Category: Covid-19

The woman was dying. Workers at New Yorks Mt. Sinai Hospital were about to call her husband and break the news that there was nothing left to try. Then Dr. Hooman Poor took a gamble.

With high-stress, high-stakes decisions, doctors around the world are frantically trying to figure out how COVID-19 is killing their patients so they can attempt new ways to fight back. One growing theory: In the sickest of the sick, little blood clots clog the lungs.

Poor couldnt prove it. The tests required would further endanger his staff, who were already at risk of exposure to the novel coronavirus, which causes COVID-19. But the lung specialist saw clues that were screaming blood clots. So Poor pulled out a drug best known for treating strokes, and he held his breath.

I said, What do we actually have to lose? Poor said. Thats when I decided to give not just a blood thinner but a blood-clot buster.

Exactly whats going on with blood clots in at least some COVID-19 patients is a mystery.

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Chinese doctors were first to sound the alarm. In March, Chinese heart specialists advised the American College of Cardiology to watch for clots and said certain blood tests showing a rise in clot risk might signal which patients were in greatest danger. Other reports suggested the clots can show up all over the body. But were they a cause of deterioration or an effect?

Already, many hospitals are attempting preventive doses of blood thinners to keep clots from forming. Theres huge debate over what kind to try, what dose is safe the drugs can cause dangerous bleeding and how soon to start.

In New York, Poor was going a step further with a drug called tissue plasminogen activator, or tPA, which doesnt prevent clots it breaks them up.

Its an example of how, with no vaccine or approved treatment for COVID-19, many overwhelmed doctors are following trails of clues to figure out what to try next.

Poors 55-year-old patient wasnt getting enough oxygen even after doctors rolled her onto her stomach for an extreme ventilation technique called prone positioning. She was in shock. Other organs were failing fast.

Twenty minutes after the injection of tPA, her oxygen levels rose. Poor was elated. But not for long.

She gets better, but then she starts to get worse, he said. Most likely were breaking up the clot, but she is immediately forming the clot again.

So he tried something novel, putting the woman on a low-dose drip of tPA for about 24 hours, together with a blood thinner, in hopes of chipping away at existing clots while blocking new ones.

To Poors dismay, the experimental treatment bought the woman only a few more days of life. A sudden, different complication killed her on Friday.

But last weekend, Poors team tested the new clot-fighting approach in four other severely ill patients. One didnt survive, dying of cardiac arrest from a massive blood clot in his heart.

The rest saw improvement in oxygen levels and shock. As of Friday, three remained on ventilators but were doing better, especially one who had been treated soon after her lungs failed. In a new report, Poor called for urgent study of whether abnormal clotting drives at least some patients deterioration, even as his own hospital updated treatment advice for its sickest cases.

Others are onto the same lead. Specialists at the University of Colorado and Harvard recently published a similar tPA research call and cited three additional cases in which it was tried, as hospitals in Colorado and Massachusetts prepare for a study.

Were taking care of extremely ill patients that are dying in front of us, and we cant get any diagnostic testing, yet still have to make treatment decisions, said Dr. Steven Pugliese, a pulmonologist at the University of Pennsylvania.

Pugliese called Poors tPA report very intriguing and concluded: What these doctors did in these very ill patients who were dying was a judgment call, and it was the right thing to do.

But with the bleeding risk, the strategy has to be studied in carefully chosen patients, Pugliese said, especially with no good way to tell in advance who really has these tiny clots.

Poor first noticed oddities as his ICU filled with patients who just werent responding to care the way doctors expected. They were on breathing machines after developing acute respiratory distress syndrome, or ARDS. Its an inflammatory form of lung failure that, when caused by other infections, stiffens lungs.

At least early on, Poor didnt see that.

It was like Groundhog Day with each patient, he said, referring to the movie in which the same events repeat day after day. They had severe abnormalities in oxygen and carbon dioxide levels, but, shockingly, their lungs were not stiff.

He recalled Italian doctors who spotted the same thing and wrote in an American Thoracic Society journal that COVID-19 was causing atypical ARDS.

