How are hospitalized patients treated?
Patients who are hospitalized with mild to moderate symptoms of COVID-19n often receive steroids, which reduce some of the inflammation caused by the virus. Physicians say it decreases a patient’s chances of dying or experiencing more serious symptoms.
Patients might also receive remdesivir, which became available under an emergency use authorization about a year ago. The treatment aims to reduce the replication of the virus. It has a low side effect profile and has been shown to reduce recovery time. However, studies have shown mixed benefits, and it’s not clear if the treatment reduces a patient’s chances of requiring a ventilator. Since it’s relatively safe, physicians administer it fairly readily to hospitalized patients.
Patients experiencing more severe disease, such as inflammation in their lungs, and who require high amounts of oxygen or ventilator support, often receive anti-inflammatory treatment.
“There are a number of receptors and pathways within our body that the virus can trigger and cause an immune response, which then causes a global inflammation or inflammatory response,” said Dr. Vinay Maheshwari, Hugh R. Sharp Jr. Chair of Medicine and physician executive of The Medical Group at ChristianaCare.
“So there are a few classes of agents that are really targeted at this immune response. And the early studies have demonstrated definite benefits in terms of reducing mortality, reducing the likelihood of progression of the disease, and reducing the likelihood of requiring a ventilator.”
Other mainstays of therapy include oxygen support, like high-flow nasal therapy.
How has COVID-19 treatment evolved?
There’s been a dramatic change in treatment protocols over the last several months, informed by clinical adaptive trials to examine which therapies work and which ones don’t.
Early on, the antimalarial medication called hydroxychloroquine was touted to treat COVID-19. However, research eventually showed that it was not beneficial and posed some risk. Physicians then removed it from the treatment paradigm.
Puri said while current treatment for patients with mild to moderate symptoms is somewhat limited, the evolution of treatment is important to note because “there have been many other things proposed over a period of time, including vitamin D, including hydroxychloroquine … so significant change.”
Steroids, which are now widely used, also were not originally recommended.
“That was a hot debate in the beginning of the pandemic, where it was mainly used in Southeast Asia, and was by expert opinion, kind of, stated not to be used,” Criner said. “Even the CDC originally recommended that, but that’s the mainstay of therapy now.”
During the beginning of the pandemic, convalescent plasma was a commonly used treatment for COVID-19 patients, but today, physicians aren’t using it as frequently because it’s not clear if it significantly reduces disease progression and mortality among hospitalized patients. Physicians sometimes prescribe it, though, for patients who are severely immunosuppressed, or for those who can’t be treated with remdesivir because of kidney problems.
Studies are underway, however, to determine if convalescent plasma is beneficial for outpatient treatment.
“I think it will be part of the ongoing learning journey with COVID about whether that will really provide benefits for those patients in the outpatient realm,” Maheshwari said. “In the meantime, I think that it’s a great opportunity for those who are willing to donate to continue to do so. It will provide us more access to that therapy, as well as the opportunity to continue to investigate it.”
There’s also been discussion around starting non-critical but hospitalized patients on blood thinners to prevent clots. Preliminary data suggests hospitalized patients with mild to moderate illness have a survival benefit with this treatment.
The physicians say they’re also examining how long which medications can be prescribed in a way that can maximize their benefits, but also limit the likelihood of side effects.
Health care systems have participated in numerous studies to improve patient outcomes. Cooper Health participated in a study finding that ICU patients who were put in the prone position early did better than patients who were not. Cooper also is participating in stem cell research and blood purification studies.
“The promise of stem cells to help regenerate the lungs after the lungs have been destroyed by the COVID virus is fascinating,” Puri said.
