Doctors Develop a Protocol for Identifying and Treating COVID-19 Cases Likely to Be Most Serious

With growing numbers of severe COVID-19 patients in need of limited numbers of ventilators, the health care system has struggled to answer a two-pronged question.

How to identify which new cases will lead to respiratory failure, and how to treat it?

Doctors at a San Fernando Valley hospital have developed protocols for both that focus on tracking key protein markers.

“If we follow these protocols, I am 100% sure we can keep patients from having to go on mechanical ventilators,” said Dr. Tom Yadegar, MD, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center, and the protocol report’s principal author.

Early on as COVID cases began appearing, Yadegar realized he had fo find an explanation for the sudden condition deterioration in some cases, while other remained relatively mild.  A growing body of global medical literature–including papers that Yadegar cites in his–suggests that in the more severe cases, the most devastating damage is caused not by the virus directly, but by the response of the patient’s own immune system at an extreme level known as a Cytokine storm.

Yadegar said in those cases reigning in the immune system takes precedence over the virus.

“The way to treat it is to suppress the immune system,” said Yadegar, aware of how counter-intuitive that would seem. “If you can disarm this aspect of it, you can save thousands of lives.”

Yadagar does caution that physicians must test for opportunistic infections and other maladies that could become grave threats if the patient’s immune system were suppressed. 

Among the score of markers that treating physicians can monitor, the study recommends when evaluating new COVID-19 patients, physicians focus on levels of the protein ferritin as a predictor of affliction with Cytokine Storm.  Levels of C-reactive protein provide a measure of the success of treatment with immunosuppressants.

Based on Yadegar’s experience, one drug tried as a COVID treatment, hydrochlorquine, is not a powerful enough immunosuppressant to be effective in more severe cases, he said.

Yadegar is trying to make the newly developed protocols available to other doctors and hospitals as quickly as possible. The usual path is through publication of peer-reviewed papers in medical journals, but as Yadegar notes, these are not normal times.

“The most important thing for me is to get this to the doctors on the front lines,” Yadegar said.

On “COVID-19 Cytokine Storm: Identification and Treatment,” Yadegar collaborated with Shahin Delkhah, M.D.,  and Katherine G. Jacobson. They intend to submit it for publication, but in the meantime are making it available online to speed its distribution.

Source: NBC Los Angeles