Congrats to Dr. Bankhead-Kendall
When a man in his 40s with Covid-19 and low oxygen saturation arrived at the Boston hospital where Brittany Bankhead-Kendall treated patients in April, he was quickly put on a ventilator, a standard first response at many American hospitals at the time.
She relied on WhatsApp messages and video calls from doctors overseas, who were also using trial and error to treat a spreading virus few knew much about. Incoming patients at her hospital were randomly assigned to antiviral and other drug trials to see what might stem the disease. “We were really flying blind,” she said.
In West Texas, where Dr. Bankhead-Kendall took a new job at Texas Tech University Health Sciences Center, the conditions of her Covid-19 patients seven months later are similar to what she had seen back in Boston, yet she treats them differently. When a woman in her mid-40s showed low blood-oxygen levels, Dr. Bankhead-Kendall gave her high-flow oxygen therapy rather than putting her on a ventilator, avoiding the invasive risks of ventilation.
The two patients spent a similar amount of time in intensive-care units, but the woman in Texas was able to avoid sedation and pain medication, with less pressure on her lungs from the treatment. “We’ve got better data now,” Dr. Bankhead-Kendall said. Memories of work earlier in the year, when she feared for her health during 12- to-14-hour shifts and rewrote her will, are fresh.
Doctors who have been treating coronavirus patients from the pandemic’s earliest days in the U.S. said they are now better equipped to face a new rise in hospitalizations, with evidence on drugs that work to combat Covid-19 symptoms, research on treatments, and their own patient experiences through the months. The virus’s resurgence across the country is testing whether what they have learned so far will lead to shorter hospital stays and fewer deaths.
Several doctors said they now think of Covid-19 as a two-phase disease. First they aim to combat the virus itself with antiviral drugs, and then address the cascade of problems caused by the usually outsize immune response. The doctors also said they were learning how to tailor treatments for each patient.
“We’ve stopped throwing the kitchen sink at everybody,” said Roger Shapiro, an associate professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health who has treated coronavirus patients throughout the pandemic.
He helped craft Covid-19 response guidelines at Beth Israel Deaconess Medical Center in Boston in the early days of the pandemic, when evidence-based treatment strategies didn’t yet exist.
Early treatment protocols at many hospitals included giving patients the antimalaria drug hydroxychloroquine, which was later found not to be beneficial, Dr. Shapiro said. Other steps included using anticoagulants to help patients avoid blood clots.
Doctors are now informed by peer-reviewed papers from around the world, clinical trials and the Food and Drug Administration’s emergency clearance of some treatments. Promising treatments for hospitalized patients include the antiviral remdesivir and convalescent plasma. Steroids such as dexamethasone have been shown in testing to be effective at tamping down the immune-system overdrive.
On Nov. 9, the FDA authorized the use of an antibody drug developed by Eli Lilly & Co. to treat people with Covid-19 in its earlier stages, filling a gap in treatment for patients who aren’t hospitalized.
Some Covid-19 Survivors Grapple With Large Medical Bills
While the federal government and the health-care industry have worked to help Americans avoid costs associated with Covid-19 testing, some patients can be subject to high out-of-pocket costs for treatment, long after leaving the hospital. Photos: Krystle Bodine and Drew Harris
The number of people hospitalized with Covid-19 in the U.S. and its territories reached a record high of 73,014 on Monday. With the virus spreading in swaths of the U.S., including less-populated areas with fewer and more remote hospitals, some doctors fear emergency rooms and intensive-care facilities will soon become overwhelmed again.
This summer, as the number of Covid-19 cases rose in Sunbelt states, Jeffrey Bander at Mount Sinai Health System in New York fielded calls from colleagues in Arizona. The cardiologist helped treat patients during New York’s first coronavirus surge in March and April, and he has since published research on plasma therapy for Covid-19 and the virus’s impact on the heart. “If they come in a trickle it’s easier,” he said of the ability to treat patients. “If they come in waves it’s harder.”
To get a better sense of whether and how emerging treatments are working, public-health officials, hospitals and doctors are monitoring how much patient hospital stays are shortening as treatment options expand.
