As physicians and scientists learn more about the novel coronavirus COVID-19, the treatment methods have changed. After the initial pleas for ventilators started in Italy, then spread to New York, the call for the machines has slackened.
One reason is because treatments for COVID-19 have changed as doctors learn how it impacts patients, Dr. Fergus Peacock ’95 said. An acute care internist for Spectrum Health, Peacock said physicians are gathering information – almost in real time thanks to social media – as more and more patients are treated.
Based in Grand Rapids, Michigan, Peacock (notice the scar on his nose from wearing his N95 mask for long periods) is one of the doctors who sees COVID-19 patients when they are at their worst. They usually come through the emergency department and are sent to the intensive care unit, where he is stationed.
“We aren’t putting people on ventilators as early as they did in Italy,” Peacock said. While Spectrum Health reacted quickly to secure more ventilators, Peacock said the changing treatment options have also lessened that need.
Advances in testing for the virus have also advanced rapidly, making treatment decisions easier. When patients were first being tested, it was taking five days to receive the results. With the new tests, Peacock knows the results before the patient leaves the emergency department. Another test takes just a matter of hours for results to come back.
While the numbers in Michigan are staggering – more than 37,700 cases with over 3,300 deaths – Peacock said the majority of the cases are centered in the Detroit area, where his fiancée Christina Riggi works as a critical care nurse. Detroit, like New York, New Orleans and Chicago, has proven to be the perfect scenario for the virus to spread. It is a densely populated area of lower-income people who are already “just sicker.”
In western Michigan, the number of cases are lighter, especially since the stay-at-home order was issued. Intensive care units are now only seeing the sickest patients, he added. But Peacock said the expansion of testing and continued social distancing are needed.
That is because the COVID-19 virus is “elusive and sinister.” And, while Peacock doesn’t want to label the virus in human terms, there is no other way to describe it. What makes the COVID-19 strain of novel coronavirus so dangerous, he said, is the very randomness of how it attacks different individuals. That makes it difficult to trace.
“Two 40-year-old men in good health could be exposed, and one won’t show any symptoms and the other will need to be hospitalized,” he explained. Trying to say one age group is more likely to get sick than another is a fallacy. Each individual case is different based on the viral load and other factors. Some people who may appear well “are crashing in a matter of hours.”
Being a droplet virus, Peacock said COVID-19 follows a path similar to influenza. But that is where the similarities stop. Once it settles into a person’s lungs, it triggers an immune response that “overwhelms” the body. The resulting inflammation results in the breathing problems, severe joint and muscle aches, and fever. In the worst cases, Peacock said it can cause blood clotting, neurological problems, and eventually settle in the kidneys and liver.
“It really is an enigma,” he said. “It’s like nothing we’ve ever seen before.”
Widespread antibody testing needs to be done to see if people have been infected and recovered, Peacock said. Because the virus impacts individuals so differently, some people may have been infected and not considered it. Knowing that information on a wide scale would help doctors better understand how the virus travels, why some get sicker than others, and if the build-up of antibodies does actually lead to an immunity.
Developing a history on the virus and how to treat it is going to be important, Peacock believes, because people are going to have to learn how to live with it for at least a year. It will take that long to develop a successful vaccine, he said. And during that time, he predicts there will be a secondary outbreak after the social distancing rules are lifted.
“The potential for a resurgence is high,” Peacock said, “so we have to be careful about opening everything too soon. Because, if it comes around a second time, it could be much worse. We all have to be vigilant.”