Far fewer people are dying from COVID-19 today than in January, but more than 1,000 Americans die from the disease every day — alone at home or in hospitals, gasping for air, suffering heart attacks or slipping silently away.
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Though treatment for the sickest patients has improved since the World Health Organization declared COVID-19 a pandemic a year ago, roughly 20% of patients sick enough to be hospitalized still end up in intensive care — a figure that hasn’t changed in the past year, said Kevin Tracey, a neurosurgeon and president and CEO of the Feinstein Institutes for Medical Research, the research arm of Northwell Health, New York’s largest health care provider.
And death rates remain concerningly high in ICUs, he said.
Doctors said the care they give is clearly better than it was a year ago, if only because the disease is better understood and hospitals aren’t overflowing with desperately sick patients.
“We’ve gotten much better at managing patients with COVID-19. Much better than back in March (2020),” said Dr. Daniel Griffin, an infectious disease specialist at ProHEALTH Care, which has 300 health care locations in New York.
A ventilator helps a COVID-19 patient breathe inside the coronavirus unit at United Memorial Medical Center July 6 in Houston.DAVID J. PHILLIP, AP
Health workers aren’t “throwing the kitchen sink” at patients anymore. They use ventilators more judiciously, finding that delivering oxygen to the throat rather than forcing air into the lungs with a ventilator can be safer and more effective for all but sickest patients. And doctors have one good tool to prevent death — the steroid dexamethasone — which is cheap, effective and easy to use.
The past 12 months have been largely filled with trial and error, rather than systematic learning, doctors said, with little coordinated effort and lots of missed opportunities to turn millions of people’s miserable experiences into lessons for others.
“A year later,” Tracey said, “we’re still flying blind.”
Suffering patients and hopeful caregivers have naturally filled the gaps with over-the-counter or readily available options, some of which might be helpful and some hazardous — there’s limited research to tell the difference.
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Dr. Kevin Tracey
A year later, we’re still flying blind.
The federal government has been running clinical trials in collaboration with private companies, known as the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) program to prioritize and speed development of promising treatments.
Those trials have failed to answer key questions, several physician-researchers told USA TODAY.
“Despite all the work that’s gone into trying to find a treatment, not only do we not have a lot of options for patients with severe illness, we don’t even know what doesn’t work,” said Dr. Haider Warraich, associate director of the heart failure program at the VA Boston Healthcare System.
The United States lacks a centralized system for running the types of clinical trials that would be needed to prove a drug’s effectiveness in patients, particularly when that drug is no longer patented and therefore lacks a champion in the pharmaceutical industry, he and others said.
There was a lack of funding for large, multi-centered trials needed to prove whether drugs do or don’t work against severe disease, he and others said. Instead, the system made it easier to give patients therapies with uncertain effectiveness rather than testing those therapies in clinical trials.
“Our response was so fractured, especially in the United States, that we really weren’t able to generate any meaningful information,” Warraich, said. “I can’t but think of the lives that have been lost.”
Clinical trials in a pandemic aren’t easy
Randomized, placebo-controlled clinical trials are the gold standard for determining the effectiveness of new drugs, but they can be tricky to pull off, especially during a pandemic.
Drs. David Leaf, and Shruti Gupta, kidney specialists at Brigham and Women’s Hospital in Boston, focused on collecting information on how some of the sickest COVID-19 patients fared at hospitals across the country.
Last March and April, Leaf and Gupta used their personal connections to get friends and colleagues at 67 other hospital systems nationwide to collect data on COVID-19 patients in intensive care. They created one of the largest independent collaborative networks for studying treatments, called STOP-COVID.
The group has published a dozen studies, including one finding CPR rarely helps COVID-19 patients whose hearts have stopped beating, and another suggesting that ECMO, which temporarily replaces the function of the lungs, can save lives. It found that the anti-inflammatory drug tocilizumab, if given early, appears to save lives — a finding confirmed by large randomized clinical trials.
Without funding, STOP-COVID relied on more than 400 research coordinators, nurses, residents, medical students and physicians across a range of specialties — all volunteers — to review the charts of more than 5,000 patients and hand-enter 800 data points on each. Many times, caregivers would finish a grueling shift in the intensive care unit, then come home and spend unpaid hours entering data.
The grassroots research does not meet the gold standard for clinical research, Leaf conceded. The patients were not randomized to take different therapies, then compared with others who took a placebo.
But the relatively large numbers of very sick patients and robust statistical analysis allowed them to draw reasonable conclusions, Leaf said.
Many of the COVID-19 randomized trials have been too small to definitively determine the effect of treatments on survival.
“Demonstrating an effect on survival is really difficult in these studies unless you have thousands of really sick patients,” Leaf said.
