1st FDA approved COVID treatment changes little
Doctors: pandemic only ends with an effective vaccine
Last updated 11/8/2020 at 9:50am
With COVID-19 infection rates climbing back to the levels seen in March, medical minds continue to communicate the pandemic mantra: mask up, wash up, stay distant.
Maintaining a reasonable hospital capacity and protecting vulnerable populations are still the two reasons to stay vigilant.
"The most important thing is prevention," said David Russian, pulmonologist and CEO at Western Washington Medical Group, a 20-site agency with more than 100 providers in three counties. One site is located just outside of Mill Creek city limits, off 128th Street SE, and an endocrinology focused clinic is in Bothell.
Russian adds that outdoor interactions are safer, and said some scientific literature shows "medical professionals are becoming infected at lower than expected rates." The protection of PPE as well as other advised precautions around the pandemic are followed by medical professionals, as part of the profession.
"That means masks work," he said.
The FDA recently cleared remdesivir, an antiviral drug, for treatment of seriously ill COVID-19 patients. But the shift in status did not change much at WWMG, which was already accustomed to using remdesivir under compassionate-use protocols. The IV drug is effective, but expensive, as it must be administered onsite in a hospital setting. And while it has shown promise in that it reduces the duration of illness by about three days, "it is not a cure," Russian said.
The use of antiviral medication early in a viral infection is ideal, to prevent replication of the virus. That is how viruses behave – they make copies of themselves, and as they do the patient gets sicker. But most people don't know they have COVID-19 when they are early in the infection, he said. Symptoms mimic other illnesses such as the flu. By the time COVID-19 infected patients arrive at the clinic in need of medical intervention, they are likely days into it.
Most of those infected still recover at home, with supportive care such as fluids and rest.
Tomasz Ziedalski, a doctor at WWMG who treats COVID patients at Providence Medical Center in Everett, echoed Russian's comments.
"All we can do is slow down the progression," Ziedalski said. "Remdesivir is not the answer" to ending the pandemic. "It's a good step in the right direction."
But minds should not be eased by it, both say.
Ziedalski said for patients hospitalized for COVID-19, remdesivir has been part of the standard of care since the beginning of the pandemic – that, along with a corticosteroid such as dexamethasone, and supportive care from nutrition, fluids and rest. Antibody cocktails, such as the one given to the president when he fell ill, are also showing promise, but no existing treatment is going to end the pandemic.
"We don't have a great drug yet at all. It just doesn't exist," Russian said.
When it comes to COVID-19 and its newness, all treatments are still somewhat experimental at this point, he said.
Clinical trials continue worldwide for both therapeutic and prophylactic strategies for fighting COVID-19 – therapeutic treatments are effective once a person is already sick, and prophylactic care prevents illness. In testing now are multiple vaccines pointed at ending the COVID-19 pandemic by teaching the body to be immune to the virus.
At WWMG, testing resources are focused on an RNA vaccine.
Early in the pandemic, COVID-19 was predicted to be most dangerous to certain groups – the elderly and those with underlying illnesses.
"We didn't get any surprises," Ziedalski said. The same high-risk conditions at the start of the pandemic persist: the elderly, and those with compromised immunity, diabetes, heart disease and lung disease. The same lower-risk individuals are still likely to recover – the young, the healthy.
And while the death rate is at 3% to 5%, Ziedalski said, one goal for precautionary measures is also the same as when the pandemic began – the goal to avoid overpacking hospitals. Filling hospitals with too many COVID-19 patients would spread staffing too thin and use up resources too fast. For example, that could result in reduced access for cardiac and trauma patients.
On the list of wintertime health advice remains the flu shot, and health officials are pushing a little harder for more people to get the shot this year. The reason: symptoms of the flu and symptoms of COVID-19 can be the same.
Ziedalski said the reason a flu shot is more important this year is for patients' peace of mind. Someone with the flu may end up anxious about having COVID-19. A second reason to get a flu shot this year is that if someone arrives in a clinic or hospital with flu symptoms, medical professionals will use an advanced level of PPE caring for that person until COVID-19 testing comes back negative.
He said if someone has the flu, and that is known, a care provider only needs the standard PPE, which is less protective. The advice to get a flu shot, much like prevention advice, circles back to resources.
Russian said the real answer to ending the pandemic is a vaccine. But finding an effective and safe vaccine takes time and testing, in a lot of people. A wider group results in more data – needed in scientific communities, before anything is considered definitive.
"If anyone tells you they know exactly how they're going to work in actual practice, they're being awfully sure of themselves, because until it really gets out, we won't know -- hopefully they'll work great. And hopefully enough people will take them that it will make a difference."
He said the answer to "how will they work" is best measured after the vaccine is given to "a couple hundred thousand or a million or so people in the country."
One problem is that even when a vaccine is found, and even though masks prevent spread, one problem is the distrust that has formed that may lower acceptance of a vaccine, and has lowered acceptance of wearing masks.
"I'm surprised how much it's been politicized," Russian said.