Back in Poors hospital, when ventilated patients had improved enough to allow them to wake up a bit, alarms would sound as their blood oxygen levels immediately plummeted.

The residents would yell at me, So and so is desaturating! Poor recalled. Classically in ARDS, we think thats because the lung is collapsing. But it wasnt.

Poor often treats patients for pulmonary embolism, a large clot in the lungs that can quickly kill. The COVID-19 patients didnt look quite like that. Nor were their hearts struggling to pump blood into the lungs.

Then, as he was doing laundry at 2 a.m., Poor remembered a rare disease in which some lung blood vessels abnormally dilate even as others are clogged. If that explains the COVID-19 contradictions, he thought, a clot-buster might help.

I did a case series of five. This does not prove anything, he cautioned. Perhaps it brings light to possibilities where further research can delve into what exactly is going on.

Neergaard writes for the Associated Press.

Link:

Doctor treating COVID-19 patients gambles on clot-busting drug - Los Angeles Times

President Donald Trump speaks during a coronavirus task force briefing at the White Houseon Friday. Seated from left, Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci, White House coronavirus response coordinator Dr. Deborah Birx, Surgeon General Jerome Adams, and Food and Drug Administration Commissioner Dr. Stephen Hahn. Evan Vucci/AP hide caption

President Donald Trump speaks during a coronavirus task force briefing at the White Houseon Friday. Seated from left, Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci, White House coronavirus response coordinator Dr. Deborah Birx, Surgeon General Jerome Adams, and Food and Drug Administration Commissioner Dr. Stephen Hahn.

The Trump administration has enlisted some of the biggest corporations in America to help expand the supply of medical equipment needed to fight COVID-19 but many of those supplies aren't going to the cities and hospitals where they're needed most.

Instead, this public-private collaboration means that the marketplace and long-established business ties often shape decisions about who gets life-saving equipment, and who has to wait, NPR found.

While FEMA is doing some of the work, corporate and U.S. officials say the medical supply shortage nationwide is so vast and dire that the federal government can't handle it alone. They say companies are needed because of their expertise and facilities to ramp up shipments fast.

So, late last month, the Trump administration shifted much of the supply effort for the COVID-19 fight to corporations, including McKesson, Cardinal Health and Medline Industries.

This arrangement surprised and dismayed many state governors. When the COVID-19 pandemic exploded in the U.S., they expected the federal government to step in aggressively, buying ventilators, N95 masks and other medical equipment, rushing supplies to growing hotspots like New York City.

"When I was in the federal government, FEMA effectively was the shipping clerk," said New York Gov. Andrew Cuomo, who served in the Clinton administration. "They did the purchasing, they disseminated to the states. That's the simplest system."

Company executives interviewed by NPR say their efforts are already accelerating deliveries and expanding the supply of medical equipment.

"We operate about 50 distribution centers in the United States, and we have about 22 manufacturing facilities," said Jesse Greenberg, a Medline spokesman. "We're doing our very best to step up to this challenge."

The executives say safeguards are in place to prevent firms from price-gouging during the pandemic. Earlier this month, the Justice Department took the extraordinary step of issuing a letter allowing five of the country's biggest medical supply companies to collaborate on the COVID-19 response, sharing information and resources in ways that would normally violate antitrust laws.

"It's totally unique. I do not remember anything like it before," said Eleanor Fox, who studies trade regulation at the New York University law school. "It would probably be an illegal cartel, but for the fact that this is a crisis."

But the majority of medical supplies procured by these companies aren't being handed out through FEMA or distributed on the basis of immediate need. Instead, the equipment is going first to companies' regular customers.

"We have existing contracts," said Medline's Greenberg. He noted that his firm stopped taking new orders from frontline health providers, even those in desperate need, as the pandemic escalated. "The inventory isn't there for Medline to service new customers."

This means a hospital with existing supply contracts with one of these companies before COVID-19 hit might get shipments of masks and gowns even when not facing a surge of sick patients.

Meanwhile, a hospital without that kind of relationship might have to wait, even if its doctors and nurses are at risk because they lack protective equipment.

