Dr. Ricardo Maldonado

Editor's note: The Villager is reprinting an article shared by EAMC and written by Dr. Ricardo Maldonado, infectious disease expert at EAMC. 

 

The life expectancy in the United States has doubled in the past 100 years. Medicine is responsible for that. When we talk about medicine, we are talking about the science of medicine. The treatments that have allowed us to live twice as long than in the early 1900s come from well-controlled scientific studies performed by physicians. 

And even though some of those studies are not perfect, they are high quality and still give enough information to determine the likelihood a treatment will be helpful. This is called evidence-based medicine — an important concept that has allowed us to help our patients better. Evidence-based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. It is the way we should envision medicine presently, and in the future. 

With the growing number of anti-scientists, evidence-based medicine is losing power and we are on a dangerous path that we cannot allow to go on. This is especially true now in this divided world where misinformation and lies take one second to create damage and 20 times longer to repair that damage. 

In America, we have freedom of speech. A licensed physician can certainly voice their opinion and even their experiences, but that does not make their opinions right. Blanket statements like “finding a cure for Covid-19” based on a personal experience is not responsible. 

The claims made on the video I am referring to have already been debunked by other physicians with fact checks and excellent notes. 

Irresponsible claims on social media of a cure or claims that masks are unnecessary generate confusion and create chaos. They also generate distrust toward medical professionals who have dedicated our lives to give you the safest treatment that will likely help you feel better, get better, or even save your life.

I have received calls to my office asking why we are not using hydroxychloroquine on all of our patients.

As the leader of the Covid-19 response team at East Alabama Medical Center (EAMC), my responsibility is to protect my community by providing education and recommendations about public health so that we decrease transmission. In doing so, we save lives and give patients the best chance to survive this awful illness. 

Covid-19 has many unique and strange characteristics. The outcomes vary more than anything I have seen in my life from any other infection. Some people don’t have symptoms, while other people die. The mortality rate climbs steadily as we go up in age groups.

Among all American deaths, those younger than age 24 account for only 0.15 percent. In comparison, 92.5 percent of deaths among Americans are in people older than age 55. Clearly, it seems, Covid-19 spares most of our children and young adults. 

Let’s imagine a pediatrician who decides to give 350 young people diagnosed with Covid-19 (even those with comorbidities like high blood pressure or diabetes) a treatment with Hydroxychloroquine and Azithromycin and no one dies. That doctor then claims finding the cure for Covid-19 when the reality is those patients would have survived anyway with or without any medication. 

That would be comparable to me saying that because I have given 500 adolescents with the flu a combination of Tylenol and Vitamin C, and no one died, that I just found the cure for the flu. That does not make much sense to me.  

I have practiced adult medicine throughout my professional career. Adults are the ones that Covid-19 has killed the most.

At EAMC, we have seen over 400 hospitalized patients with Covid-19 since mid March. Our mortality rate in March was 19 percent. It dropped to 15 percent in April as we learned more about the virus. By June, it went down to 12 percent and is at 7 percent so far in late July. We are working tirelessly to keep our mortality the lowest possible. 

Our treatments have changed over time. In March and April, we used a lot of Hydroxychloroquine and Azithromycin, with and without zinc. Now, after so many studies suggesting there is no benefit to them, we have reduced the use of those drugs to very little. It is uncertain if there will be any role at some point of this medication on certain populations, especially early in the disease. But I doubt it needs to be offered to those who have a 99.5 percent chance of surviving with no treatment. Unfortunately, those with the highest risk are also the ones who will likely develop cardiac toxicity with Hydroxychloroquine. We will wait on those studies before we recommend it more than we are doing now. 

Dexamethasone and other steroids improve survival in patients with Covid-19 who present with pneumonia with hypoxemia.  

For the vast majority of our patients admitted with Covid-19, we are using basic concepts of permissive hypoxemia, proning and careful use of blood thinners as we know the incidence of blood clots is higher than usual on these patients. The drug Remdesivir has been used in limited amount as our supply is not great. It appears safe, but probably the most benefit would be earlier in the illness as it is an antiviral and the serious cases are usually characterized by hyperinflammation where anti-inflammatory medications are more useful. 

We joined the Mayo Clinic trial on convalescent plasma about three months ago, but plasma supply from patients who have recovered from Covid-19 and have antibodies remain low. 

For those who develop serious complications like Cytokine storm syndrome, we have used a medication called Tocilizumab. This medication can compromise your immune system for a few weeks, so it has to be used judiciously and only when the benefits outweigh the risks. We have used it successfully in several cases. 

Recently, we have been performing some experimental treatments for life-threatening cases where there is not much else we can offer (a situation known as salvage therapy) after aggressive treatments. We hope to publish our results in the near future.

My colleagues and I at EAMC have studied this virus relentlessly so we can make the best decisions for our patients. We are committed to finding the best treatments possible while being careful of not causing any unnecessary harm.

Ricardo Maldonado, M.D. is an Infectious Diseases specialist and is the sole practitioner with East Alabama Infectious Disease.  Maldonado is leading the clinical response to Covid-19 at East Alabama Medical Center.

(1) comment

JDean

I spent 9 days at EAMC with covid pneumonia, the treatment I was given could not have been better. Once they began treatment I began feeling better in 3 days, I'm at home now and doing very well. I was scared of being alone there but I have to say the doctors and nurses became family, I would never want to be treated by any other medical team. I am very proud to know what we have at EAMC!

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