Our composition of COVID patients has changed a bit. We have begun seeing patients who require intensive care for other diseases but incidentally test positive for COVID. A few months ago, all patients with COVID in the ICU had respiratory failure from coronavirus, but now we have patients with heart attacks, strokes, diabetic crises, and other typical intensive care illnesses who also have COVID (since we test virtually everyone who presents to the hospital). What does this mean? I think it contributes to the finding that there is a community reservoir of asymptomatic people with COVID; these patients who tested positive would not have otherwise presented to the hospital. It also reveals the heterogeneity of COVID infections.

A young woman who is self-isolating because she knows she has COVID decides to pass the time by taking some hallucinogens. Unfortunately, she has a bad fall leading to brain bleeding; she is brought in by paramedics, intubated, and admitted to the intensive care unit. As we treat her brain bleeding, we notice that despite being COVID positive and having an abnormal chest X-ray, her oxygen needs are minimal. This seems consistent with the finding that COVID's effects on the lungs vary by age.

A young diabetic who gets COVID feels miserable, is unable to take his medications, and cannot eat or drink. He goes into diabetic ketoacidosis, his sugars eight times normal, his body unable to maintain its acid-base balance. He is admitted to the intensive care unit overnight. He doesn't require any supplemental oxygen, and he is discharged home several days later. Even mild COVID that doesn't cause significant alterations in oxygen can trigger other medical comorbidities that stress our hospital system. Although coronavirus in these patients may not require advanced oxygen therapies, it does limit which rooms these patients go to, nursing ratios, and use of personal protective equipment. With the high prevalence of coronavirus in our communities, we will have to remain cognizant of our resources and limitations. As this pandemic unfolds, we will have to be nimble in our hospital operations to handle the changing landscape of healthcare.