When Pedro Gonzalez arrived at Hudson Regional Hospital on March 18, the doctors didn’t know exactly how to treat him.
Gonzalez had with a 102 degree fever and shortness of breath, was one of the Secaucus hospital’s first confirmed coronavirus patients and the first to require a ventilator. At the time, the state had seen only five deaths, while there were 24 confirmed cases in Hudson County and 267 statewide.
As Gonzalez’s condition deteriorated, doctors gave him hydroxychloroquine, antibiotics, immunosuppressants, zinc, Vitamin C— “every single type of treatment,” said Dr. Nizar Kifaieh, the hospital’s president and CEO. “We left no stone unturned to get him back to his family.”
Now, more than a month into the pandemic, doctors have unraveled some of the mysteries of the virus. After hundreds of patients have passed through their emergency rooms, hospitals across Hudson County have improved their treatments and managed to bring down deaths and intubations.
Dr. Anthony Passannante, president of Palisades Medical Center in North Bergen, said the coronavirus was a “total unknown” at the beginning of the outbreak. “No community immunity, obviously sudden onset, very contagious,” he said. “It’s a big challenge.”
Aside from limited data from countries in Asia and Europe, information about the virus and effective treatments was scarce. Since the coronavirus behaves differently from other respiratory diseases, doctors have been forced to rethink their methods.
Early in the COVID-19 outbreak, doctors leaned heavily on ventilators for patients who struggled to breathe. But once coronavirus patients are on ventilators, it’s extremely difficult to get them off, doctors said. After weeks of seeing ventilated patients deteriorate and die, doctors are now trying to avoid them.
“In many pneumonias and respiratory failure patients in the past, the idea was, well, if someone’s working hard, you might as well intubate them earlier on, help them to be able to rest, conserve energy,” Passannante said. “With this disease it’s a little different.”
Instead, doctors will use other methods of delivering oxygen to patients such as BiPAP, a machine that aids breathing using air pressure, often used to treat patients with sleep apnea. Other treatments of improving patients’ breathing are less high-tech: doctors report that, often, simply turning patients onto their stomachs, or “proning” them, can dramatically improve their breathing.
“It’s been shown over and over and over that once a patient is placed on a ventilator, the outcome is no good,” Kifaieh said. “We’re trying to avoid ventilators at all cost.”
And some of the initial information about treatments has turned out to be incorrect. Citing data from early studies, doctors said that at the outset, they avoided administering steroids to coronavirus patients, for fear of dangerous side effects. Now, after doctors found those fears to be overblown, the drugs are a common component of coronavirus treatments.
“Initially we were told that steroids might be taboo in this disease,” said Dr. Aaron Stein, the chief medical officer at Palisades Medical Center. “It turns out not to be the case.”
Doctors have also learned that many COVID-19 patients suffer from other conditions and complications. Patients are appearing in emergency rooms with kidney failure, or after suffering strokes or heart attacks, and later will test positive for coronavirus.
To combat this, hospitals have begun running tests on all patients who are thought to have the virus when they arrive at the hospital. These tests can help predict whether or not patients are at risk of severe symptoms or complications such as blood clotting, which can lead to strokes or heart attacks.
Doctors are also working to discover new therapies. Hospitals are incorporating the anti-malarial hydroxychloroquine and the antiviral remdesivir into their treatments, and Hackensack Meridian Health, Palisades Medical Center’s network, is seeking recovered COVID-19 patients to donate plasma to study its potential as a treatment. Christ Hospital is taking part in a plasma study through the Mayo Clinic.
But doctors warn there is currently no silver bullet for the virus. Dr. Naresh Patel, a hospitalist at Jersey City’s Christ Hospital, said the hospital was still “tweaking” its “treatment algorithm,” which incorporates a number of different medications. Even if new drugs or treatments are proven to be effective, he said, there will still be many details that need to be hammered out, such as dosage, duration, and when to administer.
“There are so many variables,” he said. “When, how much, for how long — all of these things are going to have to be worked out.”
But even without a wonder drug, doctors are confident coronavirus treatment has improved.
Last week, Gonzalez was discharged from Hudson Regional. He spent 22 days on a ventilator and was bed-ridden in the hospital for so long that he’d lost function in his muscles and his voice.
“We feel that his recovery was basically a miracle,” Gonzalez’s wife, Victoria, said.
Kifaieh cautioned against generalizing from Gonzalez’s experience, saying “a lot of this is really random with a lot of these patients.”
But in terms of the hospital’s success in bringing down intubations, Kifaieh said, “someone like Pedro coming in today would have a much, much better chance of doing as well as he did, in a much faster period of time.”