CORONAVIRUS

Iowa hospitals, equipped with better knowledge of coronavirus, are confident looking to future of pandemic

But some officials worry about impact of delayed medical care on health systems

Blake DeMaria of Cedar Rapids has his temperature checked by receptionist Abby Hathaway before entering UnityPoint St. L
Blake DeMaria of Cedar Rapids has his temperature checked by receptionist Abby Hathaway before entering UnityPoint St. Luke’s Hospital in Cedar Rapids on Friday, Oct. 2, 2020. The hospital is still allowing only one guest per patient into the building, and visitors must have their temperatures taken and be symptom-free upon entry. (Rebecca F. Miller/The Gazette)
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After nearly seven months caring for patients infected with the novel coronavirus, Iowa’s hospitals are better equipped than ever before to take on the pandemic while resuming normal patient care.

Medical directors at hospitals in Eastern Iowa say their staff better understand the best strategies to help patients fighting COVID-19, which had been unknown to local providers until the virus first arrived in the state in March.

While some hospital officials say they are confident they can handle whatever the pandemic throws at them next, an official with the state’s largest hospital said the possibility that health care systems across Iowa and the United States could be overwhelmed is far from over.

And as it comes at a time when some residents are choosing to forgo public health safety measures — which are not mandated by state officials — another possible spike in new positive cases could present the same challenges it did in the spring.

In the past few weeks, Iowa has seen a continued rise in its positive cases. Spikes in recent weeks prompted Gov. Kim Reynolds to close businesses — namely those that serve alcohol — in Johnson and Story counties after hot spots in college towns this fall.

COVID-19 takes its toll on the body, doctors say. That’s particularly true for those placed on a ventilator. The process to regain strength and reach full recovery can take weeks or even months.

“What that means then is that those patients stay in the hospital much longer, and so they are utilizing beds longer,” said Dr. Theresa Brennan, chief medical officer at the University of Iowa Hospitals and Clinics.

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However, it’s not just about coping with COVID-19 as health care providers look to the future, according to Brennan. Other patients’ growing health concerns could contribute to an overworked health care systems as the pandemic enters the winter months.

Early on, in March and April, hospitals across the country suspended non-elective surgeries and delayed routine medical care in an effort to preserve beds and supplies.

If the pandemic had been a short term phenomena, delaying certain patients’ care could happen without dire consequences.

But as its gone on six months, it’s clear the pandemic will continue for some time, Brennan said.

“Those patients can’t delay their health care,” Brennan said. “So when we think about flattening the curve, it’s not just that we’ll have enough beds for patients who have been diagnosed with COVID-19. It’s having enough beds for those patients plus all the other patients who have a medical need.”

Doctors Are Better at Treating Covid-19 Patients

Now months into the novel coronavirus pandemic that has infected more than 90,000 Iowans since early March, physicians and other providers are intimately familiar with the care of these patients.

“Right away, we learned you don’t underestimate the virus, that it can move pretty fast,” said Dr. Dustin Arnold, UnityPoint Health-St. Luke’s Hospital’s chief medical officer.

One of the most significant changes in providers’ approach to infected individuals since the start of the pandemic is the use of the ventilator, a life-support machine that helps patients breathe, said Dr. Tony Myers, chief medical officer for Mercy Medical Center in Cedar Rapids.

Doctors from other countries initially were recommending American doctors put patients in a medically induced coma and ventilate them early. The thought was that it would help patients with low oxygen levels and would present less risk for viral transmission to health care providers.

However, providers learned very quickly that the health of patients on ventilators would deteriorate rapidly. Once a patient was on the life-support machine, it became very difficult to take them off, resulting in patients who were in comas for weeks — an unusually long amount of time, Myers said.

“Over time, it became very apparent that if we were using appropriate (personal protective equipment) and taking appropriate precaution — which we became good at right away — the risk to providers was very low,” he said.

Physicians instead moved to other forms of support to help patients breathe, including high-flow oxygen given through a mask.

Hospital officials emphasize there’s no magic bullet when it comes to medication to treat COVID-19. But they found steroids were an effective treatment option, despite the fact some early recommendations did not advise their use.

Hospitals’ chief medical officers say convalescent plasma also has shown some benefits, as has remdesivir, an antiviral medication.

Though an anti-malaria drug called hydroxychloroquine often was touted nationally, Myers said not many doctors locally used the medication to treat COVID-19 patients. There was a small study that indicated hydroxychloroquine would help, but, Myers said, “We as doctors do not respond to small studies.”

Recommendations from international and federal public health experts were changing rapidly, but doctors in Iowa had the benefit of communicating with colleagues in communities such as in New York, where the virus hit earlier in the year.

“Medicine is a small world,” Arnold said. “We do share best practices all the time, and we’re always talking to each other.”

The Questions Remaining

Not every question that providers have grappled with since the virus was discovered has been answered. Medical professionals and other scientists still are working to understand the long-term effects of COVID-19, for example.

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Thousands of individuals across the United States, including those in Iowa, say they still feel the effects for some time after they no longer have an active infection.

Sometimes described as “long-haulers,” these individuals are reporting lingering effects that last for weeks, including fatigue, shortness of breath and heart problems, among other symptoms.

Researchers nationwide are beginning to publish studies on the trend. Doctors at UIHC established a clinic for patients following a COVID-19 infection to study the effect of COVID-19 on the lungs and other parts of the body.

“We’ve learned a lot about that, and that would still be one place I think we have a lot more to learn,” UIHC’s Brennan said. “Those sorts of things will perhaps take months to years for us to better understand.”

Looking Ahead

Brennan said Iowa’s health care systems have made great learning strides in caring for actively infected individuals while keeping the medical providers around them safe.

Physicians also have been successful in enabling more patients to recover at home, Brennan said, which helps to offset the concerns of hospitals reaching capacity.

Frequent check-ins from care teams to ensure patients are hydrated and moving around “is very helpful in keeping people out of the hospital.”

But in cases in which patients do need to go to a hospital, officials say their staffing levels and stock of necessary supplies, including personal protective gear, is in a better place than it was in March. Now that the international market of supplies has recovered, hospitals can meet all future patient demands without delaying elective care.

“We have good plans in place, they’ve been tested, and I feel confident,” Arnold said.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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