Wait, you're OK? I. You're listening to Radiolab Radio from WNYC. Hey, I'm Jad Abumrad, this is Radiolab Korona, Dispatch five. So I grew up in a lab, and, you know what I mean is my mother was a researcher. I would go to her research lab every day after school. I'm very familiar with what a research place feels like.

People are focused. It's very quiet. So it has been interesting to me to listen to the voice memos you're about to hear, because it is not the sound I'm used to, it's not the sound that I associate with research.

We forget that throughout much of the history of science, science was done on the battlefield.

There wasn't that sort of division between the research people over here and the patient, people over there saw the same thing. And maybe in this moment, we've kind of gone back to that state a little bit. So some of the stuff that you're going to hear in this dispatch might be a little hard to listen to, so this might not be the one to listen to with your kids, although we do have a feed called Radio Lab for Kids, which you should check out.

But I wanted you to hear it to give you a sense of what science on the battlefield actually sounds like now.

Well, the story really centers around this guy nice introduce yourself, OK, my name, Xavier Mitra. I know you because back in the day when you guys are in season three of Radiolab, wow. I emailed you because I heard an episode and I was like, this is the future, Chad. I want to work with you guys. I majored in science and I have my own recording studio because at the time I was doing music. Let me hang out with you guys.

That's so crazy. Look what happened.

You went on to do something much more useful. Not at all. No, I made the wrong choice. Clearly after Radiolab, I went to med school, ended up specializing in emergency medicine.

I remember, too, there was either you were a rock star for a minute and then then you went to med school, community college in Edison, bamboo shoots.

There's that little thing you would just been our intern at that point. Yeah, it was just that was a crazy time. I always imagine you go back to that at some point.

I know. I wonder where you are and where you want to go and if you want to go with me.

All right. So you went to med school after that. Did you imagine you'd end up in an E.R. when I first went to med school? Yeah, not really. It's kind of a weird specialty in that a lot of ways it's looked down on by the other specialties, which most people outside wouldn't kind of see. But it's a new specialty, relatively speaking. It started in, I think, like 1970. And so it's kind of like this redheaded stepchild of medicine, because the cool thing to do in medicine is to be a specialist, you know, an electrophysiologist that just focuses on the right atrium of the heart and that's their specialty.

So going into one of the more primary specialties like emergency medicine isn't as sexy in some ways, although I wonder if that'll change now. Right.

Maybe it able to.

OK, so one of the ways that I have been experiencing this pandemic kind of as a voyeur is through evere of your works, three or four shifts a week at an E.R., at a very busy Manhattan hospital and after every shift.

Hey, welcome. How are you? He would send me voice memos to the end, which is what he was thinking and experiencing.

March 20th, 20, 20. Just got into work to start the night shift. Oh, I think so.

The good news is the city looks pretty dead for sure. There's just this underlying tension.

New York is preparing for the worst, kind of uncertain. And you get a sense now there's a real inevitability about what comes next.

Sometimes we make some jokes about who's going to us, but it's a little bit of gallows humor.

Would say the rate of increase in the number of cases portends a total overwhelming of our hospital system.

I'm just curious, like, what were you thinking at that point when, like, people were saying, it's coming, it's coming, it's coming, it's going to be big, but it hadn't yet really hit yet.

Trying to take myself back to that chest. I do remember just thinking looking at patients, because already at that point, you know, we had seen several coming in. They looked like they had it.

And so we isolated them gowned up until you really feel you had shortness of breath.

But then I had a case where it was a patient just coming in with some random complaint, you know, blood in their urine or something, just something completely random. So I doing my regular thing, pressing on their belly, talking to them, and for whatever reason, they had to get admitted. And later on they spiked a fever, got tested and were positive. And that really threw me for a loop because I was like, oh, my God, this is just everywhere.

I just remember looking at every patient with just this suspicion, OK, where is this patient sitting and how closely to the other patient?

And I just remember telling the charge nurse, like, you know, let's just separate these patients if we can, when you should come back, if you start getting really short of breath, like you feel like you just sprinted alive and you just here, like huffing and puffing like that, if that starts to happen, it keeps happening getting worse. I'm back here because then we need to check your oxygen level again to make sure you're getting enough.

