Since March, physicians have also figured out other ways to help severely ill patients avoid ventilation. “We appreciate that it’s probably not a great thing for these patients, and we’ve developed other ways to get people high levels of oxygen,” says James Hudspeth, the COVID response inpatient floor lead at Boston Medical Center. For example, doctors are turning to nasal cannulas, which are noninvasive prongs that blow oxygen into the nose, before a ventilator.
They have better medications for hospitalized patients now, too. Since March, doctors have cycled through a few different options — like hydroxychloroquine, which turned out not to be effective. Now, they’re primarily using remdesivir, and antiviral drug that appears to help COVID-19 patients recover more quickly, and the steroid dexamethasone, which helps improve the survival rate for patients on ventilators. “Many intensive care units and many hospitals have created their own standard order sets, or standard therapies, for people with COVID-19,” Ranney says. Those shift as new evidence comes out around different medications.
That’s not unusual, Ranney says. Hospitals regularly change the drugs they use for conditions like flu and pneumonia as new data comes out. “What’s unusual is to change practice so quickly,” she says. “That’s just the reality of a global pandemic, with a disease we’ve never seen before.”
Most of the changes in doctors’ strategies over the past few months have been in patients who are severely ill.
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