BENGALURU - Doctor Gopi Patel recalls how powerless she felt when New York’s Mount Sinai Hospital overflowed with COVID-19 patients in March.
Guidance on how to treat the disease was scant, and medical studies were being performed so hastily they couldn’t always be trusted. “You felt very helpless,” said Patel, an infectious disease doctor at the hospital. “I’m standing in front of a patient, watching them struggle to breathe. What can I give them?”
Despite a steady rise in COVID-19 cases, driven to some extent by wider testing, the daily death toll from the disease is falling in some countries, including the United States. Doctors say they are more confident in caring for patients than they were in the chaotic first weeks of the pandemic, when they operated on nothing but blind instinct.
Even nuts-and-bolts issues, like how to re-organize hospital space to handle a surge of COVID-19 patients and secure personal protective equipment for medical workers, are not the time-consuming, mad scrambles they were before. And while medical knowledge has improved, doctors continue to emphasize that the best way for people to survive is to avoid infection in the first place through good hygiene, face coverings and limited group interaction.
At Stanford Health Care, treatment guidelines changed almost daily in the early weeks of the pandemic, Blomkalns said. She described a patchwork approach that began by following guidelines established by the U.S. Centers for Disease Control and Prevention, then modifying them to reflect a shortage of resources, and finally adding new measures not addressed by the CDC, such as how to handle pregnant healthcare workers.
While rates of COVID-19 infection have recently been rising in many parts of the United States, the total number of US patients hospitalized with COVID-19 has been steadily falling since a peak in late April, according to the CDC. “What has really helped us triage patients is the availability of rapid testing that came on about six weeks ago,” said Falk of Cedars-Sinai. “Initially, we had to wait two, three or even four days to get a test back. That really clogged up the COVID areas of the hospital.”
It gained attention in March, when US President Donald Trump began publicly touting it. Early reports showed the drug could have some benefit, and hospitals, desperate for solutions, started giving it to critically sick patients. But subsequent trial data have told a different story, suggesting the drug is not effective for treatment or prevention, and might even cause harm. Other clinical trials of the drug are still underway.
The lingering questions about use of hydroxychloroquine highlight the hazards of quickly moving science. Hospitals normally rely on fully vetted research published by prominent medical journals like the Lancet and the New England Journal of Medicine to flag important medical findings. But as the pandemic built, so did the number of so-called “pre-print” studies that have not been peer-reviewed.
People who survive an infectious disease like COVID-19 are generally left with blood containing antibodies, which are proteins made by the body’s immune system to fight off a virus. The blood component that carries the antibodies, known as convalescent plasma, can be collected and given to new patients.
Dr Abdullatif al-Khal, head of infectious diseases at Qatar’s Hamad Medical Corporation and a co-chair of the country’s pandemic preparedness team, said he saw patients improve after he started using donated plasma early in the course of COVID-19 before the patients deteriorated. Remdesivir is designed to disable the mechanism by which certain viruses, including the new coronavirus, make copies of themselves and potentially overwhelm their host’s immune system.
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