A crucial difference in hospital treatment has stemmed from a better understanding of how to approach respiratory problems caused by the virus. Instead of rushing to put patients with low oxygen saturation on ventilators, which brings its own risks, doctors now know that people with low oxygen levels can remain that way longer than previously thought, Dr. Bankhead-Kendall said. For the most critically ill who do require ventilation, hospitals are expanding the use of technology to monitor those patients.
Doctors said that much remains unknown and that treatments continue to evolve. Researchers are still learning about the systemwide effects of Covid-19, including blood clotting, fatigue, cognitive issues and kidney damage. The disease is still proving to take a harsh toll on some previously healthy people who become infected, and comorbidities common in many Americans including diabetes and asthma are complicating outcomes.
Ben Daxon, a critical-care physician at Mayo Clinic in Rochester, Minn., arrived in New York to volunteer in April with almost no experience caring for Covid-19 patients.
Are hospitals near you better prepared now for a surge in Covid-19 patients than they were for the first surge? Why or why not? Join the conversation below.
During his first shift in New York, when protective gear was scarce, he donned a scuba mask with a viral filter held in place by a part made on a 3-D printer.
Doctors in New York at the time debated when to try untested therapies, he said. Patients might benefit, but they might also be harmed. “I was in the middle,” Dr. Daxon said. He was surprised to find one patient on an uncommon mode of breathing support known as airway pressure release ventilation. Existing evidence suggests some benefit from it, but there isn’t a lot of evidence, said Dr. Daxon, who found that the doctors in New York were managing the patient’s breathing well.
One evening, as the patient struggled to breathe, Dr. Daxon gave him paper to write on. He scrawled the word “scared.” The physician sat with him, telling him stories. “The air is good now,” wrote the patient.
Dr. Daxon returned after a week to Minnesota, one of the Midwestern states now seeing hospitalizations rising. He said he would like to see the ventilation mode studied further, but he is now focused on well-researched therapies. Studies have shown, for example, the importance of carefully managing ventilator settings. “If we do those things well, then we’re going to do well by our patients,” he said.
/SPOILER]
She relied on WhatsApp messages and video calls from doctors overseas, who were also using trial and error to treat a spreading virus few knew much about. Incoming patients at her hospital were randomly assigned to antiviral and other drug trials to see what might stem the disease. “We were really flying blind,” she said.
In West Texas, where Dr. Bankhead-Kendall took a new job at Texas Tech University Health Sciences Center, the conditions of her Covid-19 patients seven months later are similar to what she had seen back in Boston, yet she treats them differently. When a woman in her mid-40s showed low blood-oxygen levels, Dr. Bankhead-Kendall gave her high-flow oxygen therapy rather than putting her on a ventilator, avoiding the invasive risks of ventilation.
The two patients spent a similar amount of time in intensive-care units, but the woman in Texas was able to avoid sedation and pain medication, with less pressure on her lungs from the treatment. “We’ve got better data now,” Dr. Bankhead-Kendall said. Memories of work earlier in the year, when she feared for her health during 12- to-14-hour shifts and rewrote her will, are fresh.
Doctors who have been treating coronavirus patients from the pandemic’s earliest days in the U.S. said they are now better equipped to face a new rise in hospitalizations, with evidence on drugs that work to combat Covid-19 symptoms, research on treatments, and their own patient experiences through the months. The virus’s resurgence across the country is testing whether what they have learned so far will lead to shorter hospital stays and fewer deaths.
Several doctors said they now think of Covid-19 as a two-phase disease. First they aim to combat the virus itself with antiviral drugs, and then address the cascade of problems caused by the usually outsize immune response. The doctors also said they were learning how to tailor treatments for each patient.
“We’ve stopped throwing the kitchen sink at everybody,” said Roger Shapiro, an associate professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health who has treated coronavirus patients throughout the pandemic.
He helped craft Covid-19 response guidelines at Beth Israel Deaconess Medical Center in Boston in the early days of the pandemic, when evidence-based treatment strategies didn’t yet exist.
