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COVID-19: Advice From the Front Lines



COVID-19 Care in Low- and Middle-Income Countries

Thursday, November 5, 2020
1 pm PT/3 pm CT/4 pm ET

We are all aware of the difficulties of COVID-19 in the United States, and previous CHEST webinars have featured speakers from some of the country's hardest-hit areas. However, the US has an advantage in that financial resources are abundant. Join us on November 5 as we interview some of the world’s leading intensivists from low- and middle-income countries. We will discuss the special challenges that they have faced on the COVID-19 front lines, talk about what their countries are doing to combat the disease, and explore the impact of COVID-19 on their flu season as they are emerging from winter into spring.

Moderators: Steven Q. Simpson, MD, FCCP, and Alice Gallo De Moraes, MD
Panelists: Sai Praveen Haranath, MBBS, MPH, FCCP; Flavia Machado, MD; and Mervyn Mer, MBBCh, PhD, FCCP

This program was made possible by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc., who provided financial support for the program.

Register now


Lung Transplantation in the Era of COVID-19

Recorded: October 8, 2020

This webinar discusses various aspects of lung transplantation in the era of COVID-19, including lung transplantation donation during COVID-19, the management and outcome of lung transplant recipients with COVID-19, and lung transplantation for COVID-19-related respiratory failure.

Listen to this webinar as a podcast

Living 6 Feet Apart: Experiences With COVID-19 From the CF Community

Recorded: September 24, 2020

Infection prevention is not a new concept for the cystic fibrosis (CF) community, but COVID-19 is different. This webinar highlights how the CF Foundation, the Care Center Network, patients, and families partnered together in response to the challenges of life during a pandemic.

Critical Care, Pulmonary, and Sleep Medicine Coding and Billing During the Pandemic and Beyond

Recorded: September 17, 2020

COVID-19 created unprecedented challenges, which led to innovative and expanded clinical services. This webinar highlights opportunities in pulmonary, critical care, and sleep medicine with associated coding and billing requirements in 2020 and some anticipated changes for 2021.

How Do I Know It’s COVID-19? A Discussion About Available Testing Strategies and Future Directions

Recorded: September 10, 2020

As COVID-19 has spread across the world, the ability to understand the spread of the virus in our communities, as well as diagnose the patient right in front of us, has been a challenge. Molecular, antigen, and antibody tests are now widely available, and the FDA recently approved the SalivaDirect test, which offers a rapid and inexpensive option for testing. Hear from the experts about the current state and future directions for testing for COVID-19.

Lung Cancer Diagnosis and Management During the COVID-19 Pandemic

Recorded: September 3, 2020

In this webinar, learn how to manage patients with suspected or confirmed lung cancer during the COVID-19 pandemic. A multidisciplinary panel of speakers discuss diagnosis and staging, alterations to standard treatment strategies, and more.

Teaching Through Chaos: Fellowship Learning During Pandemic Surges

Recorded: August 27, 2020

The COVID-19 pandemic has disrupted many aspects of American life, and postgraduate medical education is not an exception. PCCM fellowship directors and their fellows discuss the challenges and opportunities, setbacks, and innovations.

COVID-19 Clinical Trial Update: Drugs, Vaccines, and Thrombosis

Recorded: August 20, 2020

The pace of COVID-19 research continues to move at an unprecedented speed. In this webinar, expert panelists present the current state of high-quality data for the practicing clinician.

COVID-19 in Rural America: Challenges, Solutions, and Tele-ICU Support

Recorded: August 13, 2020

This webinar outlines the challenges of providing critical care to rural/resource-constrained America and additional issues faced due to COVID-19 as experienced in rural New England and Texas. Experts provide support solutions for patients and providers, including the use of tele-ICU in these settings.

Acute and Long-term Neurological Implications of COVID-19

Recorded: August 6, 2020

Acute hypoxemic respiratory failure is the calling card of COVID-19, but there are detrimental effects on the central nervous system, including numerous organs. In this webinar, experts in ICU sedation, neurointensive care, and postcritical care outcomes discuss issues related to the sedation of ventilated COVID-19 patients, acute direct and indirect neurological effects, chronic neurological recovery, and the interplay of all three.

