Lecciones desde el epicentro occidental de la pandemia: la experiencia de Montefiore Health System en el manejo de pacientes infectados con COVID-19 en la ciudad de Nueva York

Resumen Montefiore Health System, red de hospitales universitarios afiliados al Albert Einstein College of Medicine, ha sido uno de los principales frentes de batalla contra el COVID-19 en la ciudad de Nueva York, epicentro occidental de la pandemia. Con multiples campuses localizados principalmente en el Bronx, donde la tasa de infeccion por COVID-19 es de 2,048/100,000 habitantes, ha tenido que enfrentar la pandemia desde sus inicios. La experiencia acumulada a lo largo de estos meses es invaluable, aunque desafortunadamente gran parte de ella ha sido adquirida en base a ensayo y error, dada la novedad de este virus y la ausencia de guias de manejo basadas en la evidencia. Nuestra experiencia es tambien relevante ya que el 35% de nuestra poblacion es de raza Hispana. En las siguientes paginas repasamos aquello que sabemos sobre los inicios del SARS-CoV-2, las tesis mas aceptadas acerca de su fisiopatologia, su curso clinico, el manejo inicial una vez el paciente es admitido a nuestra institucion con el diagnostico de COVID-19. Tambien exponemos nuestras experiencias en el manejo terapeutico de las complicaciones multiorganicas que provoca esta entidad. Abstract Montefiore Health System, a network of university hospitals affiliated with the Albert Einstein College of Medicine, has been one of the main fronts in the battle against COVID-19 in New York City, western epicenter of the pandemic. With multiple campuses located mainly in The Bronx, where the rate of infection is of 2,048/100,000 inhabitants, it had to fight the pandemic since its very beginning. The experience gained during these past months is invaluable, although unfortunately most of it had to be learned by trial and error, given the novelty of this coronavirus and the complete lack of evidence-based guidelines. Our experience is particularly relevant given that 35% of our patient population is of Hispanic heritage. In the next few pages, we’ll go over what we currently know about the beginnings of SARS-CoV-2, the currently accepted hypothesis about its pathogenesis, its clinical course, and its initial management once a COVID+ patient is admitted to our institution. We also share our experiences with the clinical management of the multiorgan complications caused by this disease.