For those on the front lines at The Medical Center at Bowling Green and TriStar Greenview Regional Hospital, battling COVID-19 each day brings new challenges.
Dr. Rebecca Shadowen, an infectious disease specialist with Med Center Health, said recently it takes a lot of work to care for patients, but that her team has been diligent in keeping up with rapidly changing treatments and options for patients.
Shadowen spoke to the Daily News before announcing last week that she tested positive for the coronavirus. She said she contracted the virus not at the hospital, but instead through community-acquired exposure after an elderly family member received care at home from an infected caregiver.
There are now at least 750 confirmed cases of the coronavirus in Warren County, including two deaths to date, according to official statistics. Gov. Andy Beshear has recently described the situation locally as a significant outbreak.
“In a situation where there isn’t real clear treatments, we’ve been able to meet what is a pretty good standard of care that is being done – not just nationally, but worldwide – here,” Shadowen said.
Shadowen said Med Center Health has been involved in National Institutes of Health trials. When the hospital isn’t able to do an NIH trial, it has done parallel trials with patients to give them cutting-edge treatments. She said some good outcomes have been seen so far, but the staff is still constantly learning.
“We have to spend a lot of time reading and a lot of time talking to people, plugging into what is being done everywhere,” Shadowen said. “We have a group of physicians and pharmacists and nurses that sit down once a week and review all the options. We look at the NIH trials that are being done across the world. We look at all the data that has been released.
“We discuss all the calls that we’ve been on and we make a decision based on what we think has good merit and what we think has good safety for our patients and what doesn’t. Then we implement those things to try to help the patient population recover as much as possible.”
Shadowen said much has been learned. For instance, the drugs hydroxychloroquine and vermectin have been used to try to slow the virus, while remdesivir has shown to be effective late in the disease, so doctors try to get it for patients who are critically ill. Shadowen said there is a national shortage of remdesiver, with the government controlling where it is dispensed.
Another form of treatment is convalescent plasma therapy, in which patients are given antibodies from someone who has recovered. Shadowen said this has been used quite a bit, with the hospital always looking for plasma donations from anyone who is 14 days out from being fully recovered or 28 days from the first positive test.
While not involved in any NIH trials, Dr. David Smith, Greenview’s chief medical officer, said the hospital has the ability to do trial-type medications and convalescent plasma if needed.
“So far, we have not had patients that have fallen into those categories and would require that,” Smith said.
Med Center Health is in an NIH trial for convalescent plasma, with all plasma going through the Mayo Clinic. Shadowen said the staff has a call list of recovered patients and is trying to get them to donate to help treat patients more aggressively.
Currently, anyone interested in donating plasma has to go to Louisville, but the Plasma Center on Morgantown Road will take donations for research Monday.
“The convenience factor is a big deal,” Shadowen said. “For most people who are trying to self-isolate, driving to Louisville is a big deal for them. If we can get people locally to go over to Morgantown Road and donate, that would be fabulous.”
Smith said increased data from this area could paint a clearer picture for medical staffs.
“I think we have high hopes that convalescent plasma will be an important mainstay in the future as far as treatment of people with the disease,” Smith said. “One of the things we are not 100 percent sure of – and that’s why they collect data on this – is whether some of the antibodies that would be present in convalescent plasma are actually neutralizing to the COVID-19 virus. There might be positive antibodies, but not necessarily neutralizing antibodies. That’s why these are studies.”
Though physical health is the main concern, mental health is an important part of the process as well for patients in isolation.
Med Center staff provides telehealth services, with rooms equipped with cameras to allow patients to talk to loved ones. Shadowen said there are iPads throughout the COVID unit that allows patients to FaceTime. Med Center Health also has a process for clergy to visit virtually and provides psychology counseling and physical therapy in the unit.
Greenview has the ability for patients to do Skype calls or Facetime on iPads with families.
“I think that is an area that shouldn’t be overlooked,” Smith said. “We do our best to try to make sure patients stay connected. ... That’s one of the things we try to do while still maintaining an isolation precaution for employees that don’t necessarily need to be in the room.”
While the fight continues, Shadowen said the flattening of the curve has given the staff critical time to learn new approaches to treatment.
“The longer we make this flattened curve a curve, there is more time for newer therapies to be shown whether they are effective or not,” Shadowen said. “There is more time for newer therapies, but the bigger issue is saving lives. If people don’t understand at this point that they need to be compliant with their mask wearing, their social distancing, their hand hygiene, then we have a real problem and people are going to die from that.”
Smith believes understanding of the virus is significantly better than it was two months ago.
“I think when it initially started, there was widespread speculations and some real concern that the health care system could be overrun,” Smith said. “We’ve seen that in some places. ... Italy was an example of that. New York City had some of that, although I don’t think it panned out as badly as it appeared it would be.
“We do the best we can to mitigate the spread, but this is a viral infection without a medical cure. We still have significant viral activity in our community. That’s not a secret. You watch the daily count and there are (more) cases. Now, most of those cases aren’t extremely sick and can be managed at home relatively easily, but there is still significant activity.”
Smith believes the public must continue to do its part as businesses and services slowly start to reopen.
“We are social animals, and so we need to be out and we need to be able to do things that we normally do,” Smith said. “We need to make sure that we adhere to precautions. We need to make sure that we maintain our distances. I think, for the benefit of all, people should be masked.”
Shadowen cautions that adhering to proper Centers for Disease Control and Prevention guidelines will be critical in continuing the fight against the virus.
“We have come a very long way and I expect us to continue to do so from a medical perspective, but there is no way that we can relax our social distancing, our mask wearing and our hand hygiene,” Shadowen said.