One high-profile part of this public-private arrangement is known as the Airbridge project. The Trump administration is chartering dozens of cargo flights packed with medical supplies from overseas.

"That gear and those outfits are being handed out as they arrive," said President Trump during his White House briefing on Thursday. "They're going directly to point."

In fact, the masks, gowns and other gear carried on those planes go first to private companies.

Firms partnering on the Airbridge flights tell NPR that under their agreement with the White House and FEMA, roughly half the medical equipment in those deliveries is theirs to sell however they like. The other half will be shipped to COVID-19 hotspots but not necessarily to the worst-hit hospitals. Once again, supplies go to existing customers.

"This product that we're moving is primarily commercial product," said Navy Rear Adm. John Polowczyk, who leads FEMA's procurement task force. "That would enter the commercial system and be distributed through financial business transactions between hospitals and these distributors."

Asked why more supplies aren't being prioritized and distributed based on need rather than market-driven factors, Polowczyk said he didn't want to disrupt existing supply chains. "We're bringing product in, they're filling orders for hospitals and nursing homes, like normal."

But many governors say the situation isn't normal. In many places, nurses, doctors and first responders are still caring for patients without enough protective equipment.

As a result, many states have chosen to work around the Trump administration's public-private supply chain, seeking their own suppliers. Governors say this has led to confusion and chaotic bidding wars with suppliers around the world.

"I have to figure out how to do business with China where I have no natural connection as a state," Cuomo said. "Every state has to scramble to find business connections with China."

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Market And Business Ties Often Determine Where COVID-19 Supplies Go - NPR

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The number of people with COVID-19 in Alaska continued to increase on Saturday with 11 new cases announced by the states health department, bringing the states total to 257.

The updated numbers come at the end of a week in which Alaska saw its sharpest single-day increase in COVID-19 cases (Mondays 22 new positives) and state officials took additional steps to limit the spread of the illness statewide, extending social distancing and travel mandates and closing schools through the end of the school year.

New cases announced Saturday include a Wasilla resident, as well as nine more Anchorage residents and an individual who lives in Craig the first among residents of that Southeast Alaska community. So far, 121 Municipality of Anchorage residents and 10 Matanuska-Susitna Borough residents have tested positive for COVID-19.

The updated numbers also include the eighth COVID-19-related death of an Alaskan, the third announced this week. A 73-year-old woman with underlying health conditions died Friday at Fairbanks Memorial Hospital, according to officials from Foundation Health Partners, which operates the hospital. The death is the second to occur in Interior Alaska.

Two Alaskans have died from COVID-19 while out of state. Most who died were over the age of 60 with underlying health conditions, though an Anchorage woman in her 40s and an Anchor Point man in his 30s are among the fatalities.

The state had received COVID-19 test results for a total of 7,732 Alaska residents through Friday. The state of Alaska does not publish information on the number of tests that are outstanding.

In Anchorage, a person who tested positive for COVID-19 is staying in isolation at the Dempsey Anderson Ice Arena on West Northern Lights Boulevard, said Carolyn Hall, spokeswoman for Mayor Ethan Berkowitz.

The arena, which contains two ice rinks, was recently converted into an isolation and quarantine medical site for people sick with COVID-19 who do not have anywhere else to recover, including people experiencing homelessness. Hall said the city couldnt disclose any information about the person in isolation at the ice arena.

Sixty-three Alaskans have recovered from the illness, according to the state, and a total of 31 have been hospitalized, including three new hospitalizations Friday.

The states case count numbers reflect the number of positive test results between midnight and 11:59 p.m. on the previous day, meaning that cases of COVID-19 reported on Saturday represent the number of people who tested positive for the disease on Friday.

In addition, the state reports cases based on a persons residency. They dont necessarily reflect where a person is at the time of their positive test result or where they became ill.

As case counts rose, state officials extended measures intended to curb the spread of COVID-19 and prevent health care facilities from being overwhelmed.

This week, Gov. Mike Dunleavy said that a previously announced school closure would last through the end of the school year for Alaska.

