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Hospital coronavirus treatment has changed. Here’s what it looks like now in Philadelphia

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Philadelphia Inquirer  10/03/2020

Hospital coronavirus treatment has changed. Here’s what it looks like now in Philadelphia.
 

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In the early days of the coronavirus pandemic, doctors in Philadelphia-area hospitals, like colleagues everywhere, were learning on the fly, desperately searching for anything that might help critically ill patients. They were quick to put patients on ventilators and try drugs that had shown even a hint of effectiveness in small studies in China. They called friends in Europe, West Coast hospitals, or New York, where the virus hit a little earlier, in search of anecdotal evidence that anything could stem the tide of death....

...Currently, the number of patients hospitalized for COVID-19 is low. At the local peak of cases in mid-April, Penn hospitals had more than 300 patients a day, Hamilton said. In September, they averaged fewer than 30. Hospitalized cases have fallen from 225 a day to 25 at Temple and from 220 to 10 at Cooper. COVID-19 patients at Jefferson’s 14 hospitals peaked at around 800 and are now 50 to 60. However, hospitals worry that cases may rise once cold weather drives people back inside where the virus spreads more easily....

...Doctors now agree on a core set of treatments

Doctors representing a range of Philadelphia-area health systems — Cooper, Jefferson, Main Line Health, Penn, Prime Healthcare, Temple, Tower Health, and Virtua — described very similar approaches to core protocols for COVID-19 patients. While these groups usually compete, the pandemic has led to an exceptional degree of cooperation and data-sharing, the doctors said....

...Because there is no cure, good treatment still rests on supportive care. Doctors say they are slower now to use breathing machines for coronavirus patients with low blood oxygen levels, because the lungs of coronavirus patients did not respond as expected to ventilation.

Doctors now try giving extra oxygen in a variety of less invasive ways before switching to a ventilator. Proning, which allows for more efficient use of diseased lungs, is also common. Some hospitals use it for almost every patient who is short of breath....

Patients also now routinely get remdesivir, a drug that is still being tested but was given emergency authorization by the U.S. Food and Drug Administration. So far, it has been shown to reduce days in the hospital but not deaths....

...Patients also often receive blood plasma from COVID-19 survivors, which contains antibodies. Some doctors are more enthusiastic than others about this approach, which is still being studied. Some say results are uneven, possibly because not all plasma contains the same amount of antibodies. “We gave a ton of convalescent plasma,” Puri said. “I don’t know if it helped.” Two Virtua patients who got plasma from the same donor had great results, Sztejman said. Others did not do as well. John Zurlo, an infectious-diseases doctor at Jefferson Health, said there’s “very little” demand for plasma. ...