Fewer Cases, Better Treatments in Second Wave of COVID-19
As Americans begin to receive the COVID-19 vaccine, positive news is also showing up in the treatment of patients who do contract the virus.
At Einstein, advances in safety measures, knowledge and treatments already have shown improved patient outcomes.
Lessons learned since the initial spring 2020 surge of COVID cases have led to:
- About 40% fewer hospital patients in Philadelphia during the current winter surge compared with the first surge
- Better treatments, including early treatments to keep people out of hospitals
- About 50% fewer patients in city intensive care units during the fall-winter peak compared with spring 2020
- A one-third reduction in the number of patients who are sick enough to require a ventilator
- A reduction in death rates of hospitalized patients
Rohit Gulati, MD, Executive Vice President and Chief Medical Officer of Einstein Healthcare Network facilities in Philadelphia and Elkins Park, gives credit to experience, research and strong public health measures for these improvements in the second wave of COVID cases.
Fewer Cases at Peak in City
“At Einstein Medical Center Philadelphia, we were beyond 200 COVID patients in the hospital during our spring peak in April,” Dr. Gulati says. “Our second peak in December was around 130, and today that number has gone done to the 70 to 80 range Dr. Gulati says. “In the second peak, we never reached the height of the spring, and it’s come down 25%.
“I think maybe it’s because of all the lessons we learned: early treatment, increased testing, social distancing and increased quarantining, everything helped,” he says. “And those were in effect in the second wave.”
The suburbs did not experience the same decline in cases. For example, Einstein Medical Center Philadelphia is using far fewer intensive care unit (ICU) beds in this second wave compared with spring 2020, Dr. Gulati says. But more ICU beds have been used in several suburban hospitals, including Einstein Medical Center Montgomery.
Since both city and suburban hospitals have had the benefit of improved treatments, Dr. Gulati attributes the difference to stricter public health measures in the city compared with the suburbs.
Earlier Treatments Lead to Better Outcomes
Advancing knowledge about the virus that causes COVID-19, which was brand new a year ago, has led to better treatments, Dr. Gulati says. Improvements in care include the following:
- Faster tests results and earlier recognition of who has COVID
- Earlier treatment with high-flow oxygen through the nose or with a mask similar to the kind used by people with sleep apnea
- Early use of proning – lying on the stomach to make it easier to breathe
- Less need for ventilators, the last-resort treatment for the sickest patients, because of better early care
- Use of a monoclonal antibody infusion for patients who are not in the hospital but are at high risk of getting worse to prevent hospitalizations
- Use of remdesivir, an intravenous anti-viral drug, for early-stage hospitalized patients to prevent them from getting sicker or going into the ICU
- Treatment with the steroid drug dexamethasone for some of the sickest patients
“I think the use of remdesivir, steroids, better oxygenation techniques, early recognition of the disease, have all resulted in early treatment and better outcomes,” Dr. Gulati says. “For example, now we know that it’s best to use remdesivir on day one in the hospital.
“We’ve also now learned that early recognition and isolation of patients helps as well so that other family members don’t get infected. “
Meanwhile, measures such as social distancing, wearing masks and avoiding unnecessary trips and contacts have helped hold down case numbers compared with the spring.
Elective Surgeries Continue
Because of lower case numbers and more flexibility in state guidelines, Dr. Gulati says, Einstein has been able to safely continue doing some elective surgeries that were shut down last spring and resumed in the summer.
At all Einstein hospitals, he says, administrators have kept watch on COVID patient totals and adapted the number of surgeries that can be done based on availability of staff and ICU beds.
Many procedures that don’t require an overnight stay have been moved to outpatient surgery centers such as Center One in Northeast Philadelphia.
The next step for controlling the disease is to make the COVID-19 vaccine available as soon as possible to the whole population especially minority populations that have been hard hit by this disease., Dr. Gulati says.
“Now people need to keep taking the same precautions with masking and social distancing and give it a little time so that the vaccine can be effective and we can stop this cycle,” he says. “It’s safe, and there’s no issues with it. I’m getting my second dose today. As soon as we can, we want to give it to everybody.”