Since March 2020, healthcare providers have been on the forefront of the COVID-19 pandemic, adapting to new information and treatment options in order to achieve optimal patient outcomes.
Vermont health professionals are no exception, and our local physicians, physician assistants, nurses and EMS staff have been working together to treat COVID-19 patients while continuing to study best practices and optimize patient care.
One of these health professionals is Leah Skypeck, a physician assistant in the intensive care unit at the Rutland Regional Medical Center. She joined us (virtually) for an interview regarding her experience in treating COVID-19 patients. In this interview, we explored the different manifestations of COVID-19 in severe cases, as well as the practices used in the ICU to care for these patients.
When a COVID-19 patient arrives at a hospital, there are a few options for treatment, which all depend on severity, symptoms, and wishes of the patient. Two drug treatments have become common in severe COVID-19 cases here in Vermont and across the country. The first of these drugs is remdesivir, an antiviral medication that slows the spread of the virus in the body by inhibiting viral replication.
Specifically, remdesivir prevents the host cells from making copies of the viral RNA, the genetic material of the virus.
The second drug treatment is dexamethasone, a steroid treatment that suppresses the immune system and thus is useful for patients with an overactive immune response to COVID-19.
These treatments can be used independently or in tandem. PA Skypeck noted that she and her team “are using both of those drugs, dexamethasone and remdesivir, right now for anyone with severe COVID-19.”
She said the Rutland hospital has been using these drugs “since the fall if not earlier … because the early studies, though small, showed pretty good data.” This data comes from clinical studies that showed improvements in recovery time of severely ill patients when using remdesivir and dexamethasone. While it is hard to know whether either of these drugs are the specific reason for a patient’s recovery, Skypeck saw that her patients given these two drugs were able to recover from COVID-19.
SARS-CoV-2, the virus that causes COVID-19, affects the respiratory system, among other parts of the body, and in some cases causes shortness of breath. A staple of COVID-19 treatment that we have all been hearing about since March is the use of ventilators. In the experience of PA Skypeck, a patient is likely to be put on a ventilator if they have difficulty breathing and lack sufficient oxygen flow to their tissues. A ventilator will pump oxygen into your body for you through a tube that goes through your mouth and down your windpipe. The ventilator basically breathes for the patient.
Although COVID-19 uniformly affects the lungs, COVID-19 patients may also experience complications in organs outside of the respiratory system. Critically ill patients are at risk for kidney failure due to dehydration, metabolic dysfunction, and low blood pressure, Skypeck explained.
This is not distinct to COVID-19, however, as patients with many different illnesses can be at risk for renal failure due to the sensitivity of the kidneys. Although the mechanisms of how COVID-19 affects the kidneys are not fully understood, at least 20% of hospitalized patients develop COVID-19-associated kidney injuries. Patients with preexisting kidney disease are also at increased health risk when they contract COVID-19. In severe cases of kidney failure, dialysis can be used to treat the kidney damage.
Research is ongoing to better understand COVID-19 and develop further treatment options. A rising potential treatment is convalescent plasma transfusions. The transfusion plasma contains antibodies from the blood of patients who have recovered from COVID-19. The donor antibodies can fight off the illness by binding to the virus, thereby targeting the virus for destruction and preventing the virus from infecting new cells. However, PA Skypeck explained that the Rutland hospital has not used this newer treatment method due to limited data on its effectiveness. The plasma transfusion treatment is also not as useful in Vermont; due to the low levels of positive COVID-19 cases, there are not many people with the antibodies who could donate their blood.
Overall, the type of treatment used for COVID-19 depends on each patient’s reaction to the virus and how severe the symptoms are for individuals. Health care providers will treat patients with upper respiratory symptoms like any other respiratory illness. In more severe cases, treatments such as remdesivir and dexamethasone, ventilators, and dialysis are used depending on the patient.
One major takeaway Skypeck has had from her experience treating COVID-19 patients is that the best outcomes result from healthcare providers like herself relying on their training and experience in treating pulmonary illness, and caring for these patients as they would for any other respiratory disease. Although the specifics of treatment varies, the approach to treating COVID-19 is the same, Skypeck explained:
“Doing the things we know how to do well — just standard of care, medical management, and support — is honestly the most effective thing to do.”
References
(1) COVID-19 and Your Health. Centers for Disease Control and Prevention, 8 December 2020. https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html.
(2) Coronavirus: Kidney Damage Caused by COVID-19. Johns Hopkins Medicine, 14 May 2020.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-kidney-damage-caused-by-covid19
(3) Treatments for COVID-19. Harvard Health Publishing. 23 November 2020. https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19
(4) What does a ventilator do? WebMD, 26 March 2020. https://www.webmd.com/lung/coronavirus-ventilators
(5) Skypeck, Leah. Interview. 16 December 2020.