Dr. Anand Kumar remembers what it was like treating some of the first patients with COVID-19 in hospital in Manitoba.
“All of the same things that I might have used to describe H1N1 10 years ago — in terms of the patients coming in extremely ill, unable to get their breath, turning blue, having to immediately go onto ventilators — it was all very, very similar,” said Kumar, a Winnipeg intensive care physician and infectious disease specialist
“It’s just the numbers with COVID-19 were just so much more substantial and so much more frightening.”
Over the last year, he’s seen changes to when patients are put on a ventilator, and how clinical trials have helped determine which drugs to use and when.
“If you look at the numbers that were published early on, to the numbers that we’re seeing now for survival, it’s markedly improved,” said Kumar.
Ventilator usage shifts
One of the things learned early on in the pandemic was when to use a ventilator.
“We saw that a lot of patients would tend to deteriorate relatively quickly and so we were intubating them right away,” said Kumar.
“Now part of that was also because of the concern about the spread of infection, that is to say that once you have them intubated they’re not coughing so much and they’re less likely to spread it to other people.”
WATCH | How treating COVID-19 patients has changed in the last year, according to Dr. Anand Kumar:
He said that a lot of patients with COVID-19 put on a ventilator were unable to be taken off of the mechanical breathing machines and died.
Different techniques were developed to help oxygenate COVID-19 patients, and while ventilators are still used, they are a last resort, according to Kumar.
Doctors discovered that simply changing the position of the patient in bed — putting them on their stomachs instead of their backs — made a big difference in their oxygen levels.
“So that became very much a standard of care, and early intubations became something of the past,” he said.
More treatment options
Kumar said doctors have also used a device called a membrane oxygenator to oxygenate a COVID-19 patient’s blood outside the body — while they are on a ventilator — to try to give their lungs a chance to recover.
Fighting COVID-19 also comes down to discovering which drugs can help a patient get better.
A steroid called dexamethasone was introduced early on and is now being used more often, Kumar said.
“Back in 2009, we actually found that steroids were not good for influenza pneumonia and so the inclination with COVID was initially to go away from that,” said Kumar.
“Some people thought it might be well to test it because COVID is a different virus and it may act differently and so it was tested … steroids, dexamethasone in particular, were shown to be helpful in people who progressed to the point they needed intubation.”
Kumar referred to the blood thinner heparin as a game changer in the treatment for COVID-19. That’s where Winnipeg hematologist and critical care physician Dr. Ryan Zarychanski comes in.
“When we knew we were in the midst of a pandemic with no specific therapies, obviously there was quite an imperative to move quickly,” said Zarychanski.
Zarychanski said Manitoba has been involved with a number of clinical trials in the last year — whether it’s been by developing them, launching them or participating in them.
There was a point, he said, that he was involved with seven clinical trials related to COVID-19, happening in Manitoba at one time.
A global study led by Zarychanski has shown a benefit to giving hospitalized COVID-19 patients a full dose of heparin — which also has anti-inflammatory properties — before they get critically ill with the disease.
COVID-19 has led to inflammation in the organs of some patients, which can result in complications such as stroke, lung failure and heart attack.
The study, which involved more than 300 hospitals across five continents, showed 20 per cent of patients given the full dose of heparin required ICU admission, compared to about 30 per cent of those who received the smaller dose.
“We have shown that an inexpensive, widely available drug can reduce mortality and progression to ICU,” Zarychanski said.
WATCH | COVID-19 clinical trial models could shape how these trials are done in the future:
Zarychanski said that some of the clinical trials, such as one done with hydroxychloroquine, can also show when drugs don’t work. That benefits patients too.
“We had all this early faith in hydroxychloroquine and other drugs that people just thought might work,” said Zarychanski.
“If we didn’t do those studies, we’d still be using them right now…. We’d think we were doing good when it turns out we weren’t.”
Zarychanski said the work done to understand how to treat COVID-19 in the last year has been incredible.
“It’s inspiring and it’s never been done before,” he said.
“It will change the way we do clinical research forever. I think that we’ve shown the importance and the practicality, really, of embedding clinical research into clinical care each day. ”
Health Canada has now approved four vaccines for use against COVID-19, and Manitoba’s timeline suggests that anyone who wants a vaccine will be able to get one by the end of June.
WATCH | Doctors discuss next steps in research, patient care and long-term impacts of COVID-19:
But both Kumar and Zarychanski said that research about COVID-19 won’t be stopping any time soon.
“Two residual questions in my mind are where’s the specific anti-viral medication that works … for this specific virus,” said Zarychanski, adding the other is looking at the consequences for the body after someone has been sick with COVID-19.
“We’re going to be dealing with COVID and its manifestations for years to come,” said Kumar.
He, like Zarychanski, predicts research will start to look at long-term health impacts of COVID-19 and how to treat them.
He also said it’s unknown what role COVID-19 variants will play in the coming months.