Name: Bay Area doctors explain the COVID-19 treatments they’re using now
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Bay Area doctors explain the COVID-19 treatments they’re using now

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There is no cure or vaccine yet for COVID-19, but Bay Area doctors now have months of experience treating the illness, using what they’ve learned from similar respiratory diseases while absorbing new research and trying out different drugs to help people heal.These front-line health professionals say the shelter-in-place orders put in place back in March bought them valuable time to learn how to treat the disease before seeing more cases.“We’re writing history as we’re living it, but we do anchor in what we do know,” said Dr. Erica Farrand, a pulmonologist specializing in lung diseases at UCSF.The ongoing developments and treatments and methods will be crucial in coming weeks as COVID-19 hospitalizations spiked in the Bay Area. So far, there have been more people admitted to general care than intensive care units, which could buy doctors time to prepare. And deaths rates also rose, but not as drastically. But those trends could change quickly, and local doctors planned for a surge during the past three months.“The sacrifices that people have made gave us time to understand the disease better to manage it without people getting sick and the development of some beginnings to keep it from getting severe,” said Dr. Kathleen Clanon, Medical Director for Alameda County’s Health Care Services Agency.The Chronicle interviewed doctors at Bay Area hospitals about the five main ways they’re treating coronavirus patients right now:Anti-inflammatory steroids: Patients get seriously sick from COVID-19 when their body’s immune system overreacts while fighting the infection and produces too many proteins called cytokines, creating what’s known as a “cytokine storm.” These inflammatory proteins attack blood vessels around the lungs, filling them with fluid and causing acute respiratory distress syndrome and sometimes death.Doctors are using anti-inflammatory steroids to calm that reaction when a patient is severely sick, requiring oxygen, and declining. One such drug that gained recent global attention is . An early assesment of dexamethasone use in the U.K. showed that it reduced deaths in patients on ventilators by one-third, and patients on oxygen by one-fifth, according to a press release from the University of Oxford. The official peer-reviewed study hasn’t been released yet.Some Bay Area doctors are trying it out with small patient sub-sets, but couldn’t yet trace whether the use of the drug was directly responsible for better outcomes. Dr. Greg Warner, infectious disease physician and medical director for infection prevention for NorthBay Healthcare in Solano County, said four out of five patients he treated with the drug are stable and showing signs of minimal improvement.Some Bay Area doctors are also using other anti-inflammatory drugs that calm the body’s immune system, including the steroid prednisone. Steroids can have negative side effects, such as increasing blood sugars.Coronavirus TreatmentRemdesivir: Remdesivir is an antiviral drug, produced by the Bay Area biotech company Gilead Sciences, that has shown in some early clinical trials to for COVID-19 patients. A federal study in late April shortened recovery time by about four days for hospitalized COVID-19 patients and reduced mortality rate to 8% for the group that took the drug compared to 12% for the placebo group.What the drug does is inhibit a component of the viral replication, which is useful in the earlier stages of the disease, when patients need some extra oxygen but not a lot. The drug is given through an IV over the course of five days.Warner said he’s had “quite a good string of outcomes” using remdesivir on several patients. Every patient, except for one, avoided intubation and was eventually taken off oxygen and discharged home.“We’re always cautiously optimistic,” he said. He added the drug isn’t recommended for patients with impaired kidney functions.Supply of the drug is limited and currently being rationed by the federal government. On Wednesday, the U.S. government bought much of the world’s supply of the drug to treat Americans, a move that global health experts criticized.Bay Area doctors interviewed said they have enough of the drug to give to patients currently in need, but they wonder how long that will last if cases keep climbing. Some doubted widespread use before more study.