How intensive care physicians treat critically ill COVID-19 patients has come a long way since Canada treated its first patient in hospital in January.
“All the things that we were doing were merely supporting the failing lungs through the use of oxygen or ventilators,” said Dr. Daniel Niven, an intensive care physician and an assistant professor at the University of Calgary.
More than six months later and thanks to a flurry of international research, some new therapies have emerged. In recent weeks, doctors say an anti-inflammatory steroid, dexamethasone, has become standard care in intensive care units across the country.
“Prior to the last few weeks, you might have only had about 50 per cent of doctors using steroids in patients with COVID-19 lung injury. Now I would say almost 100 per cent of doctors are using steroids in the population,” said Dr. Bram Rochwerg, an intensive care clinician and researcher at McMaster University in Hamilton.
In the race to find new therapies to fight the new coronavirus, one of the biggest advancements came in mid-June. That’s when a team of researchers from the University of Oxford released research that found the cheap and readily available steroid drug could help COVID-19 patients who were being treated in hospital.
In a trial of 2,104 patients who received either low-dose dexamethasone or usual care, dexamethasone reduced deaths by one-third in patients who required ventilation and one-fifth in patients who required supplemental oxygen.
The researchers found no effect on patients who did not require respiratory support.
“We’ve gone from not using steroids routinely to everybody who has COVID and is in the ICU is getting dexamethasone,” said Dr. Niall Ferguson, a critical care physician with the University Health Network in Toronto.
A second therapy, an anti-viral drug called remdesivir, has also shown promise after two major clinical trials.
“It’s a drug that’s not used for anything else currently. They looked at it for Ebola and some other viral illnesses and it was investigated in the seeing of COVID in a couple of large trials, one done in the United States and one in China,” said Rochwerg.
The trials found evidence that remdisivir can shorten the duration of illness in critically ill patients and reduce the risk of death. However, the drug was only recently approved for use in Canada to treat COVID-19.
“At the beginning of the pandemic we were using it on special access permit but it took many days to obtain so it really wasn’t practical,” said Niven. “Now with the Health Canada approval, it’ll be interesting to see its use. There’s a greater benefit with dexamethasone so might the two in combination produce even greater benefit, I think, that’s the next question.”