A patient suffering from COVID-19 is seen in early April on a ventilator in the intensive care unit of a Paris hospital. Medical professionals have since learned that blood-thinning drugs improve the flow of oxygen through the blood system. (CNS photo/Benoit Tessier, Reuters)
by Bill Miller
WINDSOR TERRACE — Confusion and desperation prevailed last spring among medical professionals responding to the sudden and massive hospitalization of patients felled by COVID-19.
First-responders recalled how they could not keep up with the pandemic’s rampage through the five boroughs. Angie Alburquerque, a Brooklyn-based paramedic, recently told The Tablet, “In five days, I saw 37 cardiac arrests and all were (dead on arrival).”
In those early days, thousands of patients who reached the hospital ended up dying. But as tragedies increased, medical professionals learned more about the unique ways the coronavirus dragged its victims into respiratory distress.
As the world awaits a vaccine, lessons learned in emergency rooms and intensive care units have spurred adjustments in treatments such as oxygen therapy and some therapeutic drugs and steroids.
Health experts believe these practices helped reduce COVID-19 death rates across the globe. However, they’re quick to add that these methods aren’t actual cures, nor are they appropriate in every case.
“The practice of medicine is not standard in any form or fashion,” Dr. Robert Tiballi told The Tablet. “Doctors do things differently. It’s like how much salt you put in your soup.”
The more that tested techniques are used and proven helpful in some cases, the more confidence they give responders in ERs and ICUs. “And, Tiballi said, “everybody rapidly adapts to that.”
Tiballi is a Chicago-area infectious disease specialist with the Catholic Medical Association and a contributor to the “Ask the Doctor” segment on Currents News.
His assessments of COVID-19 treatments are from a dual perspective. As he treats patients, he understands their distress, having contracted and survived the disease last March.
“In all honesty, I thought I was going to die,” he said, “but I didn’t. It took a couple of months to get back on my feet.”
Since then, he’s had time to assess how COVID-19 treatments have changed.
One example of change is the use of ventilators in hospitals, which, Tiballi said, “aren’t really helpful.”
“We thought it was a problem with the patient not getting oxygen across membranes of the lungs,” he said. “A ventilator forces gasses in the lung and pulls them out again. Normally, that’s what we do for bacterial pneumonia. But we discovered it’s really a vascular problem.”
Specifically, Tiballi explained, the disease causes a “microvascular problem” in which tiny vessels are “precipitously clogged in a clotting cascade.”
Doctors subsequently found success by giving blood thinners, including basic aspirin, Tiballi said.
He added that the steroid dexamethasone also eases blood flow by reducing inflammation. The steroid was part of the treatment received by President Donald Trump after he tested positive for the coronavirus on Oct. 1.
Another method that helps some COVID patients breathe is rolling them onto their stomachs in a prone position, also known as “proning.” Favorable data about proning surfaced in early summer.
“It’s a practice we’ve been using for decades in other situations,” Tiballi said. “So, it’s not uncommon to rotate patients from front to back, which causes a shift in blood flow to other parts of the lungs.”
The National Institutes of Health, on Oct. 9, issued proning recommendations in its updated COVID-19 Treatment Guidelines.
According to the NIH, “Appropriate candidates for awake prone positioning are those who are able to adjust their position independently and tolerate lying prone,” but not recommended for patients “who are in respiratory distress and who require immediate intubation.”
Blood plasma taken from COVID-19 patients may contain antibodies that could “help suppress the virus and modify the inflammatory response,” according to the NIH.
Tiballi explained that plasma is “the liquid that blood cells float in,” but it also contains “antibodies that the human body makes.”
When people donate plasma, the lab workers spin off the red blood cells, return those to the blood system, but keep the fluid that contains antibodies, Tiballi explained.
However, blood plasma is an example of how one treatment works in some patients but not others. Tiballi said the coronavirus is very good at mutating, so a patient in Illinois might have a different strain than another in California.
“These antibodies might be strain-specific,” Tiballi said. “So, a woman might be better with mine, but not Joe’s.”
That’s why, according to Tiballi, pharmaceutical companies rush to develop and test therapeutic drugs with “standardized” antibodies that offer more overall effectiveness among patients.
Early last week, President Trump emerged from a weekend of COVID-19 treatments and proclaimed a drug he was given, REGN-COV2, had cured him. He pledged to make the drug freely available to anyone.
REGN-COV2 is made by Regeneron, based in Westchester County, N.Y. The federal government has awarded $450 million to Regeneron to develop REGN-COV2 as part of “Operation Warp Speed” — the public-private partnership to accelerate the development of vaccines and therapeutics to fight COVID-19.
However, REGN-COV2 is not yet among drugs approved for “emergency use authorization” by the Food and Drug Administration. More than 550 COVID-19 drug development programs were underway as of Oct. 12. Meanwhile, more than 350 drug trials were under review by the FDA.
Trump received REGN-COV2 via a “compassionate use” approval, but medical experts said it was too soon to tell if it had cured him. They noted he had also taken the antiviral drug Remdesivir, which has been approved for emergency use by the FDA.
Remdesivir is a therapeutic drug also recommended by the NIH, either alone or in combination with the steroid dexamethasone.
Officials with the World Health Organization monitor developments in the COVID-19 Pandemic, and they’re glad to see death rates drop worldwide.
In recent press briefings, they commended medical professionals for sharing information on techniques that helped some patients.
“We’re seeing clinical case fatality rates slowly drop,” said Dr. Mike Ryan, executive director of the WHO’s Health Emergency Program. “We’re seeing doctors and nurses making better use of oxygen, better use of intensive care, better use of dexamethasone, and other therapeutics as they come online.”
But Ryan, an epidemiologist from Ireland, also stressed that prevention is important too. He urged people not to let up on social distancing, wearing personal protective equipment like face masks and gloves.
“Remember, we have things we can do now to drive transmission down and drive down the number of deaths,” he said. “As we’ve all learned at the school of hard knocks over the last number of months, the fact that disease is on the way down does not mean that disease will not pick up again and very, very quickly in certain circumstances. So we need to remain vigilant in all countries.”