‘Rather get COVID now’: Why CT doctors say patient outcomes have changed

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COVID-19 case rates are down, but Connecticut residents are still catching the disease.

Marna Borgstrom, outgoing CEO of Yale New Haven Health, said her health system has a survival rate of 92 percent, which has improved “as treatments have become more effective.”

COVID patient outcomes have improved significantly since the start of the pandemic, Connecticut doctors say, with patients far likelier to survive even when there are other medical concerns taken into consideration.

“I would much rather get COVID now than I would in March of 2020,” said Dr. Scott Roberts, associate medical director for infection prevention at Yale New Haven Hospital.

Ulysses Wu agreed. “Patient outcomes are much better than earlier on in the pandemic,” said Wu, chief epidemiologist and system director for infectious diseases at Hartford HealthCare.

Better courses of treatment are not the only reason why outcomes have improved. Here’s what doctors are saying has had an impact:

Vaccinations

Wu said the majority of patients in the intensive care units at Hartford HealthCare are not vaccinated.

“This still remains a pandemic of the unvaccinated,” he said. “The purpose of the vaccine was to take the disease, which was potentially deadly, and turn it into a mild one.”

Roberts talked about COVID-19 vaccinations as though they are a treatment as well as a preventative.

“I think the vaccine is definitely the most effective way to prevent hospitalization and death or other complications from COVID,” he said.

Should the virus become endemic, circulating among communities in waves for the foreseeable future, UConn Health infectious disease doctor and epidemiologist David Banach said individuals who are not vaccinated and who have not developed immunity after catching COVID, will continue to see worse outcomes.

“Those individuals will likely get more severe illness, whereas those who are either vaccinated or have some immunity potentially from prior infection may have a milder case,” he said.

Overall resources

Despite some supply chain issues, hospitals have not seen a decrease in the availability of personal protective equipment, according to Ohm Deshpande, who manages vaccine administration for Yale New Haven Health.

“From a PPE standpoint, we are in good shape,” Deshpande said.

According to Roberts, better resource availability means better outcomes for patients.

“Let's say I was not vaccinated, I would still rather get COVID now than in March of 2020,” he said. “We’re much more able to handle COVID patients now than we were in March of 2020, when we saw this massive influx that almost overwhelmed the health care system. We were seeing shortages of respirators, shortages of staff to care for these patients.”

That availability of resources is going to make a difference should there be future COVID outbreaks, Banach said, calling it the difference between “a flare-up of cases versus a real surge in cases.”

“The latter has the potential to really test the capacity of hospitals providing care to patients with COVID, and even patients without COVID,” Banach said. “Whereas the former can be much more manageable from a clinical care perspective, the latter, with a surge, can really test capacity and that can potentially contribute to worse outcomes.”

Treatments we know work

There’s a pill being developed by pharmaceutical company Merck that Roberts said “appears to cut the rate of hospitalization and death by half.”

But even before that gets approval, there are drugs like Remdesivir, and “we have monoclonal antibodies that are becoming a key part of our armamentarium,” Banach said. There also are “anti-inflammatories like dexamethasone, we now know works that we did not know before,” Roberts said.

Wu said that while treatments have improved, they are not significantly beyond where they were a year ago. He said, “the treatments are better, but not to the extent that we want them to be.”

“The actual treatment modalities have probably not gotten as far as we’d like them to,” he said, though “what we have gotten better at is the timing.”

The disease often comes in two phases. First, you get the symptoms from the virus itself, and then you get an overreaction from your body’s own immune system, often called a cytokine storm.

“The viremic phase is usually within the first seven to eight days, then what kicks in is the inflammatory response,” Wu said.

Doctors know better now, he said, “when should we give monoclonal antibodies, when should we give Remdesivir.”

Treatments we know don’t work

Then there are the treatments doctors already know haven’t been effective. Roberts mentioned two in particular.

“There was a very small study showing in the lab setting that some of the prior viruses like SARS and MERS were able to be inhibited by hydroxychloroquine,” Roberts said. “At the beginning of the pandemic, I, myself, and many of my colleagues were prescribing it because we had no other option at the time.”

Things have changed, he said, since then. “We now know that not only is it not helpful, but it's actually harmful and can contribute to worsening complications, such as cardiac arrhythmias.”

Then, of course, there’s ivermectin, which Roberts said he hasn’t actually prescribed though it did offer some promise.

“There is a study showing it may be helpful in the lab setting when you just infect certain cells with the ivermectin itself,” Roberts said. “But when we look at clinical outcomes and actually giving it to patients, we are not seeing clear benefits, and we are seeing instances where there's very clear harm being done.”