Crisis Standards of Care in COVID-19

Recorded: July 23, 2020

As the COVID-19 pandemic continues to surge at a catastrophic rate, many health-care systems have been placed under a significant degree of strain. The experience in New York City taught us that existing guidelines regarding crisis standards of care (CSC) are difficult to operationalize, might not be nimble enough, and many frontline decisions regarding resource allocation are made subjectively. This webinar describes crisis CSC, identifies current vulnerabilities, and provides ideas on how to approach CSC in the setting of an ongoing pandemic.

Coronavirus in Houston — Report From the Front Lines

Recorded: July 10, 2020

CHEST Past President Kalpalatha K. Guntupalli, MD, Master FCCP, of Baylor College of Medicine is interviewed by JAMA Editor-in-Chief Howard Bauchner, MD, about the surge and ICU management of COVID-19 patients in Houston, Texas. They discuss availability of testing, COVID-19 treatments and therapies, protocols for proning, off-label use of heparin and inhaled budesonide, and thoughts on the weeks ahead.

Approach to Hypoxia in COVID-19 Patients

Recorded: July 9, 2020

Moderator Viren Kaul, MD, and expert panel members Alice Gallo De Moraes, MD; Vikramjit Mukherjee, MD, MBBS; and Nida Qadir, MD, discuss updates in the management of hypoxia in patients with COVID-19 based on emerging evidence and experience gained during the pandemic. The panel covers assessment and the role of various invasive and noninvasive interventions when managing critically ill patients with COVID-19.

Multisystem Inflammatory Syndrome in Children

Recorded: July 2, 2020

In May, the CDC issued a national health advisory on a newly reported multisystem inflammatory syndrome in children. This syndrome presented with fever, shock, and signs of hyperinflammation, and temporally occurred 2-4 weeks following COVID-19 exposure. In this webinar, panelists discuss this newly identified syndrome, its presentation, clinical course, potential pathophysiology, and potential treatment options.

Racism, COVID, and CHEST: A Candid Fireside Discussion on Whiteness, Inequity, and a Path Forward

Recorded: June 25, 2020

This webinar examines why COVID-19 has impacted the African-American community and other communities of color so intensely. Panelists discuss the history of racism in medicine, with particular attention to racism within chest medicine, and how that history established the reality seen today with the pandemic. They also talk about whiteness and the continued support of systemic racism within medicine and how to move forward with systemic change.

Bronchoscopy and Tracheostomy During COVID-19: Take-home Messages From the Expert Panel Reports

Recorded: June 18, 2020

In conjunction with interventional pulmonology societies, CHEST has developed and published two expert panel reports outlining strategies for performing bronchoscopy and tracheostomy during COVID-19 pandemic. This webinar addresses questions regarding indications, the role of preprocedure testing, optimal timing, location and techniques for minimizing the risk of infection to health care workers.

Virchow's Triad and the Perfect Storm: VTE in Patients With COVID-19

Recorded: June 11, 2020

Moderator Ryan Maves, MD, FCCP, interviews Lisa Moores, MD, FCCP, and other authors of the recently published "Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19: CHEST Guideline and Expert Panel Report."

ICU/Hospital Discharge: Where Do the Patients Go?

Recorded: June 4, 2020

Moderator De De Gardner, DrPH, RRT, FCCP, and a panel of interprofessional, interdisciplinary health-care providers discuss their discharge criteria or processes within health-care facilities, and from health-care facilities to long-term care facilities, for patients identified as COVID-19-positive.

Personal COVID-19 Experiences Webinar

Recorded: May 21, 2020

Moderators Casey Cable, MD, MSc, and Steven Simpson, MD, FCCP, interview physicians on the front lines of the COVID epidemic in New York and New Jersey, who share their stories and challenges.

COVID-19 Journal Club

Recorded: May 14, 2020

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic
CHEST Expert Panel Report

COVID-19: Is It Viral Sepsis or Something More?

Recorded: May 7, 2020

Panelists Timothy Buchman, PhD, MD, FCCP, and Michael Klompas, MD, MPH, and moderators Casey Cable, MD, MSc, and Christopher Carroll, MD, FCCP, have a pro/con discussion on whether COVID-19 is viral sepsis or something more or different.

COVID-19 Clinical Trials: Current Outcomes and Future Expectations

Recorded: April 30, 2020

Panelists Ryan Maves, MD, FCCP, and Antonio Anzueto, MD, and moderator Holly Keyt, MD, FCCP, discuss the current knowledge of COVID-19 therapeutics based on recently concluded and still-in-progress national trials.

