How has the way hospitals treat COVID-19 evolved?

In less than a year health care providers have experienced a "huge evolution" in the way they treat patients with COVID-19, said Dr. Andrew Thompson, an infectious disease physician at St. Luke's in Duluth.

"This is going to foster a whole generation of people who will study this and it'll be really interesting to see over the next decade what our conclusions are: What we did right to start with and what we did wrong," Thompson said.

So far, the only drug used to treat people with COVID-19 that's been found to reduce the chance of deaths is a steroid called dexamethasone, which is used to reduce inflammation in COVID-19 patients, he said. The drug has been around for about 60 years and has been used broadly, including as cancer and allergy treatments.

Thompson said the steroid is routinely given to patients who require oxygen, including severely ill people in an intensive care unit on a ventilator.

"We think it helps decrease some of the destruction that the virus sets off, this sort of cycle of destruction in the lungs," Thompson said. "Part of that is inflammatory, so if we can turn down that inflammation with the drug the damage is reduced. It’s kind of a blunt tool, honestly, but it works. So we'll use what works."

He suspects the biggest improvement in the way hospitals treat COVID-19 is giving steroids to those who need it.

Initially, health care workers weren't giving steroids due to a concern that some might be harmful. That has since changed.

Over the summer hospitals began receiving allocations of an antiviral drug called remdesivir. Until then, hospitals like St. Luke's could only read about it and wish they had it, Thompson said. It wasn't the miracle drug they had hoped for.

While there isn't strong evidence suggesting the antiviral reduces deaths, it has shown effectiveness in reducing the amount of time people with low oxygen levels, but aren't critically ill, are in the hospital. The earlier those patients get the treatment the better, he said.

"It's a very narrow group of folks that it’s demonstrated benefit on," Thompson said. "Some studies have not really shown benefit. It’s a good tool to have and we use it on anyone who has low oxygen in the hospital, but not those who we don't think it's going to help. It’s also expensive. "

Asked if there's potential that studies on other treatments like remdesivir could reveal reduction in mortality, Thompson said it's possible they could learn about additional benefits to the drug in the future.

In the spring the U.S. Food and Drug Administration granted hospitals permission to use convalescent plasma therapy to treat COVID-19 patients. The therapy uses the blood products of those who have recovered from COVID-19 and have developed the antibodies to the virus.

Early on in the pandemic providers were using the antibody treatment on hospitalized patients later in the illness, Thompson said. They have since learned from a large trial that there weren't any benefits to doing that. Instead, a smaller trial has suggested the antibody-filled plasma can reduce the progression of illness if given early on in.

"The thinking now is it's probably because they gave it too late, the damage was done, that horse was out of the barn," Thompson said. "Giving plasma late after all that damage has been caused to the lungs isn’t going to change anything."

Now health care systems like St. Luke's and Essentia Health are focusing on getting a newer treatment antibody treatment called monoclonal antibodies to people who are in the earliest stages of COVID-19 and at risk of becoming hospitalized.

PREVIOUSLY Duluth hospitals offer COVID-19 treatment for those in early stages of symptoms, at risk of hospitalization Physicians encourage those eligible to consider monoclonal antibody treatment in first 10 days of symptoms.
"The theory behind treating with either plasmas — convalescent or monoclonal — is that as soon as we discover someone's infected, if we can get them those antibodies to neutralize, deactivate the virus, it's likely they're going to do better," he said. "The longer you wait the more damage the virus can do."