Growing knowledge about COVID-19 has changed the way doctors in Monroe County treat patients with the disease.
At the beginning of the outbreak locally, doctors at Rochester Regional Health and the University of Rochester Medical Center found that some patients who seemed like they would weather the illness instead deteriorated very quickly.
Doctors started getting patients on ventilators early. The reasoning was that it might be the only way to save a patient’s life.
But ventilators carry consequences of their own, and if a patient doesn’t need one, doctors said they want to avoid using it. As local hospitals got more experience with COVID-19, they found ways to support patients who were having trouble breathing without resorting to ventilators.
They had to get creative, said Dr. Paritosh Prasad, who directs the Strong Memorial Hospital unit that handles critically ill COVID-19 patients.
“This is the art of medicine, not the science of medicine,” he said.
One of the methods they began using is called “proning.” Put simply, they roll patients onto their stomachs. The position changes the way fluid accumulates in the lungs and allows oxygen to transfer better from the lungs to the bloodstream.
Evidence supporting proning for COVID-19 patients was scant, but doctors relied on studies of patients who developed acute respiratory problems from other diseases to guide their decisions.
Doctors have also changed the medications they use to treat COVID-19.
For several weeks, both URMC and Rochester Regional Health prescribed hydroxychloroquine for some patients with the disease.
Now, patients recovering from a novel coronavirus infection in Monroe County are likely to be prescribed steroids.
The reasoning, Prasad said, is that the virus triggers a massive immune response in some patients -- so large that the body hurts itself.
“When our immune systems recognize COVID-19 and respond, they go berserk,” said Prasad. “The problem with that is that, even if it’s successful in getting rid of the virus, it’s causing so much inflammation, so much damage, that it can’t turn itself off.”
Steroids help to reduce inflammation and turn off the immune response, he said.
Doctors at URMC have been using steroids for COVID-19 patients for months, but new research points to a particular steroid, dexamethasone, as a potentially lifesaving treatment.
The drug still needs peer review, but Prasad said initial results look promising.