MONTGOMERY, Ala. (WSFA) - Most people who get diagnosed with COVID-19 will be able to recover at home. But what is it like for those that end up in the hospital?
Montgomery-area pulmonologist Dr. William Saliski said treatment for COVID-19 in the United States, and across the world, is anecdotal. He says they rely on constant information from credible sources like the American Thoracic Society and the American College of Chest Physicians for continuous treatment information.
“Anyone that we feel is credible we read,” said Saliski. “Then we try to make our own decisions based on what they say. However, there is a huge amount of information that comes across daily that changes. So, we really have to make our own decisions locally.”
Without a specific treatment or vaccine existent for COVID-19, doctors and nurses are doing everything they can to help patients heal.
Saliski said this is how he is treating his COVID-19 patients. Some of his partners might do things differently.
Oxygen therapy and Prone Positioning
“Patients that are not critically ill, that are in a regular room, who have low-grade COVID pneumonitis, they are coughing and somewhat short of breath. Of course, oxygen therapy is paramount,” Saliski said.
There are various forms of oxygenation being used.
“If someone does go into Adult Respiratory Distress Syndrome, then we have parameters that we follow for Adult Respiratory Distress Syndrome on how we ventilate patients,” Saliski said.
He said they try to refrain from using a BiPAP machine because that machine aerosolizes the virus in rooms and it puts healthcare workers at risk.
Along with oxygen therapy, a process called “prone positioning” is also used. Prone positioning involves frequently turning a patient over on their stomach to increase airflow to different areas of a patient’s lungs, hopefully preventing the need for ventilation.
“It is one of the bedrock treatments for this disease,” Saliski said. “What happens is by proning somebody, you flip them over on their stomach, this disease process then, it’s called ‘atelectasis’ or collapse of the lung, then will settle out from one side of the lung to the other side and as it does that your oxygenation improves.”
He said proning is used on patients that are intubated, on a mechanical ventilator, and for patients receiving oxygen therapy at home.
The cytokine storm – treatment before it’s too late
More severely symptomatic COVID-19 patients are experiencing what Dr. Saliski called a “cytokine storm.”
This is where a patient’s blood is teeming with high levels of immune system proteins called “cytokines.” Scientists believe these cytokines are evidence that the body is beginning to attack its own cells and tissues instead of fighting the virus.
“Basically what happens is the virus turns the immune system on and the body is in a storm state where organs are attacked. Primarily lung, but it can be kidney, heart, any part of the body,” Saliski said. “What we are trying to do is prevent that storm from occurring.”
This is why Saliski said, “timing of this disease for treatment is extremely important. A lot of the medications that we’re giving, we’re timing so that that storm does not occur.”
The storm causes inflammation that he says is being treated with steroids.
“A recent study came out with the use of what’s called ‘Dexamethasone,' which is a steroid, and we’re using that early on in the disease process to try to prevent further inflammatory storm,” Saliski said.
Another drug called “Actemra,” an IL-6 inhibitor, is also being used to help prevent the cytokine storm.
Blood Clot prevention
“We feel that this disease process causes one to be what’s called ‘hypercoagulable,’ where the blood thickens, creating a clot in the venous system breaking off from the leg to the lungs causing a pulmonary embolism,” Salsiki said.
A pulmonary embolism, or sudden blockage in the lung artery, is life-threatening. That is why they are giving some patients blood thinners to prevent the blood clots from happening.
“Early anticoagulation will prevent blood from clotting, said Saliski. “What degree of anticoagulation depends on how sick the patient is.”
Convalescent plasma, or the blood from those who have already fought and recovered from COVID-19, is being given to sick patients in an effort to help build the immune system.
“That’s plasma that has been taken from patients who have already had COVID-19, and they have developed antibodies and what we’re doing is taking that plasma and giving it to other patients who have similar blood types, and it’s basically boosting their immune system with antibodies that have been made by someone else,” said Saliski. “That has been given across the board early to late with variable response.”
“When we give someone convalescent plasma, it’s like giving them a vaccine in a respect that we are revving their immune system to protect them from getting this virus,” Saliski said.
Salsiki said they are also continuing to use the FDA approved antiviral drug Remdesivir when needed.
“I feel it has been effective, but again it’s the timing of when you give it,” said Saliski. “I feel like if somebody is already on the ventilator with severe disease and multisystem organ failure it’s less effective.”
“We don’t know the exact time frame of a vaccine. I don’t think anyone does,” Saliski said. “But I do know multiple companies are working super overtime to get this vaccine out.”
Saliski said he believes a vaccine will be developed in the next six to eight months.
“I am a huge advocate of vaccines for all viruses. I believe that we were able to eradicate some horrific diseases in the past like polio, measles, etc,” said Saiski. “This is no different.”
“I think everyone, everyone, should get this vaccine,” Saliski said.