New COVID treatments help doctors manage hospitalizations
When Connecticut hospitals were slammed with the first wave of COVID-19 patients about 10 months ago, there was a lot they didn’t know.
“Early on, we were utilizing any therapies that we thought might be useful,” said Dr. Gregory Buller, associate chief medical officer and chairman of the department of medicine at Bridgeport Hospital.
Dr. Zane Saul, the hospital’s chief of infectious disease, said they were using hydroxychloroquine and HIV medications at first “because we didn’t know what else to do.”
Some of the early medications, including hydroxychloroquine, were found to be less effective than originally thought. Other early tactics, such as quickly putting patients on ventilators, also have been found to less helpful than first believed.
“Treatments continue to evolve,” Saul said.
One major way that treatment has evolved since the spring is the increased use of steroids to treat COVID, which can cause inflammation. In June, the World Health Organization reported that a clinical trial in the U.K. showed that corticosteroid dexamethasone reduced mortality by about a third in patients on ventilators and reduced mortality by roughly a fifth in patients on oxygen.
Dexamethasone is now listed as part of the National Institute of Health’s treatment guidelines for COVID-19, as it “has been found to improve survival in hospitalized patients who require supplemental oxygen, with the greatest effect observed in patients who require mechanical ventilation. Therefore, the use of dexamethasone is strongly recommended in this setting.”
Other big changes include the way ventilators have been used in patients with serious cases of COVID.
“Early on, in the spring, our thought was that we should intubate patients early,” said Dr. Asha Shah, associate director of infectious disease at Stamford Health. “But now we know that’s not the case.”
She said doctors now know that leaving patients on a ventilator longer can lead to complications and they try to avoid using them.
Another major evolution is the use of monoclonal antibodies in COVID patients who aren’t sick enough to be hospitalized, Shah said. “We’re basically giving patients antibodies to fight the COVID,” Shah said. “It’s very similar to the convalescent plasma that we give to inpatients.”
Convalescent plasma — taken from those who have contracted and recovered from COVID — became an increasingly popular treatment in the earlier days of COVID, and continues to be used.
Though COVID hospitalizations have surged since the summer, they have remained relatively steady with around 1,100 patients in recent months. They also haven’t yet come close to the peak of 1,972 that was hit on April 22. Experts said this is likely due at least in part to doctors now knowing more about the illness and are better equipped to treat it.
But Buller said the public has had at least some role in keeping hospitalizations manageable. “Everybody — well, a significant number of people — are now masking and doing social distancing,” he said. “I think that really makes the difference.”