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Hospital releases COVID-19 patients after steroid treatment
Four patients diagnosed with COVID-19 occupied beds in the intensive care unit at Frio Regional Hospital in Pearsall last week, and all were released within days of receiving an innovative treatment for their restricted breathing due to lung inflammation.
The highly contagious coronavirus that has spread across the United States has claimed more than 137,000 lives since January, according to the Centers for Disease Control, and Frio and La Salle counties have not been immune.
At the beginning of July, officials in both Frio and La Salle counties reported that local residents had died from the coronavirus. While those reports came from county authorities, an updated online COVID-19 website in Frio County had yet to confirm the statistic by mid-month.
As of Sunday, July 12, the Texas Department of State Health Services was reporting that Frio County had 336 cases of the coronavirus. The agency reported 76 cases for La Salle County.
Among the symptoms of the coronavirus is an aggressive inflammation of lung tissue, making it almost impossible for patients severely afflicted to breathe without a mechanical ventilator. In many cases, patients have failed to recover after being attached to ventilators.
Other medical issues related to COVID-19 are serious gastro-intestinal illness, body aches and extreme fatigue.
At Frio Regional Hospital, CEO John Hughson said in an interview late Friday, July 10, that physicians have used corticosteroids on patients with serious viral infections in their lungs. Those patients, he said, had been released on Thursday and beds in the hospital’s ICU were emptying.
Hughson indicated that at least two coronavirus patients in the hospital “appeared to have recovered completely” from the effects of the virus related to their lung inflammation.
Hughson stopped short of describing the treatment as a cure-all for the virus and said state- and nationwide media reports touting the use of the corticosteroid budesonide (commercially branded as Pulmicort) contained what he and other hospital staff are describing as ‘generalizations and exaggerations.’
“This is not a miracle cure,” the hospital CEO said, and was joined in an interview by Frio Regional Hospital’s Dr. Samer Arab in describing the use of corticosteroids as ‘a treatment for the restricted breathing associated with COVID-19.’
“We do not want people believing that the virus is defeated,” Hughson and Dr. Arab said. “We cannot make promises like that.”
Hughson said Frio Hospital staff took action in treating patients with corticosteroids after a West Texas physician indicated his use of budesonide had proven effective for treating coronavirus patients. That physician, identified in cable newscasts as Dr. Richard Bartlett of Odessa, later gave an interview announcing that Frio Hospital’s ICU beds were empty after patients had been treated with steroids. Dr. Bartlett also credited Frio Regional Hospital Chief of Staff Dr. Oscar Garza with taking the innovative step of prescribing corticosteroids to COVID-19 patients and finding the drugs effective.
“Corticosteroids are used mainly for asthma and COPD patients,” Dr. Arab said Monday, July 13.
Asthma treatment drugs are delivered through the airways, usually with a form of inhaler or nebulizer. Physicians describe them as effective in opening the airways and reducing the restriction on the lungs, making it easier for patients to breathe.
“It is important to note that corticosteroids are not effective in eradicating the virus,” the hospital CEO said. “This is not a cure for COVID-19. This is a treatment for one of the effects of the virus on the human body.”
“I’m not afraid of COVID-19 anymore,” Dr. Bartlett said in an interview on a national cable news network. “The silver bullet is the inhaled steroid.”
Hughson said in a telephone interview on Monday that he speaks on behalf of all physicians at Frio Regional Hospital in describing Dr. Bartlett’s statements as attention-grabbing.
“Dr. Bartlett has taken a very extreme stance, which we believe is misleading,” the hospital CEO said. “Budesonide is certainly not a cure.
“Dr. Bartlett insinuated that we were on board with his ‘silver bullet’ theory, and we do not take that position,” the hospital’s chief executive officer said.
Physicians at the hospital said they have incorporated budesonide in a broad battery of treatments aimed at relieving the worst effects of the coronavirus and shortening the length of time that patients may spend in the intensive care unit.
Andrea Malcolm, certified registered nurse anesthetist (CRNA) at Frio Regional Hospital, said Monday that the facility was ‘maxed out’ when four of its ICU beds were occupied last week. She noted that the majority of patients treated at the hospital have come from a similar demographic, namely men aged between 50 and 74, most with cardiac disease and diabetes, and many being overweight. These, she said, are patients who are considered at the highest risk of falling victim to the worst effects of the virus.
Malcolm said that hospital staff were able to record improvement in each of the hospital’s ICU patients within 36 hours of beginning budesonide treatment.
“One patient was in very serious condition and could have been intubated for a ventilator in a short time,” Nurse Malcolm said. “The three others began the therapy and were soon transferred out of intensive care. They were later released.
“These were Dr. Garza’s patients,” the nurse anesthetist said. “We began budesonide therapy on Tuesday evening. We saw improvement after the first treatment. One patient was a complete turn-around.
“We went from transferring and intubating a high number of people to none,” Nurse Malcolm said. “Since beginning the nebulizer treatment, we have not intubated anyone.”
Intubation involves the insertion of pipes into a patient’s airways in preparation for attachment to a ventilator. It is not required for therapy with budesonide.
Frio hospital staff are concerned about the number of intensive care bed spaces available at the facility and have converted a delivery room into a ‘negative pressure’ space for virus patients, thereby ensuring that no airborne contaminants are distributed to other areas of the building. In the event of a surge in the number of coronavirus cases in the area, however, Hughson said he and physicians have concerns about the hospital’s capacity.
Dr. Bartlett said in the cable news broadcast last week that he believes patients may be treated with the corticosteroid at home, thereby avoiding a hospital visit. It is a point with which Hughson and Frio Drs. Garza and Arab agree, provided that the patient in question does not suffer from other serious medical conditions related to COVID-19.
“Various therapies have been studied in the United Kingdom,” Dr. Arab said Monday. “They have recorded improvement in their patients by using the corticosteroid dexamethosone, and they have shortened the ICU and hospital stay for patients. This is definitely helping, but we have no proof of this being a so-called silver bullet.”
Dexamethosone differs from budesonide in that it is delivered intravenously, such as by IV drip, while budesonide is inhaled. Dr. Arab describes the two as having similar benefits in relieving asthma and COPD.
Dr. Arab cautioned against any mistaken belief in the community that budesonide therapy represents an elimination of COVID-19.
“This is not killing the virus,” Dr. Arab said. “This is dealing with the inflammatory reaction. This will not help with diarrhea and vomiting.
“We may see that Pulmicort used at home is effective with an inhaler or nebulizer, when patients are stable enough to avoid going to hospital,” Dr. Arab said. “This helps lower costs, and it helps protect hospital staff and others from contagion. It is an assistive treatment with others.
“We have seen some success with other drugs,” the doctor said of the wide spectrum of treatments that are deployed to combat the effects of the coronavirus, although none so far have eliminated the virus itself. “Mostly, everybody is in agreement that some are effective. We are learning more about the virus every day.”