“No clinician is hanging their hat on those drugs. We are strongly encouraging people to engage in clinical trials,” Farrand said.Plasma: An age-old treatment dating back to the last global pandemic — the Spanish influenza of 1918 — is giving sick patients the plasma of those who have already recovered to pass on antibodies. Doctors in the Bay Area are using this therapy for COVID-19 but said there’s not much study yet about about how effective it is, since they can’t trace the patient’s successful outcome exclusively to the use of plasma. It’s also not yet known whether someone is immune to the virus if they’ve had it already and could confer immunity to other patients.The good news is that there are no known negative side effects to plasma therapy.Proning: A common treatment for respiratory diseases proving effective to tackle COVID-19 is this therapy. It involves turning a patient to a different position, usually their stomach, in order to get more air and blood flow to their lungs.If patients are alert, they can turn, or prone, themselves every couple hours. If they’re ventilated, it could take a team of up to half a dozen health care workers 20 minutes to carefully prone a patient, who might then stay on their stomach for up to 24 hours.Proning doesn’t treat the virus, but supports the body’s functions while the immune system fights the infection, and has been proven to decrease deaths in other respiratory diseases.Updated to include drought zones while tracking water shortage status of your area, plus reservoir levels and a list of restrictions for the Bay Area’s largest water districts.Oxygen: When a patient suspected of having COVID-19 comes into the emergency room, doctors assess how well they can breathe by watching their neck muscles to see how much effort they’re extending and whether they can complete sentences to carry on a conversation. They also conduct a scan or chest x-ray and measure their arterial blood gas — how much carbon dioxide and oxygen is in their blood — by drawing blood from an artery at their wrist.Doctors want a patient’s oxygen level to be at least 93%. If it’s less, the person may need to be admitted to intensive care and given a high flow of air through a tube against their nose. Doctors start off with half oxygen and half ambient air and increase the concentration of oxygen up to 100% if necessary.Doctors monitor a patient’s oxygen levels compared to their effort to breathe to see whether they need to intubate the patient. Intubation involves putting a tube through the patient’s nose or mouth into their windpipe and connecting the tube to a mechanical ventilator that breathes for them. While patients are intubated, they’re given heady sedatives and painkillers.Doctors don’t want to intubate too late when patients are already too sick, but also not too early because it can scar the lungs. Bay Area doctors said they’ve started intubating people later than they were at the start of the pandemic, which caused poor outcomes and more long-term damage.Patients may be on ventilators for weeks and still recover. But if a patient has been on a ventilator for upwards of a month without a good trajectory, doctors may build on established relationships of trust with loved ones to discuss the patient’s chances of survival and recovery.“If they do survive, they may be left with long-term consequences of the illness,” said Dr. Antonio Gomez, director of critical care at San Francisco General Hospital and co-director of the medical intensive care unit. “We try to factor in will they not just live or die, but take into consideration if they do survive and leave the hospital, what would their life be like?”Ultimately, the decision is up to the patient and loved ones whether to continue treatment. At San Francisco General, around one in five people in intensive care for COVID-19 died.“COVID is really hard on people,” said Dr. Heng Duong, an ICU physician at Santa Clara Valley Medical Center. “It’s tough as a human being and a physician.”Although doctors are building on what they already know to treat COVID-19, many unknowns remain. They’re weighing the risks of rapidly evolving treatment and therapies on a daily basis.“It’s an unprecedented time to be using options without knowing fully their efficacy,” Warner said. “It’s a very uneasy time for infectious disease doctors.”Mallory Moench is a San Francisco Chronicle staff writer. Email: Twitter:Updated to include drought zones while tracking water shortage status of your area, plus reservoir levels and a list of restrictions for the Bay Area’s largest water districts.

There is no cure or vaccine yet for COVID-19, but Bay Area doctors now have months of experience treating the illness, using what they’ve learned from similar respiratory diseases while absorbing new research and trying out different drugs to help people heal.These front-line health professionals say the shelter-in-place orders put in place back in March bought them valuable time to learn how to treat the disease before seeing more cases.“We’re writing history as we’re living it, but we do anchor in what we do know,” said Dr. Erica Farrand, a pulmonologist specializing in lung diseases at...

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Mallory Moench

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Bay Area doctors explain the COVID-19 treatments they’re using now

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