March twenty second, twenty twenty. There are now more than thirty four thousand coronavirus cases in the United States. More than four hundred Americans have died.

I knew I had my first patient, just elderly lady, and she just came in for fever. I just knew right then and there that she had it, you know. But I think it hit me the most because she reminded me of my own grandpa.

I was just talking with my friend and she was telling me about her first covid case. It made me think of mine. I don't think I'll ever forget it. It it's a super nice guy, older guy, 80s, brought in by his kid because he was having fevers, chills, cough and short of breath. Everything we'd been hearing about, we all kind of had a feeling that this was it. We gathered up, we went in the room, gave him a bunch of oxygen, and he seemed to be doing better.

Spoke with the kid, you know, why don't you go home, get some rest, call in the morning. A couple of hours later, he seemed to be getting. He's breathing more and more heavily, hunched over, trying to catch his breath at that point, talk to him and made the decision to intubate him, put him on a ventilator. I'll never forget. He just kind of looked at me and said, looks like I'm going to be dying here.

I said, you know, right now you're just working really hard to breathe. Let's let you rest, give you a bunch of oxygen. It's going to make you feel a lot better. He just kind of looked at me and said, all right, I was at the head of the bed and I just kind of had my hands on his head. I told him to think of a nice place, a nice beach that he likes and give him some meds to put him to sleep.

And we put the tube in. He went up to the ICU. And yeah, a couple of days later, he passed away. March twenty third, twenty twenty five. Dr.. As expected, more cases. Everything's changing.

Tensions are high today, March twenty six, twenty twenty, all the issues are slowing down to zero two eight nine nine, almost four.

Wonder why some people are getting are barely noticing anything and other people are getting rather sick from it. Obviously, age has something to do with it, but it's more than that.

Do me a favor. Take some steps of water. Oh, I'll sit up, sit down or take a sip of water. I know it's weird because I have to drink that water. Oh, OK. That's good. That's good. You're doing good.

Regular patients have gone way down and now it seems like we're seeing way more of these patients than any other type. Good friend of mine, buddy, from residency, he's got it right now, six, seven days of having fevers, but he's doing OK.

I would call again because it's just so busy here. But let me get your name and number so that we can have the team call you tomorrow. And are you the person to make medical decisions for him in case that he's not able to make them for himself? OK. Now, if he needed to have a breathing tube and be on a ventilator, is that something that he'd want to happen? Yes, OK. And then if his heart was to stop beating, we had to do chest compressions, CPR and the like.

Would he want that as well? OK. OK, I'll go and do everything ok.

Like I said right now, his oxygen is good, his blood pressure's good, his heart rate's good, but his labs are concerned. So I just want to give you a heads up that right now he's doing good. But we're going to obviously keep a very close eye on him because if things get worse, they could get worse pretty quickly. Back home after the shift today. Basically, it's just the new normal. The entire pod that I'm in has covered.

It's just that's it. That's the only diagnosis. I left a trash bag at the door. I'm just going to put all my clothes in the trash bag and then I guess jump in the shower. Every night before you go to sleep, you say, I got it, I got it. And then every morning I got. I definitely have it.

And you still haven't gotten it or as far as we know. Maybe you have. I don't know. It seems like it's constantly on your mind. What's it been like for you for these past two months? It's just it's a lot.

It's hard to deal with, definitely. I feel bad for you because, yeah, because you're with me, you kind of become a high risk.

No one wants to see me like, oh, you live with the doctor who goes that way, please.

Yeah. After I had quarantine myself for two weeks. Well, not quarantine. I mean, I wasn't sick, but after I isolated for two weeks and I went to visit my parents, I miss my family so much and they didn't want me around. And so that was that.

On April six, twenty twenty number of deaths are up once again, the number of people.

We lost a number of New Yorkers, four thousand seven hundred and fifty eight, which is up from 159, but which is effectively flat for two days.

And with that is probably going to go over to Polu because we're running out of isolated.

It's just crazy how she's working on it. There's no there's just no guidance.

Like there's no alcohol. You're in love over there. You know, we're all out here just making our own decisions and kind of free balling it, really.

I mean, there's just so much we don't know. April 10th, twenty twenty two.

