SHA doctor offers a look at the fight against COVID in hospitals

How do hospitals treat COVID-19, a disease never seen before its arrival in 2020?

While the illness might be relatively new, it’s not unfamiliar to those who work in the health-care system who regularly care for people with severe viral infections.

It’s first important to understand what the patients are dealing with.

The Saskatchewan Health Authority’s Dr. Satchan Takaya explains when people are infected with the new coronavirus, their bodies fight the infection, experiencing symptoms like fever, chills and aches. But then, an inflammatory response is prompted.

“Your immune system is primed, it triggers this thing called the inflammatory cascade and that does more damage than the virus itself,” said Takaya, who holds multiple job titles including pandemic co-chief of staff for Saskatoon.

“So as you’re trying to recover and your immune system kicks in, it overshoots and starts to attack your own tissues and your own body and then that causes this inflammatory pneumonia and your body has trouble getting over that.”

Takaya said most of the time, patients recover on their own but severe inflammation of the lungs results in hospitalization.

There, patients are given what’s known as “supportive therapy,” including oxygen, IV fluids and possibly antibiotics, as health-care workers watch their vital signs. When cases are severe, that’s when a decision needs to be made about a transfer to intensive care.

“That’s when we start to worry. Your shortness of breath picks up, your work of breathing picks up and then you need more oxygen,” Takaya said.

“You’d need some sort of supportive ventilation; it doesn’t necessarily always mean a tube down your throat. It might be what we call positive pressure ventilation, so a really special oxygen mask that forces air into your lungs … and then at that point, we just support and hope that the inflammation settles down.”

At this stage of treatment, Takaya said medications get involved to fight the inflammation, like steroids or Tocilizumab, an anti-inflammatory that has shown to reduce mortality but, because of limited supply, is used sparingly.

“We can’t use it like water because we don’t have it like water,” she said.

Other drugs have made headlines as supposed treatments over the course of the pandemic, like the antiviral Remdesivir. Takaya said despite the hype, the drug hasn’t been shown to reduce deaths or improve patient outcomes. As well, Remdesivir works to reduce the replication of the virus when it’s inflammation that’s really the problem.

The gout medication Colchicine is another, but Takaya said it’s a weak anti-inflammatory that comes with adverse side effects.

“With drugs, we always have to weigh the risks and benefits and the risks of doing the high-dose Colchicine is too much for somebody in the ICU,” she said.

Takaya urges people not to hesitate before seeking medical assistance. She said if you have symptoms or trouble breathing, get help rather than waiting out the illness.

“We’ve had that problem,” she explained, “and a lot of the people that have done very poorly in the hospital is because they sat at home and waited.”