Early treatment protocols at many hospitals included giving patients the antimalaria drug hydroxychloroquine, which was later found not to be beneficial, Dr. Shapiro said. Other steps included using anticoagulants to help patients avoid blood clots.
Doctors are now informed by peer-reviewed papers from around the world, clinical trials and the Food and Drug Administration’s emergency clearance of some treatments. Promising treatments for hospitalized patients include the antiviral remdesivir and convalescent plasma. Steroids such as dexamethasone have been shown in testing to be effective at tamping down the immune-system overdrive.
On Nov. 9, the FDA authorized the use of an antibody drug developed by Eli Lilly & Co. to treat people with Covid-19 in its earlier stages, filling a gap in treatment for patients who aren’t hospitalized.
Some Covid-19 Survivors Grapple With Large Medical Bills
While the federal government and the health-care industry have worked to help Americans avoid costs associated with Covid-19 testing, some patients can be subject to high out-of-pocket costs for treatment, long after leaving the hospital. Photos: Krystle Bodine and Drew Harris
The number of people hospitalized with Covid-19 in the U.S. and its territories reached a record high of 73,014 on Monday. With the virus spreading in swaths of the U.S., including less-populated areas with fewer and more remote hospitals, some doctors fear emergency rooms and intensive-care facilities will soon become overwhelmed again.
This summer, as the number of Covid-19 cases rose in Sunbelt states, Jeffrey Bander at Mount Sinai Health System in New York fielded calls from colleagues in Arizona. The cardiologist helped treat patients during New York’s first coronavirus surge in March and April, and he has since published research on plasma therapy for Covid-19 and the virus’s impact on the heart. “If they come in a trickle it’s easier,” he said of the ability to treat patients. “If they come in waves it’s harder.”
To get a better sense of whether and how emerging treatments are working, public-health officials, hospitals and doctors are monitoring how much patient hospital stays are shortening as treatment options expand.
A crucial difference in hospital treatment has stemmed from a better understanding of how to approach respiratory problems caused by the virus. Instead of rushing to put patients with low oxygen saturation on ventilators, which brings its own risks, doctors now know that people with low oxygen levels can remain that way longer than previously thought, Dr. Bankhead-Kendall said. For the most critically ill who do require ventilation, hospitals are expanding the use of technology to monitor those patients.
Doctors said that much remains unknown and that treatments continue to evolve. Researchers are still learning about the systemwide effects of Covid-19, including blood clotting, fatigue, cognitive issues and kidney damage. The disease is still proving to take a harsh toll on some previously healthy people who become infected, and comorbidities common in many Americans including diabetes and asthma are complicating outcomes.
Ben Daxon, a critical-care physician at Mayo Clinic in Rochester, Minn., arrived in New York to volunteer in April with almost no experience caring for Covid-19 patients.
Are hospitals near you better prepared now for a surge in Covid-19 patients than they were for the first surge? Why or why not? Join the conversation below.
During his first shift in New York, when protective gear was scarce, he donned a scuba mask with a viral filter held in place by a part made on a 3-D printer.
Doctors in New York at the time debated when to try untested therapies, he said. Patients might benefit, but they might also be harmed. “I was in the middle,” Dr. Daxon said. He was surprised to find one patient on an uncommon mode of breathing support known as airway pressure release ventilation. Existing evidence suggests some benefit from it, but there isn’t a lot of evidence, said Dr. Daxon, who found that the doctors in New York were managing the patient’s breathing well.
One evening, as the patient struggled to breathe, Dr. Daxon gave him paper to write on. He scrawled the word “scared.” The physician sat with him, telling him stories. “The air is good now,” wrote the patient.
Dr. Daxon returned after a week to Minnesota, one of the Midwestern states now seeing hospitalizations rising. He said he would like to see the ventilation mode studied further, but he is now focused on well-researched therapies. Studies have shown, for example, the importance of carefully managing ventilator settings. “If we do those things well, then we’re going to do well by our patients,” he said.
/SPOILER]
