complications of the treatment they’ve received. Trying to optimise that in order to minimise any complications from what we’re doing is one of the things we are really focused on, and the intensivists at [Cleveland Clinic Abu Dhabi are able to do this better than physicians in any other field],” Dr Stephens said.
The expert also alluded the coronavirus affecting various groups of people differently.
“I don’t think that we’re seeing different strains of the virus so much as we’re seeing different demographics and populations being more susceptible. We do have theories as to why this might be, related to genetic factors, but more research will be needed to confirm precisely why. Also there are the more commonly understood factors that increase a person’s risk such as hypertension, obesity and diabetes,” he said.
With the world and the medical community learning more about COVID-19, the mortality rate has declined in many places.
“The virus that causes COVID-19 is quite an interesting one as its rate of spread is almost a perfect exponential, helping it to spread relatively well. [At the same time,] it is not so deadly that patients are dying before they can infect others. I think the drop in mortality is likely linked to the world having become much better at preventing the spread of the virus, and the medical community continuing to learn, share information and provide better care,” Dr Stephens said.