May 19, 2020

While there's no FDA-approved treatment to fight Covid-19, some clinicians say they've developed a workable "toolbox" of different treatments that give "patients a better shot at survival," Ariana Eunjung Cha reports for the Washington Post.

Covid-19 guidance from clinicians at the forefront

Providers 'were flying blind'

While early data suggest Gilead Sciences' remdesivir may help patients recover from Covid-19 faster, there is still no FDA-approved medication or procedure to treat patients with Covid-19, the disease caused by the new coronavirus. Instead, doctors have been testing a variety of different treatments to help some of their sickest patients survive, "throwing everything they can think of at the problem," Cha writes.

Jose Pascual, a critical care doctor at the University of Pennsylvania Health System, said providers "were flying blind" when they first starting treating patients with Covid-19. But today, Pascual said, providers are more equipped to handle Covid-19 patients. "Things changed almost completely, from knowing nothing at all and going on hearsay from Milan, Seoul, and Wuhan—to saying, 'Well, this is something we know we can do,'" he said.

Yogen Kanthi, an assistant professor of cardiology at the University of Michigan, said providers now have "a much better idea of what are the major contributors to death and are moving into the next phase of trying some more targeted treatments" for Covid-19.

Ultimately, randomized controlled trials will be needed to confirm the effectiveness of treatments doctors have been using to fight Covid-19. But the unapproved methods have given frontline providers "glimmers of hope," Cha writes.

The treatments providers are using

In the course of caring for Covid-19 patients, providers have experimented with many different types of treatments, including different types of medications and hospital care protocols, Cha reports.

Experimenting with medications

For example, providers are experimenting with drugs typically used to treat other conditions, Cha reports. Cha writes that one study of 1,536 Covid-19 patients showed that patients treated with a heartburn medication containing the active ingredient found in Pepcid were more likely to survive than those who weren't—though the researchers cautioned that the finding could have been coincidental.

Meanwhile, Kanthi and his colleagues have been examining how some combinations of anti-inflammatory drugs and blood thinners work together to treat Covid-19, Cha reports.

Separately, a study published last week in The Lancet found a combination of three antiviral drugs seemed to help patients recover from Covid-19 faster.

Further, research by Mandeep Mehra, medical director of the heart center at Brigham and Women's Hospital, and colleagues that was published this month in the New England Journal of Medicine found that ACE inhibitors—which are traditionally used to control blood pressure—appear to be safe for use in patients hospitalized with Covid-19. Initially, providers thought the drug might exacerbate the disease and pose a danger to Covid-19 patients.

Changing protocols

Providers also have started adjusting hospital protocols in ways they say have helped fight Covid-19, Cha reports.

For example, many primary care providers initially considered Covid-19 patients with "silent hypoxia," a condition in which a patient has low oxygen levels but no shortness of breath, as having mild cases of the Covid-19. However, providers soon learned that such patients could suddenly lose consciousness and die from a lack of oxygen. Now, doctors are advising that all Covid-19 patients be monitored with oximeters that clip onto their fingers to track the saturation of oxygen in their blood.

Some providers also have found that "proning," a procedure in which a patient with respiratory problems is flipped onto their side or stomach, has helped bring patients' oxygen levels back to normal. Some doctors even say they believe proning has helped some Covid-19 patients avoid being placed on a ventilator.

In addition, a number of hospitals have changed the timing of when they place a Covid-19 patient on a ventilator, as well as the concentration and flow of oxygen being used to treat such patients—which many providers say has made a noticeable difference, Cha reports.

Challenges remain

Despite discovering some promising treatments for patients with Covid-19, challenges remain for providers trying to combat the disease.

According to Pascual, one challenge providers still face when treating Covid-19 patients is the amount of different treatments critically ill patients may need in a short period of time, as the virus attacks multiple parts of the body. For example, Pascual said such patients could need blood pressure medications for their hearts, dialysis for their kidneys, and ventilators for their breathing.

But Pascual said the longer providers can keep such patients alive, the better chance the patients have at surviving.

"The reassuring thing is this virus, like others, eventually burns out," he said. "In the end, it's a waiting game" (Cha, Washington Post, 5/13).

Covid-19 guidance from clinicians at the forefront

The unprecedented nature of the Covid-19 crisis has made it difficult for clinical leaders to stay up-to-date on rapidly changing best practices. Advisory Board researchers have compiled a list of key resources on everything from clinical indicators to discharge protocols from teams at the forefront of the epidemic.

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