Hospitals Vary Treatment For Coronavirus Patients
RACHEL MARTIN, HOST:
Without a cure for COVID-19, doctors are desperately trying to figure out the best treatment regimen for these patients. And what they're trying may look very different depending on the hospital. Joining us now to talk about this living experiment, we've got Michigan Radio's Kate Wells and WBUR's Martha Bebinger in Boston. Thanks to you both for being with us.
KATE WELLS, BYLINE: Thanks, Rachel.
MARTHA BEBINGER, BYLINE: Thank you, Rachel.
MARTIN: Kate, can you give us an idea of the range of medications and treatments that a patient with COVID-19 might be given?
WELLS: Yeah, it's a pretty big range right now. Patients could get anywhere from an assortment of about a dozen or so treatments. Usually, hospitals are trying various combinations of those. For example, at the Henry Ford Health System here in Michigan, doctors say that they are seeing early but dramatic results from convalescent plasma, which is plasma from somebody who's already recovered from COVID in the hopes that it might help a patient actually fight off the virus. And then over at Michigan Medicine, some doctors there are really enthusiastic about these anti-inflammatory drugs. They're often used for rheumatoid arthritis. And the hope there is that this might help calm down the immune system when it has that overreaction to COVID sometimes.
MARTIN: But when there are all these different treatments being tried at different hospitals, I mean, inevitably, patients are going to get confused, right?
WELLS: Oh, yeah. I mean, it's a lot for even doctors to keep track of right now. I spoke with the CEO of the Henry Ford Medical Group. His name is Dr. Steve Kalkanis, and this is how he put it.
STEVE KALKANIS: We just don't have all the answers, and I think that people need to understand that it's OK if we are constantly reassessing our policies based on the evidence that's coming in because all of this is happening in real time.
WELLS: I will say, Rachel, that one thing that I've been really struck by when I'm talking to doctors in different health care systems is that it is almost like they are treating different diseases. It's all COVID, right? But they all have these different patient populations. Like, one hospital I talked to gets a lot of patients from these nearby nursing homes, and COVID doesn't look the same in every patient. Like, those nursing home patients, they may not have a fever or chills. So each hospital right now is kind of basing their treatments on what they've seen work best in their patients.
MARTIN: Right. So let's bring in Martha Bebinger. Martha, you're in Boston. Are you seeing the same kind of wide variety in treatments right now?
BEBINGER: Absolutely. Doctors in Boston are trying all of those things that Kate just mentioned, plus others - an over-the-counter antacid called Pepcid and also nitric oxide. It's something patients can inhale, and doctors think it might improve oxygen levels.
MARTIN: So why is that? I mean, why are patients seeing so many different approaches to treating COVID-19?
BEBINGER: Well, Rachel, as you mentioned, doctors are desperate to find something that's going to work. This is a new virus, a new disease that's causing so many deaths. Boston hospitals are running dozens of trials. And now doctors are investigating a new condition in children that may include dangerous inflammation in their skin or their blood vessels. But there is one drug that patients and their families are asking for. That's remdesivir. It shows improved recovery maybe by four days or so in the ICU. Though, it's not been proven to save lives. I talked to Dr. Eric Rubin. He's the editor-in-chief at The New England Journal of Medicine.
ERIC RUBIN: So we're still far from something that's going to make a huge dent in the amount of disease out there, even if it hopefully makes it more likely that you won't get as sick.
BEBINGER: Now, Rachel, remdesivir is available in many hospitals in Boston, but that's not true everywhere in the country.
MARTIN: Kate, what about the other drug that we've heard the name bandied about now for so many weeks, hydroxychloroquine? This is the drug that President Trump at one point mistakenly called a miracle drug.
WELLS: Right. This one has been controversial. It's an anti-malarial drug. People take it to treat lupus. And initially at the start of the pandemic, some small studies looked really good for it. But now we're getting more evidence that actually point to dangerous heart problems. So at Michigan Medicine, for example, Dr. Vineet Chopra tells me that it was actually making their patients worse. They were already having trouble breathing. They'd take hydroxychloroquine. Suddenly, they would start vomiting, be nauseous. But he says when they stopped using it, you know, they got a lot of pushback.
VINEET INDER CHOPRA: And I remember it kind of getting a lot of folks very angry about what do you have to lose? This is - you know, it's sort of a no-brainer. Just give it to people. And it wasn't a no-brainer because the harms were real. We saw liver toxicities. We saw electrical toxicities to the heart.
WELLS: But, you know, Rachel, I will then talk to other hospitals that'll tell me exactly the opposite. You know, they'll say we're monitoring these patients really carefully, but we think it's helping keep them off ventilators. And then you've got large trials going on this drug still. Like, Henry Ford Health System is testing hydroxychloroquine on 3,000 health care workers and first responders to see if it might actually prevent COVID.
MARTIN: And, Martha, you've been reporting on other areas of medicine where there is also so much uncertainty for coronavirus patients, right? What have you found?
BEBINGER: So, Rachel, let's go to a labor and delivery floor. Take a new mom who's tested positive for the coronavirus and has just given birth. Well, how do you protect the baby from getting infected? At one Boston hospital, the protocol is to separate the mother and infant immediately. That mom can pump breast milk that will be used to feed her baby because, so far, there's no trace of the virus found in breast milk. But at a hospital just a few miles away, the baby is allowed to sleep in the mother's room at a distance of at least six feet. And that mom would be allowed to breastfeed as long as she wears a mask, a fresh gown and cleans her hands carefully.
MARTIN: Wow. So just such completely different prescriptions for the same condition. I mean, given all these different treatments and protocols, what's the takeaway for patients? I mean, do they have a choice about which hospital they want to use - I mean, if it's a matter of getting to be able to be with your newborn or not?
BEBINGER: Right. So in the case of a newborn, many mothers would have made that decision months ago and not know that protocols in hospitals are changing. For most COVID-19 patients in an emergency, an ambulance is going to take them to the nearest hospital, whoever has room for you. In any case, it probably doesn't make sense for those patients to shop for any particular treatment because the options are changing so rapidly. Now, doctors hope this situation will all calm down soon and patients will have equal access to whatever works. I spoke with Arthur Kim. He's an infectious disease specialist at Massachusetts General Hospital.
ARTHUR KIM: We really look forward to a fair and equitable process so that whether you are in Boston or whether you're on the other hard hit areas, such as the Navajo Nation, that you will have equitable access to these types of therapies.
BEBINGER: But it's not clear when that will be the case.
MARTIN: Martha Bebinger with WBUR in Boston and also Kate Wells of Michigan Public Radio, thanks to you both.
WELLS: Thanks, Rachel.
BEBINGER: Thank you, Rachel.
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