Treatments that Houston hospitals are using right now in fight against COVID-19

Memorial Hermann doctors, Dr. John Butler and Dr. Shivani Patel are clarifying some misconceptions about current COVID-19 treatments that are effective.

Memorial Hermann doctors, Dr. John Butler and Dr. Shivani Patel are clarifying some misconceptions about current COVID-19 treatments that are effective.

Photo: Memorial Hermann

Memorial Hermann doctors, Dr. John Butler and Dr. Shivani Patel are clarifying some misconceptions about current COVID-19 treatments that are effective.

Memorial Hermann doctors, Dr. John Butler and Dr. Shivani Patel are clarifying some misconceptions about current COVID-19 treatments that are effective.

Photo: Memorial Hermann

Treatments that Houston hospitals are using right now in fight against COVID-19

Hospitals are faced with a difficult decision in the fight against COVID-19. When a patient tests positive for coronavirus, there are currently no FDA-approved drugs for treating them.  Since the coronavirus outbreak began, doctors in hospitals across the country have tried experimental drugs on patients with severe symptoms including Hydroxychloroquine, Remdesivir, Tocilizumab, and Sarilumab.

The one significant caveat with experimental drugs is that these medications can also potentially do grave harm. That's why Memorial Hermann doctors Dr. John Butler and Dr. Shivani Patel are clarifying some misconceptions about current treatments that are effective. Butler is the Infectious Disease Specialist at Memorial Hermann, and Patel serves as the Clinical Pharmacist at Memorial Hermann Southwest.

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"There might be a misconception out in the community--that if you test positive, you need to go and get treatment.  Some of the therapies can cause harm. The most recent guidelines are not recommending aggressive treatment for all patients," Dr. Butler said.

HYDROXYCHLOROQUINE CONCERNS

"Hydroxychloroquine has been currently our mainstay of therapy," Dr. Patel said. But now there's a significant shift away from using the drug in combination with other drugs, like azithromycin. In a new study of 368 patients posted on medrxiv.org, 97 patients who took hydroxychloroquine had a 27.8% death rate, while 158 patients who didn't take the drug had an 11.4% death rate.

"Just because you’re admitted to hospital, you won’t be started on hydroxychloroquine," Patel added. "We’re still evaluating it because the data is not robust.

"The real concern with these combination treatments is the altering of heart rhythms," Butler said. "These drugs were promoted by politicians and promoted in the press. As we get more data, we shouldn’t go this way. Potentially there is harm. Maybe we need to think twice about starting these therapies particularly if you’re at home."

Butler added that there's a lot of anxiety when you get a positive test, you feel the need to do something.

"The one general concept is that really the vast majority of the people who get infected with COVID-19 are not going to need any treatment at all and will recover," Butler said. "In the future, 90% patients will be treated as outpatients.  As we test more, most patients are not meeting criteria for aggressive therapy."

SUPPORTIVE CARE

Supportive care is the crucial key to recovery for most patients, as Patel explains.

"Supportive care entails medication to reduce fever, adequate hydration, respiratory support and positioning of the patient," Patel said.

The focus now is to treat with supportive care before using any aggressive therapy, and a significant shift away from using combination treatments with hydroxychloroquine.

"As far as using combination treatment with hydroxychloroquine and azithromycin, we’re really monitoring those patients closely," Butler said. "We’re moving away from that combination due to concerns of doing possible harm."

CONVALESCENT PLASMA THERAPY

So, what does Dr. Butler feel encouraged about in the treatment of COVID-19 patients in Houston?

"We feel optimistic about convalescent plasma therapy,"  Butler said.   Both Memorial Hermann and Houston Methodist use this innovative therapy.  Houston Methodist was the first in the country to try coronavirus blood transfusion therapy on Saturday, March 28.

Butler said one of the pivotal keys to seeing a patient on the road to recovery is through evaluating oxygen levels.

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"We can monitor their oxygen levels.  That’s the best sign that they’re turning the corner. That goes hand in hand with vital signs," Butler said.

The good news for Houston is that the mortality rate has seen a decrease. As of Thursday April 23rd, the city of Houston has reported no new deaths for the 4th day in a row.

“This is better than expected.” Butler said. Houston has done well especially compared to New York City.  The mortality rate is lower than I expected.

Patel echoed that sentiment.

"We’re really grateful that we've seen success in lower mortality rates." Patel said. "In  terms of future steps, we want to take a closer look at COVID-19 patients and learn how to take care of people to the best of our ability. We’re reviewing the new data that’s coming out. We really take patient safety very seriously."

alison.medley@chron.com


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