I have never in my short career seen people spreading information amongst E.R. doctors and ICU doctors, literally by WhatsApp texting each other images of charts that people have written, kind of really just figuring it out as it goes, which is kind of incredible because in medicine in general, we're very cautious. We'll sit in journal club meetings and debate whether we should give somebody one hundred sixty two milligrams of aspirin or three hundred twenty five milligrams of aspirin. We will literally debate that for hours.

But but right now, we're just trying different things out almost on a whim. So this WhatsApp groups you were telling me about where you're. Yeah, you're exchanging information with doctors in Italy and China.

Yeah. And a lot from Washington. Also Washington state right there.

Outbreak started, I don't know what was it, a week or two before ours.

So based on I find this part of it really interesting. Like, so what were what were you hearing from them?

I guess phase one was expecting things based on what they were seeing. And at the time that was OK, a virus comes to the back of your throat. It's flu like it's upper respiratory. It's like up here in your neck. And a lot of people clear it. But if it gets worse, it progresses down to your lungs, becomes lower tract, and that's when you start to see these pneumonias. And then if these pneumonias get bad, it becomes AIDS Acute Respiratory Distress Syndrome.

That was phase one.

So that made perfect sense to me, you know, but then I think phase two is seeing things that didn't add up with that.

And we'll get into all of that after the break when the battlefield science really begins to.

Hi, my name is Madeleine Dubois, and I'm calling from the hamlet of Poolesville, New York, Radiolab is supported in part by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at w w w w omg.

This is Radiolab, I'm Jad Abumrad. OK, a year before the break was describing how in that moment when the ear I was getting slammed and doctors were just trying to figure out what is going on, what is this new disease? What he and his colleagues started doing was going on these massive WhatsApp groups and exchanging information with doctors in Italy and China who sort of like this. Network of people with tin cans to their ears connected by giant strings, and he says what he was expecting to see in his are based on what they were telling him, were people coming in with respiratory infections which started in their throats and then moved down into the lungs and then got much worse.

But instead, what he ended up seeing was just much stranger than that.

The biggest thing that struck me is a patient comes in, you measure their oxygen level with a pulse ox and just take a step back to pulse ox. Is that little thing you put on your finger with the laser light?

It shines a laser through your finger and reads the color of your blood.

And from that it tells you your oxygen concentration, if normal is, you know, ninety seven to one hundred percent. You know, we're seeing patients that are at 60, 70 percent routinely. Normally, if someone's oxygen saturation is anything close to 70 percent, they're not awake.

They're they're out of it completely. They're grasping at anything, trying to get oxygen. But these patients we're seeing routinely that are looking at us, talking to us, they're wide awake, texting on their phone and their oxygen saturation is already super low levels.

I remember you sent me a text message of somebody who had an oxygen saturation reading of like in the 50s and they were on their phone. Exactly.

That one got circulated around because we were all seeing the same thing. And it's like you look at someone with a fifty four, that's a person that you're like, OK, Mam. You're going to be taking a long nap. You know, you're going on a ventilator and they may be like, what? Can I just finish posting on Instagram first? You know, it's just so surreal.

Oh, OK. Can you tell me where you are? No one here is. But I get up early because I know for a fact that I do.

This is if you're in a colleague working with a patient whose blood oxygen level had had bottomed out at around 50.

And yet the patient was sitting up talking to them all, but coming up slowly. And clinically, very how are you, Professor, even if I take some deep breath, breath, breath like that, three or four? Oh, yeah, perfect. Perfect for doing that for me. Going to get your energy.

OK, so you're seeing all these patients where the numbers just seem like they should be in really bad shape, but they're not.

And at the same time, a pre-print paper came out. And again, this I mean, this is a pre-print paper. So who knows what validity it will end up having. But in this paper coming out of China, they kind of found that one of the proteins made by this virus has the ability to attack hemoglobin.

The paper basically argued that we've been thinking about covid as a lung disease. But, you know, the lungs are not the only part of the equation in terms of taking in oxygen. The lungs snatch the oxygen out of the air, but then they give it to the blood where you've got this little protein called hemoglobin.

And then the haemoglobin job is to grab that oxygen and then carry it in the blood to the tissues where it ultimately needs to go.

So the idea of the paper was it could be that the virus is attacking the haemoglobin in the blood.