The state also extended a mandate that orders Alaskans to remain at their place of residence and practice social distancing," which is set to be re-evaluated by April 21. The mandate says that everyone in the state must not participate in public or private gatherings that include non-household members, regardless of the number of people involved.

The mandate includes an exemption for outdoor activities, but asks that Alaskans keep their distance from others while outside.

A mandate that bans all non-essential travel between Alaska communities was also extended and is expected to be re-evaluated by April 21, state officials announced.

The states chief medical officer, Dr. Anne Zink, on Friday encouraged Alaskans to wear face coverings while out in public because new information continues to show that they can be an effective tool to limit the spread of the virus.

As Alaskans approached another weekend hunkering down, with several businesses closed and many people out of work statewide, state officials expressed hope that the efforts to blunt the spread of COVID-19 would help initiate a return to normalcy.

Every day, we get new tools in, Zink said. Every day, we have more resources to be able to address this pandemic and to be able to support Alaskans.

Zink said that she hopes the state can ward off the virus long enough to get a vaccine and protect the states most vulnerable. Zink also highlighted the importance of testing in allowing officials to see early on where the spread of COVID-19 is happening, so it can be contained.

I think that we just see really promising things on the horizon, both for testing and for treatment options, Zink said.

On Friday, Dunleavy said that he would work to look at ways of going about a phased reopening throughout the state, though many aspects of the virus make the timeframe hard to predict.

We are working around the clock to try to figure out the ways to disrupt peoples lives as little as possible, Zink said.

Reporter Paula Dobbyn contributed to this story.

[Because of a high volume of comments requiring moderation, we are temporarily disabling comments on many of our articles so editors can focus on the coronavirus crisis and other coverage. We invite you to write a letter to the editor or reach out directly if youd like to communicate with us about a particular article. Thanks.]

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Alaska saw a week of more COVID-19 cases and extensions of statewide restrictions - Anchorage Daily News

And then came the coronavirus outbreak.

Stringent instructions were issued, along with dire warnings meant to protect older people, who are most vulnerable to the virus. Elderly persons must absolutely avoid leaving home or receiving guests, the Health Ministry admonished. Minister of Defense Naftali Bennet declared: The most important rule is to protect grandfather and grandmother. Find creative ways of hugging and loving them, from a distance! A public-service announcement on the military radio station said: Save Grandpa and Grandma. Dont go to visit them.

My family was divided. Most of us thought that Dad and his live-in partner should be totally isolated in their home. This led to a series of discussions, sometimes arguments, within the family. All of us had only Dads well-being in mind, but there were disagreements over the right way to ensure it.

The first people who had to stop coming to Dads house were the trainers and therapists, the ones whose daily contact with him had kept him alert and active. Attempts to continue his sessions over video chats didnt work.

Then most of us thought we, too, should stop visiting him. The health authorities were already predicting that within days, hundreds of Israelis would be on respirators, most of them old people, and their number would soon be in the thousands, with only 1,500 such machines available. (Those predictions proved wrong.) One family member made a grim prediction about what would happen if Dad were infected with the virus: It is reasonable to assume that he would have very low priority when they have to decide who to respirate and who dies.

After three weeks, I persuaded the family to allow me a visit. I immediately saw that something was seriously wrong. Dad was drifting away, disconnecting from his surroundings. Should we call a doctor? Just letting a doctor in risked infection, and there was going to be a shortage of respirators. We called one anyway.

The doctor advised us to go immediately to the emergency room. My sisters, Dads partner and I had more arguments, with some saying that hospitals were the worst place to be. We called another doctor, who said the hospital seemed too dangerous. A third doctor told us to call her again in a couple of days.

Over the next few hours I watched Dad slipping away from us. That morning he had responded to questions in a weak voice, but at around 4 p.m. he was hardly opening his eyes, and at 6 not at all. He had become totally detached. His temperature was going up. I felt I was being ripped apart. What do I know? What do I understand about medicine? Perhaps his decline was only temporary, maybe he was having a bad day, as hed had in the past. Or was it a worsening of his Alzheimers or a spread of the cancer? Under any other circumstances, we would have taken him to the E.R. immediately. But if he contracted the coronavirus at the hospital and died as a result, would I be able to look his partner and my sisters in the eye?

