PEORIA — While a cure has yet to be discovered, doctors have developed a fairly successful treatment protocol in the four months since COVID-19 patients started showing up in area hospitals.
When the pandemic began, doctors simply did not know how to treat COVID-19 patients, but today they are in a much better position to manage the course of the virus, said Dr. Manasa Kandula, an internal medicine doctor who treats COVID-19 patients at OSF HealthCare Saint Francis Medical Center.
"What I used to tell patients in the beginning was very different from what I tell them now — it’s so much better," she said. "I used to try to prepare them by telling them that we don’t have a lot of treatment options at this time, that we are trying to support your body to fight this virus. Now they come in and we have a plan going in."
At St. Francis, the treatment protocol has led to fewer patients in the intensive care unit. Instead, most patients get better and get discharged, said Kandula.
The protocol used at St. Francis was developed with information generated by doctors and researchers combating the newly emerged virus all over the world. As one of the doctors on the physician subcommittee of the pandemic task force at St. Francis, Kandula attends regular meetings to review new information when it becomes available. On Thursday, the task force met to discuss a study released earlier in the week by researchers in the United Kingdom on the steroid dexamethasone. The study showed promising results, with deaths reduced by a third and an improved chance of survival in the sickest patients.
"So we may be tweaking our protocol. We’re going to have a discussion about it tomorrow," said Kandula during a phone interview Wednesday afternoon. "I’m sure there will be another study comparing the different steroids. Before yesterday’s paper came out, there was another one that was done on a different steroid which we have been using. Most steroids have the same effect, it’s just that their potency is different. The one they used in this new study is definitely more potent."
The use of steroids exemplifies how the treatment of COVID-19 has evolved — in the beginning, doctors were told not to use steroids.
"That information came from previous pandemics, flu and SARS-CoV-1," said Kandula. "Over time, with a lot of experience all over the world, they saw that steroids have been sometimes helping. Evidence started coming out, some evidence more favorable to steroids. That’s why we started using it here. We put patients on it early to try to prevent them from progressing in the disease, and it has worked. It’s like part of the protocol to target everything, to combat the disease, reduce inflammation, stop them from progressing."
In addition to steroids, the COVID-19 protocol includes vitamin D to help boost the immune system and a blood thinner to prevent blood clots, a frequent symptom in COVID-19 patients.
"We see that around the country, all the inflammation that COVID causes can lead to clots all over the body. We try to prevent that from happening by giving them a blood thinner as soon as they come into the hospital," said Kandula.
In addition, patients without kidney or liver problems may get the antiviral medication Remdesevir. On day two of the hospital stay, patients who haven’t shown some improvement get enrolled in the convalescent plasma program, said Kandula.
"The goal is to keep anyone from going into the severe illness phase," said Kandula. "There’s a phase where the virus is causing damage, there’s a phase where the body’s immune system is causing the damage, and now we understand that a lot of these manifestations are coming from depending on which phase the patient is in. We are trying to target all these different phases. So as soon as they come in, the goal is to neutralize the virus with either convalescent plasma or the antiviral Remdesivir. We get to offer these treatments early on and then also, to make sure that they don’t go into the severe phase of the disease, which is where the body’s immune system is causing damage, so we try to avoid that by using steroids."
With a relatively low number of patients, shortages of either Remdesevir or convalescent plasma have not been an issue at St. Francis, said Kandula.
COVID-19 treatment protocols vary from hospital to hospital, even within the OSF HealthCare system. Everyone is using Remdesevir, and both Rockford and Little Company of Mary in Evergreen Park are using convalescent plasma. Steroids, however, are not being used throughout the OSF system, said Kandula.
"Based on some recent evidence, we have been giving steroids at OSF St. Francis at the treating physician's discretion," she said. "We at OSF St. Francis are working on an IRB-approved study protocol to observe the effect of steroids on outcomes, and anecdotally we have had excellent outcomes with our current coherent approach to COVID-19 with Remdesivir, steroids, convalescent plasma and anti-coagulation."
While the evolving protocols are helping to lower the number of people who get severely ill, they haven’t helped everyone. Patients who struggle more with COVID-19 are typically those who have other health issues, said Kandula.
"We are still seeing deaths, but most of the time I think it’s multi-factorial — I don’t think it’s COVID alone — like a COVID-confirmed patient, but they have bacteria floating in their blood. So there’s usually something else that makes it harder for them to recover," she said.
While the elderly have a greater chance of dying, young people are just as likely to be hospitalized, said Kandula.
"People coming into the hospital are a real mix. In the last few weeks, I’ve had really young individuals in their 20s and 30s, but even these young individuals have some other conditions, like high blood pressure or diabetes," said Kandula. "I would say we are seeing all ages. The elderly definitely are more at risk of progressing to severe disease, but I think keeping on top of things and getting them started on treatments early on has helped, even with the elderly. We had a 90-year-old who did well."
While COVID-19 is not going away any time soon, doctors are getting better at managing it, a fact that should help calm some of the anxiety in the community.
"I still want people to continue to really mask and social distance and take care of themselves while this whole reopening thing is going on, but at the same time understand and have some confidence with the health system, that we can actually tackle this, and we are not as clueless as we were," said Kandula. "Yes, COVID still has manifestations that we don’t know of, and we can be surprised with new things, but I think our knowledge has grown multifold since this pandemic started, and I think I really want the public to have that confidence in the system, that we can actually get through this pandemic and deal with COVID like any other major disease."
Leslie Renken can be reached at 686-3250 or email@example.com. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.