So maybe the problem is not the lungs so much as it could be a problem with the blood, which was super exciting to me because that's like, oh, well, we have all these arsenal of weapons that we could potentially deploy against the blood problem. All sorts of other treatments we can do. We can replace the haemoglobin. You could just get a blood transfusion. Oh, interesting. So that's when I started doing some of those experiments.

On April 10th, 20, 20 total lives lost, seven to eight hundred and forty four for the lactate is clear.

I've been running I've been running experiments.

So yeah, you want to do the degree to see if this might be true.

The way that I was thinking of and it turns out a lot of other doctors were thinking of I don't think I invented this is to test something called an egg, which stands for arterial blood gas.

And a big test is where the doctor draws a little bit of blood from the wrist and looks at dissolved oxygen in the blood. The thought was if this were a hemoglobin blood issue, this test would allow him to know that.

Yeah, you know, how people were talking about this being a hemoglobinopathies. Yeah. And that may be the hemoglobin is poisoned and it's not so much a lung issue, but the fact that the P a few is low kind of goes against that.

You know, unfortunately, by testing the patients that I've been having over the past couple of days, what I found is the hemoglobin probably isn't the main problem. It probably is.

There's a problem with the lungs, which is which is what we know, which I guess now brings me just back to square one.

I don't know. I was I was hoping for something more exciting than that. Meanwhile, April 11th, Tony, Tony, total number of lives lost.

Eighty six hundred twenty seven in the area of stark contrast there is the covid pod which is overrun, and then there is the non covid part, which is just empty. It's so surreal.

I'm not used to it standing this quiet unless it's like 4:00 in the morning on Super Bowl Sunday. I don't know where all the appendicitis things have gone. I don't know where the strokes are. Nobody has chest pain. Nobody has stomach pain. Well, what's happening with those people right now, they're probably having heart attacks at home, waiting it out because they don't want to be exposed to sick people.

This is something that we're seeing in ERs across the country, by the way, non covid related patients coming in has dipped by as much as 50 percent, April 15, 20, 20.

I did an experiment on myself today to see how the P e what we're doing is wearing a respirator and then wearing a surgical mask. On top of that, it's pretty hard to breathe in there. So I tried an experiment today to see what my pulse ox was and what my CO2 level activity.

And one was two fifty eight and the other was sixty two.

So, you know, with breathing, we're trying to do two things that are both very important and somewhat unrelated to each other. One is get oxygen in and the others get carbon dioxide out. So when I checked my oxygen levels, it wasn't really affected by the respirator and the surgical mask. I was at like 99 percent. Either way, when I checked my CO2 levels, though, normally I'm probably somewhere around 40, 45 with all that on for an hour.

I checked after wearing it for an hour.

I was up to 59 on my CO2, which are numbers in a regular context I'd actually really worry about. Yeah, they're really retainment, which means I'm retaining carbon dioxide. I was fifty nine. I really want to know you were 59, so I want to know what I have in mind because I'm also wondering if regulated your hemoglobin. I want to check my bicarb to see if I'm like compensator. Oh they were there was normal as normal. We need to publish this.

Yes. April 16th, twenty twenty six hundred people died yesterday from the disease. Today, I took a quick trip up to the ICU. The ICU is where people who have to be put on ventilators go.

It was hard to see all the patients because we have them all in isolated rooms. But I was walking by looking at their vent settings. I think one thing that really struck me is. The amount of hair that I saw, you know, I spent months working in the ICU as a resident, you just get used to seeing IV drips, pumps, ventilator equipment, big bed and gray hair on it. And I'm walking through this ICU and like jet black hair, brown hair, blonde hair.

That really struck me, I mean, I wish people could see that. I guess I'm used to processing. The sadness of the ICU in terms of people at the end of their life who lived a good life and I. Always concoct some story in my mind of how they've lived this fulfilling life and, you know, their family is going to feel sad, but they're going to feel like, OK, this is a sad but inevitable chapter, a final chapter.

But with these patients, I. These aren't people who they're not at that chapter. Their families are not going to feel closure when they die, their kids still need a dad. You know, it's just scary. April 21st, 2010.

