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risked exposing health care workers to the virus. Decontaminating the room that held the scanner would also take time, during which the scanner could not be used. (H.U.M.C. did not make some doctors involved in Cai’s care available for comment but responded in an email that they followed “C.D.C. and/or evidence-based protocols” that were “different from protocols physicians from China were advocating.”)
At around 10 a.m., Cai’s phone rang. His friend Huang wanted to talk with the infectious-disease doctor on call. He spoke to her on speakerphone so that Cai could hear. We are formally requesting a second CT scan, Huang told her. She explained, as Cai recalls, that it wasn’t necessary and most likely wouldn’t change the course of treatment, whatever the results. He pressed her on how confident she was about their treatment — and if so, on what basis? She had never treated a Covid-19 patient. How could she dismiss the collective wisdom of doctors in China who had seen thousands? Cai’s oxygen levels were not getting better, despite the antibiotics; Huang had the sense that the doctors at Hackensack did not fully appreciate how quickly patients could take a turn for the worse. The doctor said she would bring it up with Cai’s physicians.
Cai’s boss, Dr. George Hall, also made a call, not long after Huang spoke to the infectious-disease doctor on call. He spoke with another doctor on Cai’s caregiving team, a hospitalist named Danit Arad. Arad had agreed to share her phone number with Cai’s mother, who had passed it on to Hall. Hall, who is 64, studied at one of the most prestigious
medical schools in China before immigrating to the United States in 1987 and opening up four medical centers throughout the city. A father figure to Cai, he, too, had been in touch with contacts in China, including a nephew in Yangjiang, who ran an infectious-disease hospital, to get insight into Cai’s case.
Hall explained to Arad that the Chinese National Health Commission had just published the seventh edition of guidelines on how to treat coronavirus. It was true that they were based more on clinical experience than on published studies, but he urged Arad to follow some of its protocols, which included prescribing two drugs that were commonly given to patients in China soon after they showed symptoms like shortness of breath: chloroquine, an antiviral drug once used to treat malaria, and Kaletra, another antiviral that had once been used to treat H.I.V.
At the time Hall and Arad were speaking, practitioners were struggling to gauge the utility of treating coronavirus patients with chloroquine or a derivative
called hydroxychloroquine, which is used to treat autoimmune diseases like lupus. Since then, the picture has hardly become clearer. Two small studies from Marseille, France, published in March found that hydroxychloroquine and azythromycin, an antibiotic, yielded encouraging results in patients with advanced disease; but a close replication in Paris, published soon thereafter, found the drugs ineffectual. Yet another study, this one from China and published online March 30, found that patients who were mildly ill and took hydroxychloroquine fared better than the control group of mildly ill patients who