‘A large science experiment’

Steroid latest treatment for severely ill patients

Doctors now have another tool when it comes to treating hospitalized COVID-19 patients.

Dexamethasone, a corticosteroid, has been recently added to the treatment guidance for patients with severe COVID-19 at Reading Hospital and Penn State Health St. Joseph.

An article published last month in The New England Journal of Medicine stated that a recent trial provided evidence that treatment with this steroid reduces 28-day mortality rate in patients with COVID-19 who are receiving respiratory support.

No benefit was found among patients who did not require oxygen during the trial.

“Penn State Health St. Joseph, as well as the Milton S. Hershey Medical Center, uses dexamethasone in selected patients that physicians believe will benefit from use based on current available data and in line with National Institute of Health guidance,” Penn State Health said in a statement through media specialist Barbara Schindo.

This steroid is used in treating acute respiratory distress syndrome during which the lung becomes inflamed and fills with fluid.

“With COVID, we see this also occurring,” said Dr. Debra Powell, chief of section of infectious diseases, medical director for infection prevention at Tower Health. “Patients that get that acute respiratory distress syndrome have all that inflammatory fluid in their lungs and we just want to stop that cycle. That’s why steroids are being used.”

Powell said it is not surprising that the treatment is helping patients hospitalized with COVID-19. Dexamethasone has now joined antiviral agent remdesivir on the treatment guidance statement for COVID-19 patients.

“We adjusted what we do,” Powell said. “This has been an ongoing process since we started this pandemic back in March.”

Stages of treatment

At the beginning of the pandemic, Tower Health formed a committee to review current COVID-19 information and determine best treatment options.

The committee gives guidance on the treatment options for patients determined to be in the mild, moderate or severe stages of COVID-19. Those determined to be mild receive supportive care. Moderate patients tend to experience difficulty in breathing leading to the possible need of supplemental oxygen or hospitalization.

“Once you get to severe disease, that’s when we pull out all the stops and give you everything we have that has been shown to help,” Powell said. “We get (treatment) guidance for each of those stages (from the committee).”

The hospital is collecting all the data for COVID-19 patients and will use that data to compare the outcomes of patients treated with dexamethasone to those who did not receive the steroid as a treatment to see if the treatment helped that population of patients, as it did in the trial.

“We are collecting that data, and we’re going to be splitting it apart,” Powell said. “We’ll probably have to do it retrospectively and have to compare the data to patients from May and June (when we were not using steroids).”

The more information available, the better equipped health care professionals become in helping patients fight the virus.

“I feel better today than I did three months ago when we didn’t have a whole lot of information,” Powell said. “The more information we get, the more studies that are published, the better off our treatment plans will be for our patients. It’s reassuring, but again we’re just starting to collect this information.”

Risk-benefit analyses

The studies and trials help health care professionals determine if the treatment would have a greater benefit for patients than risk.

Hydroxycholoroquine was taken off the treatment guidance list because the risks to patients were greater than the benefits, according to the studies and trials.

Even remdesivir is allowed as a treatment because of emergency use authorization. Patients are given a disclaimer and need to sign a consent form stating they understand the risks and benefits to them before receiving the treatments.

“This is a large science experiment,” Powell said. “This is a novel virus that no one has seen before. We had SARS a number of years ago. Fortunately, this SARSCoV-2 isn’t as deadly as the last SARS, but that was contained. This has branched out to be a global pandemic and is much bigger than we have seen before.”

‘Doing the right thing’

New treatments and a decrease in the number of patients requiring hospitalizations is a good sign. Powell said the demand at the hospital for COVID-19 patients is stable at this time.

Several months ago at the height of the spring outbreak, Reading Hospital had 70 to 80 COVID-19 patients, and now there are about 20.

Penn State Health St. Joseph has been in the eightnine range most of the past week after peaking in the 30s.

“This is quite an improvement, but what we need to do is continue to social distance, wear your mask and practice good hand hygiene because we need to flatten the curve and keep these numbers low until a vaccine is available for us all,” Powell said.

Powell believes a vaccine is still quite some months away from being available.

Berks has been fortunate to not have case numbers as high as initially anticipated.

As a result, hospitals have not experienced overwhelmed intensive care units.

But that does not mean the virus is no longer a threat.

“We have been doing the right thing, and I just encourage people to keep doing it,” she said.

People should continue to wear masks, avoid large gatherings, practice social distancing and wash their hands often.