Acute Respiratory Failure in COVID-19: Part II Webinar

Recorded: April 23, 2020

Panelists John Kress, MD, FCCP; Kelly Cawcutt, MD; and Jasmine Marcelin, MD, and moderator Viren Kaul, MD continue the conversation around patient management in cases of COVID-19 characterized by acute respiratory failure. Panelists will focus on questions that came in during and after the initial webinar held on April 9. This follow-up webinar centers on diagnosis and treatment protocols, as well as patient management in COVID-19 cases.

Women & Pulmonary Virtual Happy Hour

Recorded: April 22, 2020

The COVID-19 pandemic has affected us all. In this hour-long virtual happy hour, we come together to share #wellnesswednesday. The panelists discuss how COVID-19 has impacted them clinically and personally and what lessons they’ve learned as female clinicians during this time.

Triage of Critical Care Resources During COVID-19 Webinar

Recorded: April 16, 2020

Authors from the article in press, Triage of Scarce Critical Care Resources in COVID-19: An Implementation Guide for Regional Allocation, discuss how to implement a system that maximizes benefits to the greatest number of critical care patients. Stemming from CHEST’s 2014 consensus statement on the Care of the Critically Ill and Injured During Pandemics and Disasters, hear suggestions that consider the particular constraints of the COVID-19 pandemic.

Acute Respiratory Failure in COVID-19

Recorded: April 9, 2020

Panelists John Kress, MD, FCCP, Kelly Cawcutt, MD, and Jasmine Marcelin, MD, and moderator Viren Kaul, MD, FCCP, address key questions around patient management, including use of chest CTs, intubation, administration of steroids and more.

The Experience From Front-Line Leaders in China: Session 1: Strategies for Controlling the Pandemic

Hear Chen Wang, MD, PhD, FCCP, describe how the Fangcang Shelter hospitals were employed for the admission of asymptomatic and mildly symptomatic patients to stem infection spread. Jieming Qu, MD, PhD, highlights the approach used in Shanghai, which successfully suppressed the curve and demonstrates a strategy for a city-wide defense.

Moderated by Stephanie Levine, MD, FCCP; Renli Qiao, MD, FCCP; and Christopher Carroll, MD, FCCP

Speaker Bios:

Chen Wang, MD, PhD, FCCP, President of the Chinese Academy of Medical Sciences and Peking Union Medical College, President of Chinese Association of Chest Physicians, Honorary President of the Chinese Thoracic Society. Dr. Wang is stationed in Wuhan for the COVID-19 epidemic and is still there. He invented the idea of the Fangcang Shelter Hospital which is the crucial step that has brought the disastrous epidemic in Wuhan under control.

Jieming Qu, MD, PhD, Professor of PCCM in Ruijin Hospital in Shanghai. President of Chinese Thoracic Society. Dr Qu developed his career in pulmonary infections and is one of the experts in the action against COVID-19 in Shanghai. Shanghai, a metropolitan with population of 22 million and expected to be the second disaster area, had only 400 cases and 4 deaths.

The Experience From Front-Line Leaders in China: Session 2: Strategies for Patient Management

Listen as Bin Cao, MD, PhD, provides an overview of the journey toward treatment, including a review of the important clinical trials underway and the current progress. Qingyuan Zhan, MD, discusses key protocols in the treatment of patients with COVID-19 and the protection of health-care providers.

Moderated by Stephanie Levine, MD, FCCP; Renli Qiao, MD, FCCP; and Christopher Carroll, MD, FCCP

Speaker Bios:

Bin Cao, MD, PhD, Vice President of China-Japan Hospital, Executive Chief of the National Center for Respiratory Diseases in Beijing. Dr. Cao was among the first medical professionals stationed in Wuhan to bolster the health-care system in the city and efforts against COVID-19. He is the principle investigator of several major clinical trials for antiviral agents, including remdesivir and lopinavir/ritonavir.

Qingyuan Zhan, MD, Chief of the Medical ICU for China-Japan Hospital in Beijing, and Chair of the Critical Care Committee, Chinese Association of Chest Physicians. Dr. Zhan is a leading expert in the field of critical care medicine, with a focus on ECMO use. During the epidemic, he went to Wuhan, practicing in the hospital designated for the sickest group of patients with COVID-19. He is still in Wuhan.

