How has treatment of COVID-19 patients improved since the start of the pandemic?

While COVID-19 is spiking in SoCal, doctors have gotten better at treating patients and saving lives.

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Friday, July 10, 2020
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While the number of coronavirus cases has spiked in the Southland, doctors say they have learned more about how to treat patients and have been more effective at saving lives.

COLTON, Calif. (KABC) -- COVID-19 cases are soaring in the Southland.

Positivity rates are going up.

And hospitals - specifically their intensive care units - are filling up quickly.

But the news isn't all bad.

The death rate - at least among hospitalized patients - is falling, in large part due to what doctors have discovered about COVID-19 since the pandemic began.

"If you roll back the clock and look at March and early April on the way we managed these patients in the hospital, we are now managing them differently," said Dr. Troy Pennington at Arrowhead Regional Medical Center in Colton. "There's a lot of things that we've learned."

Dr. Pennington gave several examples, starting with the oxygen saturation levels of COVID-19 patients.

Pennington said normal, healthy individuals have oxygen saturation levels between 98-100%. When individuals see their numbers drop to between 90-92%, it typically requires hospitalization.

Many COVID-19 patients coming into the hospital have oxygen saturation numbers that are even lower.

"We were seeing people come in with oxygen saturations in the 80s or 70s; very low numbers," said Pennington, who added that hospital staff were quick to place these patients on ventilators, like they would do with a pneumonia patient with similar numbers.

Not anymore.

"We've learned they were tolerating (the lower oxygen numbers) much better than most of our patient population. In most other patients, like a pneumonia patient, if you see them come in with an oxygen level that low we were quick to intubate. We've learned in managing COVID-19 patients that we don't need to do that."

Pennington says in large part, they're only using ventilators much later in the process. In some cases they're not using ventilators at all, but rather CPAP or BiPAP machines.

"Essentially what these devices do is provide continuous flow to the lungs. It's helping extend their air sacks from collapsing; it's helping those individuals breathe and prevent fluid from accumulating in their lungs. We find that we can bridge people on these high-flow oxygen devices for several days, and in many ways avoid intubation."

But it wasn't just lower oxygen-saturation levels that doctors were discovering in COVID-19 patients.

"One of the things we saw early on is an increased number of patients with COVID-19 who were forming blood clots. We were seeing people with premature strokes at a young age, and people with blood clots in their lungs."

Pennington said many of those patients are now given blood thinners.

"We're anticoagulating them early throughout their hospitalization, and in some cases at home."

Pennington added that many of these discoveries have led to lower death rates among COVID-19 patients.

"We're managing their airways with high flow oxygen, anticoagulating the patients, and using steroids and other medications that have helped us overall manage our COVID-19 patients.

"There are other medications that we're exploring too. Remdesivir is one that is somewhat promising. It's a combination of these things.

But one side effect to the lower death rate is a potentially longer hospital stay for some patients.

And Riverside County health officer Dr. Cameron Kaiser said with ICU bed space filling up quickly, these are numbers public health officials are keeping a close eye on.

"People are able to hang on longer; people are able to fight it off better," said Dr. Kaiser. "Of course, what this translates to is they occupy a hospital bed for longer. So the hospitals become victims of their own success.

"But we are seeing death rates drop in hospitalizations because the hospitals are getting better at how they manage (patients)."