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My Father Didnt Have Covid-19, but He Almost Died Because of It - The New York Times

For Immediate Release: April 10, 2020

The U.S. Food and Drug Administration issued an emergency use authorization for a blood purification system to treat patients 18 years of age or older with confirmed Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) with confirmed or imminent respiratory failure.

The authorized product works by reducing the amount of cytokines and other inflammatory mediators, i.e., small active proteins in the bloodstream that control a cells immune response by filtering the blood and returning the filtered blood to the patient. The proteins that are removed are typically elevated during infections and can be associated with a cytokine storm that occurs in some COVID-19 patients, leading to severe inflammation, rapidly progressive shock, respiratory failure, organ failure and death.

We continue to work across all sectors to expedite the development of numerous innovative potential preventive and treatment approaches by both facilitating emergency access for patients, to the extent we can, and supporting the evaluation of potential therapies, said FDA Commissioner Stephen M. Hahn, M.D. With todays authorization of a blood purification device, we are expediting the availability of a treatment option for patients in the ICU to help reduce the severity of the disease. Our staff will continue our around the clock review of all medical products to expedite the availability of treatments to help fight this devastating disease.

The FDA issued this emergency use authorization to Terumo BCT Inc. and Marker Therapeutics AG for their Spectra Optia Apheresis System and Depuro D2000 Adsorption Cartridge devices.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nations food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

###

04/10/2020

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Coronavirus (COVID-19) Update: FDA Authorizes Blood Purification Device to Treat COVID-19 - FDA.gov

A huge influx of coronavirus patients has started to put a strain on hospitals in Moscow as Russias death toll rose to more than 100.

Moscow and many other regions have been in lockdown for nearly two weeks to stem the contagion, but hospitals in the capital are still being pushed to their limit, the Kremlin said.

On Saturday, dozens of ambulances queued outside a hospital handling coronavirus cases in the region immediately outside Moscow, waiting to drop off patients.

One ambulance driver said he had been waiting 15 hours outside the hospital to drop off a patient suspected of having the virus.

The situation in both Moscow and St Petersburg, but mostly in Moscow, is quite tense because the number of sick people is growing, Kremlin spokesman Dmitry Peskov said in an interview on state television, news agencies reported.

There is a huge influx of patients. We are seeing hospitals in Moscow working extremely intensely, in heroic, emergency mode.

Russias coronavirus crisis response centre said hospitals were taking all possible measures to ensure rapid admissions and that cases of ambulances needing to wait hours to drop off patients was not a systemic issue.

Russia has reported 13,584 cases of the virus, and the authorities said on Saturday that 12 new coronavirus-related deaths in the last day had pushed the death toll to 106.

Peskov added that it would become clearer only in the next few weeks whether the country was nearing the worst point in its outbreak.

Sergei Sobyanin, the mayor of Moscow, said on Friday that the city was far from reaching the peak of the outbreak, saying it was merely in its foothills.

On Saturday he said Moscow would introduce digital permits next week to control movement around the city to help enforce the lockdown.

He said residents will have to request the permits, which will contain a code that identifies the holder, in order to travel using motorcycles, scooters, cars, taxi services or the citys vast public transport network.

Sobyanin added that residents should be ready to present identification documents and their digital permit to law enforcement officers patrolling the city.

Unfortunately this is a necessity, Sobyanin wrote on his website. It is needed to protect the lives and health of many Muscovites, to overcome this calamity and to return to normal life.

A stronger police presence was visible on the streets of Moscow. Traffic police had set up check points on major thoroughfares on the outskirts of the city but were not systematically carrying out checks.

In the early stages of the pandemic, Russia recorded fewer cases of the new coronavirus than many western European countries, but its tally began to rise sharply this month.

Until late March officials were saying the situation was under control and that there was no epidemic in the country.

