CORONAVIRUS

University of Iowa seeking plasma of recovered COVID-19 patients, looking at new treatments

Hospital looking for treatments; flag soaring costs, lost revenue

University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo tak
University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo taken on Friday, April 18, 2014, in Iowa City, Iowa. (The Gazette)

IOWA CITY — University of Iowa Health Care is working toward potential COVID-19 treatments and is close to receiving the federal approvals it needs to use plasma from patients who have recovered to help those now hospitalized.

“So hopefully we can start bringing in some of the donors,” UIHC Vice President for Medical Affairs Brooks Jackson said Wednesday in a report to the Board of Regents. “I think many will be very willing to give some plasma that we can give to patients that are hospitalized to see if that can really lessen the severity of their disease.”

The concept is not a new one, Jackson said, reporting that UIHC has used the technique for “many other viral infections before with some success.” The hope here, he said, is to move COVID-19 patients out of the hospital and into the recovered column faster.

“I think we will be leading in Iowa in terms of these new treatment regimens,” Jackson said in reporting his campus is “very diligently looking” at treatments, with clinical trials already in place for one drug.

Jackson said UIHC is following about 70 patients, at least 33 of whom have recovered.

“It’s probably getting closer to 40 now,” he told regents. “And no one has died in the hospital of this disease here. But obviously, in other parts of the country, one can see very high death rates.”

Patient numbers

UIHC has cared for 13 COVID-19 inpatients so far, seven of whom have been discharged.

More than 20 UIHC employees have been infected with the novel coronavirus, although none are believed to have contracted the illness from a patient. More than half were exposed in travels and the others to ill family members and co-workers.

UIHC administrators expect a swell in patients in the weeks ahead and have developed a “surge plan” that involves conserving personal protective equipment; preparing for a potential spike in demand for critical care beds and ventilators; and postponing elective surgeries or conducting virtual visits.

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Jackson told regents that UIHC also is ramping up its testing capacity — rolling out its own test, in addition to testing available at the State Hygienic Lab. Plus, UIHC is using a newly available commercial test and the hospital has ordered another one.

“So our testing capability will be greatly increased over the next week or so, although we are meeting the demand now, in terms of our testing our symptomatic patients,” Jackson said.

Symptomatic patients, using telehealth tools and virtual visits, have been funneled through a UIHC influenza-like-illness clinic to keep them separate from other patients and workers.

UIHC has tested more than 1,000 patients so far, about 7 percent of whom found to have COVID-19.

Even with those small numbers, UIHC incident command staffers meet two to three times daily, seven days a week. As a result, the system has rolled out intense measures to deal with COVID-19 — including new patient, visitor and staff guidelines that have transformed the rhythm and feel of the campus.

Financial blow

The changes have cut about two-thirds of the campus’ surgeries, including all elective procedures, plus half of its clinic visits.

“But the coronavirus, even though we only have five or six inpatients and that (influenza-like-illness) clinic, is just an incredible amount of work to prepare for this epidemic,” Jackson said.

The primary driver of the reduction in surgeries is preservation of personal protective equipment, according to UIHC Chief Executive Officer Suresh Gunasekaran.

“We have dramatically reduced our on-site, in-person delivery of care to really ensure our staff’s safety and to reduce the spread of COVID in our community, as well as to keep the PPE consumption down,” Gunasekaran said.

With the loss of patients and additional spending to get more protective equipment, Jackson underscored financial concerns.

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“This is expensive,” he said. “Instead of paying 50 cents a mask, we’re paying $8 a mask, and it’s the lost revenue that is really the major financial issue.”

He estimated COVID-19-related cuts and expenses would cost “$45 million to $50 million a month at this rate.”

“So it is a significant issue,” Jackson said. “We’re all hopeful that within a couple of weeks or more, we will peak and start going down. But if it goes on for a long time, this will be a real challenge financially, as well as with the capacity to see lots and lots of patients.”

Following month after month of reporting nearly full occupancy rates, Gunasekaran said, UIHC is “nowhere near our regular 90- to 95-percent occupancy that we would normally have.”

That’s good news for Iowa, in that it has more capacity for a surge of COVID-19 patients — plus a plan to convert other spaces and equipment if necessary.

But the lost revenue could be compounded after the crisis passes by changes in how people can pay — or not — for the delayed health care they’ll need.

“What happens if you have a COVID patient surge, is patients that have chronic health care conditions and others get delayed and don’t get the access to care that they would have normally received and the actual catch up is a health care catch up as much as it is a financial catch up,” Gunasekaran said. “We may not be able to get back to only elective procedures. There may be pent-up regular UI Health Care stuff that needs to happen.”

UIHC administrators project its payer mix will shift to more Medicaid patients “as employees lose their jobs and as companies close,” further hurting revenue.

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“We have presently not identified anything that will increase revenue,” Gunasekaran said.

But that’s not the priority right now, he said.

“We’re making every single decision right now based on what is best for Iowans and what’s best for our staff,” he said. “We are spending a lot of money on PPE. We are not worrying about what we’re paying to get the masks. This is not the time for us to figure out other financials,” he said. “ ... But good news is we’ll be here on the other side to work through those issues.”

UI President Bruce Harreld said the campus is doing everything it can to capitalize on the aid available through the federal stimulus.

“There are significant opportunities here, not only for the university and for the health care system, but also for our students.” Harreld said. “And one of the issues we’re going to get into is how we allocate those moneys in an equitable and fair way.”

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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