2020 Review: The Evolution of COVID-19 Treatment
This marks the beginning of my reflection of the year that has been. As we all know 2020, The Year of the Nurse and Midwife, has become synonymous to COVID 19.
I have been both fortunate and unfortunate to work with COVID patients first hand. I have seen the pain, the suffering, the helplessness, the confusion, the trial and error, the unity, the compassion and the successes of it all. I had previously shared my whole experience of the pandemic.
Today, I give an account of treatment options since the pandemic began based on my own personal observations. A few days ago, the UK government authorized the COVID 19 vaccine. Its been a long road to get here.
Treatment of Symptoms
At the very beginning, treatment was based on the patient's symptoms. During the first wave, common symptoms were fevers of 39 degrees and above, tachypnea and shortness of breath. At this point, IV paracetamol was the golden drug. Nebulization was considered an aerosol-generating procedure then. Therefore, despite the difficulty in breathing, no patients were nebulized in the wards.
Also, most of the patients were on oxygen. It was during this time that I learnt the different oxygen delivery methods. I mastered the color codes of the venturi masks and the FIO2 of different litres of oxygen given via nasal canula. Any patients without DNR still desaturating on 15L of oxygen via reservoir masks had to be transferred to ITU for assisted ventilation.
In addition to the above, a full course of IV antibiotics were administered to COVID patients. Interestingly, Coamoxiclav (Augmentin) and Clarithromycin, the most used antibiotics are not antivirals.
Proning started becoming popular around April. I first saw proning when I worked a shift in ITU and I must say that its not a pretty site. Proning is simply having the patient lie on their belly. It is a common position for nursing babies.
The rationale behind it is that when a person lies on their belly, oxygenation is easier because a bigger part of the lungs is located in the back of the body. Also, gravity allows secretions in the lungs to move downwards, easing lung expansion. To date, we still encourage COVID patients to prone.
Dexamethasone is a corticosterioid that is routinely used as an anti-inflammatory. It was tested in a clinical trial in the UK called RECOVERY and later recommended by WHO. Since then, it has been used as one of the treatments for COVID patients. The treatment dose is 6mg given either orally or intravenously once a day for 10 days.
This is an antiviral drug that was administered to patients as part of a clinical trial. The patients were selected randomly and given either a placebo or the drug. I have since learnt that the study concluded that Remdesivir shortens the hospital stay for patients with COVID and other respiratory illnesses. I'm waiting to see if it will be given routinely for patients with COVID moving forward.
Plasma replacement is still part of two ongoing clinical trials. The therapy involves patients getting transfused with plasma of people who have previously had COVID 19 and recovered. Such plasma is believed to contains antibodies that may help the patient's immune system to fight the ongoing infection. The trials are still ongoing as we speak so no conclusions have been reached regarding its efficacy.
Finally, the COVID 19 vaccine is here. The vaccine has attracted skepticism and awe in equal measure. I've heard several people question whether they will take the vaccine or not. I too was part of the doubting Thomases until recently.
My resolve was partly inspired by conversation with a friend and partly by my own reflection. Two reasons. First, in the current world, drugs are subjected to several stages of scrutiny before they can be approved to be used. The second reason is quite petty, so I will spare you the agony.
As I conclude, I cant help but compare these advancements with the current state of healthcare in Kenya. The progress has been made possible by a public that know how to demand their dues from their leaders and leaders who utilize resources well. Don't get me wrong, there has been a lot of gaps too but still the progress is tangible.
2020 has stretched most healthy systems across the world. We hope that the vaccine can put this whole issue to rest and that 2021 will be a better year.