So I know exploring another hypothesis, again, coming back to the same problem, that coronavirus is thought to infect the respiratory tract and the lungs, but we're seeing findings that are beyond that and can't be explained just by the lungs. One of the things that's been puzzling is just a crazy array of symptoms he's seeing in people with covid. There's the usual cough, fever, breathing issues, but you also have people reporting neurological issues. Some people, including a few folks that I work with, lost their sense of taste and smell for a while.

Others are reporting skin issues on their fingers and toes, migraines, trying to understand what's going on and more importantly, what to do about it.

So one hypothesis that has been kind of floating around and I've been thinking about and a lot of people have been thinking about, is this idea of a coagulopathy.

It's just the idea started again on a WhatsApp group.

I first heard about it from Washington. It may have gone back even to Italy or China.

I'm not sure, Doctor, I'm one of these groups says, hey, I'm seeing these weird lab values in my covid patients. Not sure what it means. Xavier and his colleagues start to investigate and ultimately notice that covid patients often seem to have very high levels of this one enzyme in their blood. It's an enzyme that's often associated with clotting if someone's making clots and breaking down clots and just going through that clotting process. So that kind of brought up this theory of could it be that this virus is somehow inducing little clots all over the body, thousands and thousands of these micro clots that might be jamming up the highways and preventing the oxygen in the blood from getting where it needs to go.

And it also could potentially explain why we're seeing heart damage, because the blood supposed to go to the heart is getting clotted before it can get there. Same thing with the brain. And as a matter of fact, we see problems with the kidneys. We're seeing problems with every end organ. Maybe it's not a problem with the organ. Maybe it's a problem with the blood supply that should be getting to the organ.

This might emphasis on the word might explain why there are so many different symptoms to this disease.

So in our hospital, the hematology department kind of sat down with this data and came up with an algorithm for us to use in the E.R. and on the floor in the ICU, which is to basically try putting these patients on blood thinners so you want to get hurt. So let's do Lovenox. Wait, they don't think so. That's what I've been doing. That's what we've been doing for the past.

It's not going to happen this week. You know, when a patient comes in covid positive and they need to be admitted, we're putting them on blood thinners. And is that where you are right now? I mean, that May 5th, we're talking for the last time before this goes out. Is that what you're doing? Yes.

For us, it's been my experience.

All right. I want to ask you about one last moment in your voice memos. This is the get to the point at which in the arc of this whole pandemic so far, that, like the volume of patients is finally leveling off. And you're talking to these two residents who are there to help lines.

And then there is this announcement over the intercom. Can you just do you remember that moment? Can you just describe what that was?

Know, basically, the kmo of our hospital comes on the intercom and says, I just want to thank you guys for everything you're doing. What you're doing is working.

Three hundred and forty patients who currently have transparency until we discharge this many people today, you know, just kind of a pep talk over this really shitty intercom.

And then they play the. Yes, I have to say, that is the sweetest thing I've ever heard in my life.

It's so sweet. And now what they're doing is every time they extubate someone, take someone off a ventilator, they play. Here Comes The Sun by the Beatles. It was really moving to hear that. Yeah. He did not try. York City. He took the midnight train. Huge, huge thanks to evere for sharing his thoughts and experiences with me and to all those people on the front lines working to help people and to help us understand what we're up against.

What you heard were obvious personal thoughts. They don't represent his institution and all the science we talked about is tentative. We're still a long way from understanding the true shape of this disease. O o o o o o o o o o o. Props to Suzy Lichtenberg for helping me produce this episode. I'm Jad Abumrad. Thank you for listening. More stuff coming at you very soon. A single.

Science reporting on Radiolab is supported in part by Science Sandbox, a science foundation initiative dedicated to engaging everyone with the process of science.

This is their schorno calling from Jefferson City, Missouri. Radiolab is created by Jad Abumrad with Robert Krulwich and produced by Sean Wheeler. Diane Keaton is our director of Sound Design. Suzy Lichtenberg is our executive producer. Our staff includes Simon Adler, Becker Bressler, Rachel Kucik, David Gevo, Double Hotcake, Tracy Hunt, Matt Kielty and McEuen, Nasser, Akari and Walk, Pat Walters' and Molly Webster with help from C.M.A. W, Harry Fortuna, Sarah Sandbox, Melissa O'Donnell, Ted Davis and Russell Gragg.

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