We have greatly emphasized early treatment for SARS-CoV-2 infection (COVID-19 illness); however, despite our efforts, there have been millions of hospitalizations, and Americans have felt the panic and despair of COVID-19 respiratory failure. In this week’s McCullough Report, we dedicate most of the hour to the “Father of Critical Care Medicine,” Dr. Paul Marik, who is one of the most acclaimed physicians in the history of medicine.
Dr. Marik walks us through step by step what should happen with each and every hospitalized patient with COVID-19. He emphasizes the importance of clinical judgment and the observation that no two patients are the same. The mass casualty context of the crisis means doctors cannot wait for large randomized trials or clinical practice guidelines to treat the next patient in front of them. They must act based on their best judgment and all available sources of medical evidence.
Because the hospitalization is often later in the course of illness, corticosteroids and full-dose anticoagulation are more important than antiviral therapies such as remdesivir. Most importantly, like so many physicians, Dr. Marik believes that a significant fraction of hospitalizations is avoidable with early multidrug therapy for high-risk patients in the incipient phase of COVID-19.
Both Dr. McCullough and Dr. Marik agree, that the errors made in COVID-19 care tend to be those of omission and not commission. Meaning far more drugs are needed to get a patient through to the other side with natural immunity than many realize. Too little treatment has been consistently associated with in-hospital death. This week, we have our music segment with a beautiful prayer song from Rev Michael Joncas.