ROUND TWO:  I have spent the last week working on a busy Boston-area COVID unit again. Last did this in April, second wave now. I wanted to share with you my 3 updated observations:

1.Patients are doing better

In line with statistics we are seeing from around the country, although the volume is up, the patients are definitely more stable and a lower percentage are going to the ICU or being ventilated. I talked to a few distinguished specialist colleagues about why there has been this improvement, and I heard some very interesting theories, ranging from a less virulent strain of COVID-19, to a more common theory: It’s the steroids we are now giving our patients. A pulmonologist I work with said that a rule he was taught by his Professors: “If all else fails, HIT THE PATIENT WITH STEROIDS!” Wouldn’t it be interesting if in the end, it’s a $5/month medicine that ends up saving us. Let’s see what further data tells us, but I wish we had started doing this earlier.

2.Risk factors

By far the biggest risk factor for being seriously affected and hospitalized, is advanced age. Our immune systems weaken with each passing year, with dramatic declines in the elderly. I don’t care if I have to say it till I’m blue in the face: PROTECT, PROTECT, PROTECT the elderly.

For under-50s who were hospitalized, the biggest risk factor I observed, was obesity (and that goes with other things like lung disease and diabetes). Then comes any other reason for immunosuppression or impaired lung function such as asthma. Interestingly, also had a few patients from a nearby prison. I read about this before but didn’t fully realize until I saw it myself—a few inmates hospitalized, prisons must be very high-risk environments—I’m assuming because of the ventilation and proximity to each other.

3.Sex differential

I witnessed earlier this year an approximate 70/30 differential with men hospitalized more. The gap narrowed a bit, probably to 60/40, but still more men. The more I have read previous scientific research on this topic (even in different species) and now witnessed it real-time during the pandemic, the more I am convinced that women are the biologically and genetically stronger sex when it comes to having more robust immune systems, and ability to bounce back faster.

This last several days, I discharged a lot of patients, including many 85+ year-olds. I also had a delightful 100+ year-old lady, who we were able to take off oxygen after 24 hours, and she was nagging us to go home ASAP!

Of course, everywhere is different, but I wanted to share those observations with you. One physician, working on one COVID hospital floor, in one part of the USA.