CLINTON — As COVID-19 began winding its way through the U.S. – the first cases in Iowa were discovered in early March – medical facilities across the nation were bracing for the unknowns.
Among the questions: How is it transmitted? How is it best treated? What are the lingering effects?
Six months in, debate continues on all three.
MercyOne Clinton Medical Center officials hope to get closer to those answers, doing so by taking part in a nationwide investigative study of convalescent plasma therapy.
The Mayo Clinic is the study’s lead institution and is providing coordinated access to investigational convalescent plasma for hospitalized patients with severe or life-threatening COVID-19 or those at high risk of progressing to it, according to its website. The thought is that convalescent plasma may help people recover from COVID-19, lessen the severity and shorten the length of the disease. The Food and Drug Administration announced the designation April 3. MercyOne has been utilizing convalescent plasma since mid-July.
Dr. Alaidden Taher, who oversees MercyOne Clinton’s hospitalist program, and Karleen Looney, registered nurse supervisor, are two MercyOne staff members at the forefront of the local battle against COVID-19.
Taher explains that convalescent plasma refers to blood plasma collected from people who have recovered from COVID-19; the plasma used at MercyOne Clinton comes from donors who gave through the Mississippi Valley Regional Blood Center. The plasma, which can be shuttled to the hospital within hours, is matched to the patient and used alongside other supportive medications in MercyOne’s arsenal, including steroids and the antiviral drug remdesivir.
After administering the plasma, MercyOne then documents the results.
“Basically, they want to know what the patient’s results are: was there a major reaction to the plasma, bad outcome, and the patient’s end result, were they discharged or expired,” Taher explains.
While the overall results of the study won’t be known for some time, Taher said locally they have been good.
“We are seeing some promising results,” he said. “We are still studying, and looking at risks and benefits. At the end of the day, we need to look at 30-day mortality and 90-day mortality.”
As for the number of COVID-19 patients MercyOne Clinton has treated, hospital officials say they aren’t allowed to talk about those numbers. The Iowa Department of Public Health website on Tuesday reported Clinton County has had 1,078 cases since the outbreak began in March. Of them, 722 have recovered and 19 have died. A total of 337 cases are considered active.
In her report to the Clinton County Board of Supervisors on Monday, Community Health Manager Michelle Cullen said Clinton County’s positive case growth trend is starting to decrease. The IDPH website lists Clinton County’s 14-day average positivity rate at 8.2 percent, half of what it was a month ago.
While MercyOne workers can’t comment on the numbers, they confirm staff members are expanding their knowledge of new techniques and therapies to better help those who do get infected. Just months ago, Taher says, MercyOne health care workers had limited knowledge of what to expect.
“I can tell you, compared to the first wave of COVID, we didn’t know much about it,” Taher says. “We’ve seen way better outcomes compared to that time. We are treating differently, though. We are using intubation and ventilators as a last result. At first, everybody was doing intubation right away.”
Looney says another technique that has gained importance is putting a patient in the prone position, basically flipping them onto their stomach so the lungs are more efficiently aerated.
“Proning is not anything new,” she says. “I’ve seen studies from the 1980s. It had been saved for the sickest of the sick and used to be saved for those on a ventilator.”
But while it is greatly beneficial for treatment, there is a drawback.
“The problem is it’s not very comfortable,” she explains, adding that having a patient on their stomach for 16 to 18 hours at a time is the best. “If we can get a few hours it helps. We try to make the patients as comfortable as possible and do it as much as they will tolerate.”
While progress is being made in finding supportive treatments, Taher points out there are a lot of unknowns as to a patient’s future.
He asks out loud whether a patient can recover and then get it a second time. “There’s no guarantee that if you get the virus that you’re not going to get it again,” he says. “Nobody knows yet.”
And what about any residual damage after recovery?
“We don’t how this virus acts in the long run,” he says. “The one who is recovered and feeling great – is he going to have any long-time cardiac illness? Is he going to have heart failure or lung fibrosis? We don’t know. We have to treat what we know and still try to avoid the illness. Your problems are not resolved until we know for sure.”
That can be years, he points out.
His hope is that people will work hard to prevent getting COVID-19 in the first place.
“The most important message is that although we are showing a lot of improvement and outcomes, and much better results, it still is a deadly illness, a very extremely serious illness,” Taher says. “We have to take it very, very seriously.”
“Having better understanding and better outcome and better treatment does not mean to relax on using the mask or socially distance,” he says. “Avoid big gatherings, hand hygiene, isolate yourself if you ever have any symptoms – these really are more important than any treatment. Because you never know who is going to get it, who is going to end up on the ventilator and not do well.”
He also is urging patients who have recovered to donate plasma through consecutive appointments set up through the Mississippi Valley Regional Blood Center, which can be reached at (833) 610-1025. Those donating must have had an initial positive molecular test result for the SARS-COVID-2 Virus, be recovered for 28 days (or 14 days if a negative test has been performed by a care provider) and be at least 17 years old.
“Try to save someone’s life and donate plasma,” he said. “Just pay back the favor and try to save someone’s life.”
He also has a word of warning.
“We knew in general, the older the population, and the more the co-morbidities, the more poor outcomes and the more of a chance of being admitted to the hospital and the higher the mortality,” he says. “We knew this on Day 1 of the coronavirus. That does not mean that if you are young and healthy that you’re not going to get it, that you’re not going to get sick.
“We saw this in New York and Italy and these other places; they were young and healthy and they still did not survive. Knowing the illness does not mean to not be scared of this illness, because it’s a deadly illness.”