Whether they’re looking for new medications or changing the way they use fans, doctors in the Chattanooga region have much more to treat COVID-19 patients since the early days of the global pandemic.
Although many others do not want to receive medical care for coronavirus, COVID-19 is a new and highly contagious disease that is more severe and deadly than the flu. The virus has led to drastic public conditioning measures and fueled a global avalanche, which is underway, to locate effective treatments.
There was no express antiviral drug for COVID-19 when the pandemic began. Many prospective pharmaceutical treatments, such as hydroxychloroquine, have come out the door but have proven ineffective.
Providers had to treat critically ill patients with popular medications, such as anti-inflammatory drugs, to relieve symptoms and supportive care, such as supplemental oxygen. Although they still rely heavily on these remedies in COVID-19 care, doctors now have a greater understanding of when and how to use them.
Fans, machines that assume the role of breathing when the lungs cannot serve, have become an early symbol of the pandemic (as well as imminent death) after horror stories about crowded hospitals appeared in the media in Italy and New York.
But much has been replaced in the 8 months since the coronavirus was first detected in Wuhan, China. Mortality rates are declining, some remedies are promising and providers are constantly looking for tactics to better treat patients.
“This is a new disease, or a new disease, that didn’t exist a year and a part ago, so we learned from our delights, as well as the published delight of other communities and other primary fitness systems,” said Dr. Carlos Baleeiro, pneumologist and medical director of intensive care at CHI Memorial Hospital.
While overall mortality trends have improved, Baleeiro said he attributes it in part to the fact that other younger, healthier people, who sometimes the progression of the disease without too many disorders compared to vulnerable older adults, are infected.
However, turning doctors into COVID-19 management is also a major factor, said Dr. Jigme Sethi, critical lung care specialist at Erlanger Medical Center.
When the disease first hit the shores of the United States, one of the main debates was whether and when a patient who had trouble breathing should be placed under a mechanical ventilator.
“Before, we taught patients [placed on fans] much faster, when they first appeared, lacked the air and run out of oxygen,” Sethi said.
“Now we’re doing our thing to keep their ventilation because a lot of them are recovering from the remedies we use,” he said. “But clearly, there is a ratio that a fan wants, and in them, the death threat is very high.”
This is a bad sign when a patient is in poor health enough to want a ventilator, regardless of their illness. However, reports of early mortality rates in COVID-19 patients requiring ventilation exceeded 50%, particularly higher mortality rates than published from 35% to 46% for patients intubated with H1N1 influenza pneumonia and other reasons for acute respiratory misery syndrome, according to being examined in the Journal of Critical Care Medicine. The same study found that mortality rates for patients intubated with coronavirus were closer to 36%.
Baleeiro said there are many benefits in delaying the use of the fan, if possible, and opting for traditional treatment with less excessive oxygen or high-speed oxygen.
“When someone is connected to a fan, because of its more invasive nature, it takes a lot of sedation,” he said. “They can’t participate as much in their care and become more dependent on the full care of staff, and their recovery can take longer.”
Patients who are not intubated can move more, which is intended to speed recovery. For patients who want to use fans, it is also helpful to “tilt”, i.e. place patients face down. The remedy can also be used in perfectly awake patients.
“If you’re only flat with mendacity, what happens is inflammation and the fluid stays in it at the back of your lungs. But when we care and replace our position, we expect you to rotate and expand other parts. Lungs,” Baleeiro said.
“And there is concern, there is no clinical agreement, that excess fan strain on this specific disease can worsen inflammation and can make disease progression longer and more difficult,” he said.
In addition to unknowns related to a new disease, the remedy of coronavirus patients is complicated. The virus is known to cause pneumonia and respiratory failure, but it affects the kidneys, heart, brain and neuromuscular systems and increases the threat of blood clots, Sethi said.
“COVID-19 has more diverse and serious occasions than we’ve ever seen,” he said.
For example, Baleeiro stated that patients with COVID-19 appear to be at higher risk of “clotting complications” than other respiratory patients.
“We’ve noticed many of these patients coming in and expanding blood clots in their legs or blood clots in their lungs,” he said. “Obviously, we have tests to look for them, but we’ve also created a protocol in which if patients have lab abnormalities that make them more likely to have clotting headaches, we use a protocol to start taking blood thinners.”
Until now, the experimental drug redesivir is the only antiviral drug that shows good fortune in terms of restricting coronavirus infection by targeting a protein that allows the virus to replicate. In May, he received an emergency use authorization from the U.S. Food and Drug Administration. For patients hospitalized with COVID-19 severe in two randomized trials.
Sethi called the drug “an incredibly vital healing break” when used with a daily dose of decaderon, a well-known corticosteroid also known for its generic dexamethasone, to soothe inflammation. The 3 hospital chattanooga systems acquired the re-ivir through the government shortly after its availability in May and have been since then.
“We believe this reduces the number of patients who want mechanical ventilation and is helping them faster,” Sethi said.
Baleeiro said his organization also uses the drug in patients who meet the criteria for use, and remains cautiously optimistic.
“Knowledge seems good, and they have a mechanism of action that makes sense, because it is a direct antiviral,” Baleeiro said. “But I can tell you that we have treated patients who have done well and have still taken a long time to recover. Array… It’s anything we can say as soon as we give it.
Remdesivir manufacturer Gilead Sciences is seeking approval for use in in patients with inflamed coronavirus despite the results of the combined trials.
While much remains to be learned, Chattanooga hospitals have been luckier and more prepared to handle COVID-19 than cities whose patient increase arrived earlier, Baleeiro said.
“Some other communities had to be informed about the passage without knowledge, without advice,” he said. “We’re still informed as we pass, but when our peak started, we may just talk and review knowledge summaries from other sites.
Dr. Robert Magill, medical director of hospitalists at Parkridge Health, said in an email that while some patients want some remedy functions, others want the full range: remdesivir, additional oxygen, antibiotics to treat a secondary infection, dexamethasone steroid and convalescent plasma. (which is the liquid component of blood drawn from patients recovered with COVID-19). Convalescent plasma contains antibodies that can help others suffering overcome the disease to fight the infection when all other functions have been exhausted.
“There is still much to report on the recovery procedure and COVID-19-related headaches,” Magill said, adding that seeking to perceive the persistent disorders of some coronavirus survivors, such as fatigue and shortness of breath, is a new frontier. for the medical community.
“In terms of long-term treatments, the promising maximum option for me is the vaccine,” he said. “If we can prevent other people from contracting COVID-19, it will be better for everyone.”
Contact or [email protected] Elizabeth Fite on Twitter @ecfite.