“As the list of proven options is quickly changing, I am proud to say that LifeCare Medical Center is on the cutting edge of providing treatment that many Critical Access Hospitals are not able to utilize,” said David Simmons, Pharm.D, BCPS, BCIDP.
I am David Simmons, a Clinical Pharmacy and Infectious Disease Specialist at LifeCare Medical Center. Over the past 8 months, we health care providers have been working diligently to come up with the best treatment approaches to this new and devastating disease. As we all know, the current COVID-19 pandemic has left humanity with more questions than answers. There have been several proposed treatment options, as people try to grasp onto hope of a cure. Some of these treatments have offered benefit, and many have not. Let us start with more mild cases of COVID-19.
Currently, there are no medications that have shown consistent benefits in the treatment of COVID-19 in people that are not hospitalized. Several therapies have been proposed and tested, such as hydroxychloroquine, azithromycin, zinc, inhaled steroids, vitamins C and D, and several others. None of these therapies have shown benefit in the treatment of COVID-19.
As the list of proven options is quickly changing, I am proud to say that LifeCare Medical Center is on the cutting edge of providing treatment that many Critical Access Hospitals are not able to utilize.
So what does work, and when do we use them?
Remdesivir: Remdesivir was approved by the FDA for emergency use earlier this summer and received full FDA approval this fall. Remdesivir is a direct acting antiviral medication that has been shown to decrease hospitalization and time to recovery in patients with moderate to severe COVID-19. Because this treatment hasn’t shown much benefit in milder cases, it is only offered to patients hospitalized with COVID-19 disease. Remdesivir also cannot be given to patients with severe liver or kidney disease. Our care team at LifeCare Medical Center utilizes remdesivir therapy on the majority of our hospitalized COVID-19 patients.
Dexamethasone: Dexamethasone (or other equivalent corticosteroids) has been shown to improve survival in severe to critical COVID-19 patients, requiring supplemental oxygen support. Steroids do NOT directly treat the SARS-COV2 virus, but prevent more severe complications of COVID such as respiratory failure. Dexamethasone therapy may actually be harmful in mild to moderate cases of COVID-19, as a result we only used in hospitalized patient requiring supplemental oxygen or ventilation.
Bamlanivimab: Bamlanivimab (or BAM) is a monoclonal antibody therapy against COVID-19. This medication is approved by the FDA for emergency use for the prevention of hospitalization for high risk COVID-19 patients. BAM essentially gives a patient’s immune system a leg up in fighting off the SARS-COV2 virus, and has a very narrow window where it may be effective. BAM is only effective early in disease (within 10 days of symptom onset), and has not been shown to be effective later in disease, when patients are already needing oxygen. Patients who test positive for COVID-19 and are high risk for severe disease would be eligible for this therapy. Currently, we are on an allocation from the federal government to only receive so many doses per week. Our patients are therefore screened and randomized to be offered therapy with a one hour infusion. As this therapy becomes more readily available, we at LifeCare will be able to offer more treatment to more patients.
Convalescent plasma: Convalescent plasma has also received approval by the FDA under emergency usage for hospitalized patients with severe COVID-19. The concept of this therapy is to take blood or plasma from a recovered individual and transfuse it into a sick patient. This plasma of recovered patients is rich in antibodies and other immune boosters that are directed toward their recent COVID-19 infection. Because convalescent plasma is a blood derived product, supply is often limited and will need to be specially ordered based on a patient’s blood type. At LifeCare Medical Center, our team will reserve treatment with convalescent plasma for hospitalized patients that are not improving on remdesivir and steroids.
Oxygen: Oxygen is often times not thought of as a medication, but essentially it is. When patients are suffering from moderate to severe COVID-19 disease their lungs become damaged and as a result a patient can feel short of breath or have low oxygen levels. Oxygen therapy is a main course of treatment to help support a patient’s lungs and allow their body to fight off the infection.
Anticoagulation (blood thinners): Much is unknown of exactly how COVID-19 disease can severely effect some patients. However, one thing that has been shown, is that patients with more severe disease are often at a much higher risk of diseases caused by blood clots (heart attack, stroke, pulmonary embolism, etc.) For this reason, high risk patients are often given blood thinners in the hospital, and possibly even sent home on a short course of blood thinning medication. Medications that we use to prevent clots for patients include heparin, enoxaparin (Lovenox®), apixaban (Eliquis®) and rivaroxaban (Xarelto®). Oftentimes we may suggest low-dose aspirin for lower risk individuals.
I have been diagnosed with COVID-19, what medication can I take to help? For most patients that get a mild case of COVID-19, the best treatments are getting plenty of rest, drinking plenty of fluids and treating cold/flu symptoms with over the counter medications such as acetaminophen (Tylenol®), ibuprofen (Advil®), decongestants (Sudafed®) and cough suppressants (Robitussin®). If someone is unable to manage at home, or feel their symptoms or shortness of breath is worse, the best course of action would be to call the clinic or emergency room to see if it is appropriate to have their oxygen levels evaluated.
Overall, medical practices and scientific study have provided us with some answers on how to best offer treatment to severely ill COVID-19 patients. As a result, our nation’s mortality rate has reduced significantly, thanks to advances in care. Here at LifeCare Medical Center, our care team has been continuously researching and pushing for the latest and most effective therapies for the communities we serve. We have worked hard to make sure the diagnostics and therapies we offer at our small rural facilities are on par with the major medical centers of the area. By doing this, we can offer high level of care to our communities throughout Roseau County.
By David Simmons, Pharm.D, BCPS, BCIDP