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Moscow hospitals see 'huge influx' of patients as Covid-19 spreads in Russia - The Guardian

Im heading to the White House in the middle of a global pandemic not a phrase I ever imagined writing when I was a schoolboy in Britain thinking about a career in journalism. Downtown Washington resembles a deserted film set these days, most of its famed monuments and museums closed. At the White House gates a white tent has been set up; a medical worker zaps me with a device that takes my temperature and gives me the all clear.

After passing through security, I arrive at the West Wing briefing room, usually bustling like a railway station, but now sparsely populated by journalists, some wearing face masks.

My temperature is taken again and I sit down, several seats apart from the other reporters. When Donald Trump and his team emerge stage right, they seem less worried than us about physical distancing (yet the US president has twice been tested, with negative results, for coronavirus).

America has the greatest number of coronavirus cases in the world. It is a public health crisis, an economic crisis and this is where we in Washington come in a crisis of leadership. Trump, a property developer and reality TV star, was the first US president elected with no prior military or political experience. It was all a bit of a lark. Well, were not laughing now. He is the man in charge of America in its biggest emergency since the second world war. And it seems that historys verdict will be unforgiving: he is not up to the job.

I watch most of his daily coronavirus taskforce briefings, which sometimes run for more than two hours, from home (grateful for TV and steady broadband, though not always easy with two boisterous children) but get to go along about once a week and ask questions. Up close, the presidents stature (he is 6ft 3in), blond mat of hair and peachy face afford a certain perverse charisma.

This is the closest any of us will get to the court of George III, with its mix of awesome power and terrifying capriciousness

I was there one evening when, defying medical advice, Trump talked baldly about reopening the economy by Easter. It was just a little scary, this realisation that the most powerful person in the world is unhinged the closest any of us will get to the court of King George III with its mix of awesome power and terrifying capriciousness. Fortunately, on that occasion, Trump eventually bowed to the experts and kept the physical distancing guidelines in place until the end of April.

Its also a presidential election year. Trump can no longer hold campaign rallies with big crowds. He has turned the daily briefings into a substitute, still airing grievances, spinning untruths, bullying reporters and narcissistically promoting his favourite brand: himself. I have, you know, hundreds of millions of people, he mused on April Fools Day. Number one on Facebook. Did you know I was number one on Facebook? I mean, I just found out Im number one on Facebook. I thought that was very nice, for whatever it means.

The wartime president Harry Truman kept a sign on his desk that said: The buck stops here. Trump adheres to the opposite view. Having downplayed the virus for so long When you have 15 people, and the 15 within a couple of days is going to be down to close to zero, thats a pretty good job weve done, he said on 26 February and failed to prepare resources, he is now, extraordinarily, trying to sell a potential death toll of 100,000 Americans as a success. Even for this master of razzle-dazzle, it would be quite a magic trick.

Typically, in times of national crisis, there is a default expectation that leaders will speak the truth, or mostly (lets not forget George W Bushs weapons of mass destruction). But with Trump that assumption no longer holds. His briefings would come with a government health warning were it not for the fact he is the government.

Amid this confusing torrent of bluster, there are also medical experts dispensing genuine information, showing predictive models, urging people to maintain physical distancing, advising on the wearing of face masks. It therefore becomes an intensive exercise in trying to sift fact from fiction.

American TV networks are having a lively debate about this. Should they show the broadcasts with a 30-second delay to allow fact-checking interventions? Should they show them at all? Increasingly, some are issuing disclaimers at the start and cutting away before the end.

At the Guardian our rolling coverage of the briefings includes real-time fact-checking from a team of reporters. It is important not to allow Trumps baseless claims, for example his pushing of an unproven drug, to hang in the air unchallenged. Our reporting is determined to hold the powerful to account. What did the president know and when did he know it? And why didnt he act?

For example, one article explored how it could be that the first confirmed cases of Covid-19 were reported in South Korea and the US on the same day 20 January yet one country took swift action to curb the outbreak while the other is still lurching towards catastrophe. Jeremy Konyndyk, who used to lead the governments response to international disasters at USAid, told the Guardian: We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.

