FORT LAUDERDALE, Fla. — With public health officials warning that COVID-19 vaccination rollouts won’t do much to tame the immediate dangers of the pandemic, a Florida Catholic hospital is looking at medications and protocols to protect and save lives.
The U.S. continues to lead the world in the number of reported deaths attributed to the coronavirus, topping 352,000 deaths Jan. 4. Rapidly expanding hospitalization numbers are stressing health care workers and facilities in many regions.
“This is obviously, in many of our lifetimes, the most significant impact to public health, even to the point of disruption across the health care system,” said Dr. Joshua Larned, a cardiologist with Holy Cross Medical Group in South Florida and a member of Holy Cross Hospital’s steering committee on management of COVID-19, the illness caused by the coronavirus.
Larned also is a past research fellow at the Centers for Disease Control and National Center for Infectious Diseases in Atlanta.
“What we are seeing here is something that happened very quickly without a lot of initial understanding of how quickly the spread could occur; and we were a little behind in terms of processes to deal with it, in spite of other respiratory lessons from SARS or MERS. This one caught the world off guard,” Larned told the Florida Catholic, newspaper of the Miami Archdiocese.
“One of the problems with COVID-19 is the fact that it doesn’t just cause pneumonia. It can also be associated with a respiratory distress syndrome, a multi-inflammatory syndrome that can affect a multitude of different organ systems, including the heart. It can be associated with thrombosis where the body wants to form clots, and is associated, in its more severe form, with multi-organ failure,” he said.
Holy Cross Hospital is participating in a study to understand if administering high doses of anticoagulants, or blood thinners, will safely reduce the risk of COVID-19 patients developing deadly clots.
Blood clots are one of the things that makes patients with COVID-19 severely ill, with clots forming either in the major arteries or veins leading to the lungs and other parts of the body, Larned explained.
He said many patients with even mild to moderate symptoms who are never hospitalized and will recover may experience lingering chronic fatigue, shortness of breath, excessive heart rate or long-term damage to lungs and heart.
Holy Cross is running two clinical trials in which COVID-19 patients under intensive care receive high doses of two anticoagulants — used together — to prevent arterial and venous clots.
Another clinical trial involves patients not in an ICU but admitted to the hospital with COVID-19 who randomly receive just one anticoagulant.
“Anecdotally, I can say the risk of having a blood clot in an artery or vein is a devastating disease that can occur to any sick patient who is admitted to a hospital, but we know the risk of that happening goes up significantly with COVID infection,” Larned said.
While the number of COVID-19 infections in Broward County, Florida, is far lower than those in Miami-Dade County, Holy Cross moved quickly in the spring to prepare for the pandemic. It managed to continue normal operations and regular patient care while also accommodating patients sick with the coronavirus.
Hospitalizations at Holy Cross peaked in June, July and August. While there is growing concern that early 2021 may see a return to those same hospitalization levels, such a scenario has not yet arrived at Holy Cross, Larned said.
There is also no universal agreement on outpatient care for COVID-19 patients who are not sick enough to be hospitalized.
Some Holy Cross patients have qualified for medical trials with the antiviral medicines and other medications.
The hospital also is studying monoclonal antibodies, which are made in a lab to mirror the body’s natural immune response to the virus. Not everyone qualifies for such treatment, Larned said, but the hospital is conducting clinical trials to determine whether every patient should receive it.
The ideal course of action for someone who tests positive for COVID-19 is to communicate with a physician, local health system or public health department to determine treatment options and eligibility for possible clinical trials.
There is no consensus on at-home treatments for the coronavirus, Larned added. That’s why public health officials are urging caution to avoid the infection in the first place.
Holy Cross will follow the Operation Warp Speed national plan for vaccine rollout and distribution consistent with the Florida state plan, with various phases prioritizing nursing home residents, first responders and the elderly.
Larned said the size of both the Pfizer and Moderna vaccine trials — each with 30,000 individuals — offers encouragement that both vaccines are effective and safe, although no one can say how long they confer protection against coronavirus.
“It is going to be a leap of faith to take a vaccine, but you may recall the polio epidemic and how devastating that was to the population. With the commitment to a vaccine America took that leap of faith together and we got over that pandemic. We are going to need that commitment again,” he said.
In the short term, Larned encouraged people to continue wearing masks, frequently wash hands and observe appropriate social distancing.
“We are reaching a point in the year where we are all starting to get tired of this and it is easy to let our guard down,” he said, suggesting that simple things like wearing a mask and avoiding overly crowded indoor places are key to staying safe.
Tracy writes for the Florida Catholic, newspaper of the Archdiocese of Miami.