Managing Clinics in the Time of COVID-19

Martha Billings, MD, MSc and Renea Jablonski, MD compare their experiences in managing outpatient pulmonary clinics as they transition to remote telemedicine care (Recorded March 19, 2020).

  • Transitioning from in-person clinic to telemedicine
  • Triaging patients in-clinic with suspected COVID-19 symptoms and reducing staff exposure
  • Treatment management of outpatients with COVID-19
  • Staffing logistics during transition and quarantines
  • Recommendations to peers to help prepare their clinics

Key Takeaway: Be flexible and forward-thinking to prepare your clinic for the remote transition, surges in patient numbers, and staff shortages and safety.

Managing Patient Ramp-Up in the Time of COVID-19

Mangala Narasimhan, DO, FCCP, discusses her experience ramping up to manage patients with COVID-19, with Bhakti Patel, MD (Recorded March 16, 2020)

  • Use PPE and isolation precautions for any patient presenting with respiratory symptoms – not doing so risks viral spread.
  • Patients whose condition is deteriorating rapidly pass quickly through the phase when HFNC or NIPPV can be helpful. Consider moving from NRB face mask directly to intubation.
  • Most intubated patients respond well to PEEP; lungs are relatively compliant compared with other causes of ARDS. Recovery is prolonged.
  • Plan now for short supplies, tired and inadvertently exposed and quarantined staff, and what rooms seriously and critically ill patients will occupy.

Key takeaway: however many patients you’re expecting, double it. And, have a plan for protecting personnel during intubations.

Managing Patients with Respiratory Conditions in the Time of COVID-19

Steven Simpson, MD, FCCP, talks to a front-line clinician about her experience managing a COVID-19 case that was caught days after the patient was admitted to the hospital.

  • Patient was admitted with symptoms of cough and fever, for possible COPD exacerbation or pneumonia.
  • The patient’s condition deteriorated and patient was transferred to the ICU and mechanically ventilated for ARDS, but COVID-19 testing was not performed initially.
  • Once tested, results were positive for SARS COV-2, and airborne and contact precautions were put in place.
  • Personnel were lost to quarantine.

Key Takeaway: It is important to consider patients with any respiratory symptoms and fever for COVID-19 and take precautionary measures among hospital staff, such as wearing personal protective equipment (PPE) when managing the patient.

Point-of-Care Ultrasound in COVID-19

Nilam J. Soni, MD, MS, discusses use of point-of-care ultrasound in COVID-19 based on his experience at South Texas Veterans Health Care System.

  • COVID-19 is difficult to diagnose because symptoms aren’t shown until about 5.1 days after getting the virus.
  • After onset of symptoms, patients are taking a long time to recover that is backing up the hospitals.
  • American College of Radiology recommendations change on a daily basis for how to manage patients with suspected COVID-19 infection.
  • Dr. Soni discusses best practices for using ultrasound in directing COVID-19 patients.
  • Dr. Mangala Narasimhan discusses her experience treating patients with COVID-19 at North Shore University Hospital & Long Island Jewish Medical Center.

Key Takeaway: Comparing regular/irregular lung ultrasound patterns through point-of-care ultrasound applications are an important tool to aid in diagnosing and managing COVID-19 patients.

Ramping-Up to Manage Patients with COVID-19

Andrew Klein, MS, RT, discusses his experience ramping up to manage patients with COVID-19 with Victor Test, MD, FCCP. (Recorded March 26, 2020)

  • After half of one shift, preparations already in place for years for Ebola turned out to be insufficient for COVID-19.
  • Rethinking how space and staff are used is key for preparation for the surge of COVID-19 patients. The medical ICU is now fully dedicated to treatment of patients with COVID-19. Surgical ICU staff have been flexed to support MICU now.
  • Fast-tracking new prone positioning protocols was immediately necessary. Staff completed rapid-fire training as first COVID-19 patients were admitted. In 3 to 4 days, 15 patients needed to be intubated.
  • All therapies continue are used according to published guidelines. An institutional protocol has been developed including from management of fluids and steroids to ventilator management. Early intubation, early prone positioning, and high levels of PEEP have been seen to be most effective.

Key Takeaway: Every team will have unique issues according to their situation. Open collaboration and communication among providers and teams is necessary for success.