For a journalist, this most peculiar presidency already felt like the story of a lifetime. Now it has collided head-on with another story of a lifetime. But day by day, I am also witnessing the unfolding of an American tragedy. For three years, Trump thought he could define events. In the end, he discovered, events will define him.

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Covid-19 from the West Wing: 'History's verdict will be unforgiving' - The Guardian

More than 100 COVID-19 patients in San Diego County are being treated at Intensive Care Units (ICU) and many of them are on ventilators. Among those responsible for running the machines are respiratory therapists.The coronavirus outbreak has made the job especially challenging.

As a front care worker, I have to not only worry about transmitting this disease to other people in the hospital but what about my own family. What about my friends. Ive had to come home to these people, and its dangerous, said Vill Miranda, a respiratory therapist at Sharp Grossmont Hospital in La Mesa.

During the health emergency, respiratory therapists have to work very closely with people who are infected with COVID-19.

Ive actually had two patients that Ive taken care of. Its a lot of time to get into these patients' rooms. I strongly suggest people follow the guidelines, do what theyre asked of and try and stay safe, Miranda said.

The word of warning comes as San Diego County rushes to get hundreds of more ventilators. There were at least 477 ventilators available to local hospitals on Saturday, according to the County of San Diego. The county has ordered 125 more and has requested 600 from the State of California.

In the coming weeks, hospitals across thecountry are expected to see more patients, and therapists with specializedtraining will be needed.

The job of a respiratory therapist hassuddenly become more dangerous, but Mirandas training has helped him take onthe challenge.

Im actually a former Marine and my mentality is actually a little different because I just go in and say, this is the job I choose to do and this is the mission Im going to complete, Miranda said.

Miranda says some of his fellow therapists have broken down and are scared to go into some rooms. Thats why he urges people to follow public health guidelines.

The State of California is calling on more respiratory therapists to help fight the COVID-19 outbreak. Trained professionals can apply for the State Health Corps by visiting its website.

How to Help in San Diego County During the Coronavirus Pandemic: Find out what you can do to lend a hand during these difficult times.

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San Diegos Respiratory Therapists on the Front Lines of COVID-19 - NBC 7 San Diego

The following is a release from the Indiana State Department of Health:

INDIANAPOLIS As the number of novel coronavirus cases continues to rise, the Indiana State Department of Health (ISDH) is partnering with local health officials in four communities to hold free drive-thru testing clinics for healthcare workers, first responders and essential workers who have symptoms of COVID-19.

Clinics will be held from 9 a.m. to 6 p.m. April 13-17 at the following locations:

Participants should bring a drivers license or other State of Indiana-issued identification card and documentation of place of employment. Only symptomatic individuals will be tested. Tests will be conducted as long as supplies last and will be limited to one individual per vehicle.

Essential workers are those identified by Governor Eric J. Holcombs executive order (https://bit.ly/2UQxqVt).

Due to patient privacy laws, media will not be able to videotape individuals as they are being tested.

To date, 7,435 Indiana residents are known to have contracted the novel coronavirus, including 537 additional cases reported Saturday. More than 39,000 test results have been reported to ISDH. A total of 330 Hoosiers have died.

A list of counties with cases is included on the ISDH COVID-19 dashboard at http://www.coronavirus.in.gov. Cases are listed by county of residence. Private lab reporting may be delayed and will be reflected in the map and count when results are received at ISDH. Beginning Monday, April 13, the dashboard will be updated at noon each day.

The dashboard also has been updated to make corrections based on updated information provided to ISDH.

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State opens free COVID-19 drive-thru testing clinics, one location in Fort Wayne - WANE

As coronavirus cases in Michigan continue to increase, Wexford County is now reporting its first death.

District Health Department #10 says it was a man in his 60s who was hospitalized on April 4.

On Saturday, both Alpena and Lake County reported their first cases of COVID-19.

Other Northern Michigan counties with new confirmed cases are:

Emmet County: 1

Grand Traverse County: 1

Otsego County: 2

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First COVID-19 Death in Wexford County, New Cases in Northern Michigan - 9&10 News