Doctors are seeing first glimmers of hope
Jose Pascual, a critical care doctor in the University of Pennsylvania Health System, recalled those first, mad days treating the sick when he had little to offer beyond hunches and Hail Marys. Each new day brought bizarre new coronavirus complications that defied textbook treatments.
“We were flying blind,” he said. “There is nothing more disturbing for me as a doctor.”
Now, for the first time since a wave of patients flooded their emergency rooms in March, Pascual and others on the front lines are feeling something they say they haven’t felt in a long time — glimmers of hope. They say they have devised a toolbox, albeit a limited and imperfect one, of drugs and therapies many believe give today’s patients a better shot at survival than those who came only a few weeks before.
To be clear, these are not therapies proved to kill or stop the virus. They range from protocols to diagnose and treat dangerous, but sometimes invisible, breathing problems that can be an early warning of COVID-19 in some people, to efforts to reduce the illness’s severity or length.
At this stage, they are still experimental approaches by doctors desperate to find ways to help gravely ill people and throwing everything they can think of at the problem.
Trying out the options
The menu of treatment options, tried singly and increasingly in combination, includes the blood plasma of COVID-19 survivors, a rich source of antibodies that may help neutralize the virus; drugs to suppress the body’s own immune response, which some believe goes into hyperdrive as it tries to fight the new invader; anticoagulants, which decrease the risk of deadly clots; and finally, antivirals, such as remdesivir, the Gilead Sciences drug that recently won approval for emergency use from the Food and Drug Administration.
Randomized clinical trials are necessary to confirm early anecdotal data, with the results probably months away. But doctors say they believe they’re seeing positive results from these and other things they have learned through trial and error these past 10 weeks.
“Things changed almost completely, from knowing nothing at all and going on hearsay from Milan, Seoul and Wuhan, to saying, ‘Well, this is something we know we can do,’ ” Pascual said.
The World Health Organization also sounded a note of optimism Tuesday, saying it sees “potentially positive data” in four or five coronavirus treatments and planned additional studies to be able to make recommendations.
“We do have some treatments that seem to be in very early studies limiting the severity or the length of the illness,” spokeswoman Margaret Harris said.
While doctors are still a long way from having a full picture of the virus and its effects, “it is a different world today,” said David Reich, a cardiac anesthesiologist and president of Mount Sinai Hospital
in New York City.
Medicine as a field evolves slowly. But during the pandemic, months have been compressed into days, decades into weeks. The knowledge accumulated during the past couple of months was due not to a single eureka moment but rather a stream of discoveries.
Yogen Kanthi, an assistant professor of cardiology at the University of Michigan, said the medical community has “a much better idea of what are the major contributors to death and are moving into the next phase of trying some more targeted treatments.”
Looking in new directions
As doctors have begun thinking of COVID-19 as an illness that causes both clotting and inflammation problems, research has pivoted in new directions. “Is there one medication that is going to do all that? My gut tells me it’s more a combination of things,” he said.
Kanthi and his rheumatology colleagues who focus on immune issues are launching a study that will look at various combinations of anti-inflammatory drugs and blood thinners to find out whether they work better together, as well as their optimal timing, dosage and mix.
One medication that has shown promise is a heartburn drug that contains the active ingredient in Pepcid. A study of 1,536 patients found those who took it were more likely to survive, but researchers cautioned it could have been just a coincidence.
A study published last week in the Lancet found a combination of three antiviral drugs — separately used to treat HIV, hepatitis C and multiple sclerosis — appeared to hasten recovery in some patients.
While the status of certain drugs has been elevated, others — including those with toxic effects that could have been hurting patients — have been largely ruled out. This includes the use of hydroxychloroquine - the anti-malarial drug touted by President Donald Trump and given to coronavirus patients at many medical centers, even by doctors skeptical of the evidence but who had nothing else to offer.