The evolution of COVID-19: 4 leaders talk symptoms, treatment & clinical trends

As the U.S. enters winter, four clinical leaders reflected on COVID-19 patients, symptoms and clinical trends. 

Becker's asked the four clinical leaders: Does COVID-19 look different clinically now compared to spring?

Note: Responses have been edited lightly for length and clarity.

Debi Pasley, RN, system senior vice president and chief nursing officer at Christus Health (Irving, Texas): Our hospital CNOs report that more patients are being treated at home and that a lower percentage of hospitalized patients are requiring critical care and ventilators than in early spring. Currently, however, the numbers of cases in the states we serve are high, leading to higher numbers of hospitalized patients. The overall hospital acuity is currently elevated due to the higher concentration of COVID-19 positive patients in the admitted population. The ability to adequately staff healthcare professionals and other personnel is increasingly challenging. Texas Regional Advisory Council's provision of nurses and other professionals through agreements with governmental and staffing agencies has been critical to our efforts in the state. 

Scott Lethi, RN, chief nursing officer at Cookeville (Tenn.) Regional Medical Center: PCR testing is still the standard. Symptomatology now seems to be less GI/generalized, and instead more respiratory-based and affecting a younger population, with some requiring short hospitalizations for oxygen support. We've seen an uptick in elderly patients from skilled nursing facilities, with the virus rates in some facilities very high and the belief that these infections were acquired via staff or visitors. 

Treatment has been the same over the past months, except we are now giving bamlanivimab, an antibody drug, to early-stage patients who meet requirements from the community. We haven't seen a positive impact from convalescent plasma infusions for intensive care unit patients.  

Laura Jill Rose, RN, infection control manager at Blount Memorial Hospital (Maryville, Tenn.): I'm not sure if the symptoms have changed or if we are just more aware of them now. We see a lot of diarrhea, deep vein thrombosis, headaches and heart issues associated with COVID-19. The high fever we originally thought was a big indicator of the virus is not always present either. 

Ulysses Wu, MD, system director of infectious diseases, chief epidemiologist and chief antimicrobial steward with Hartford (Conn.) HealthCare Medical Group: Different is a tough word. We've always known the colder weather would drive people indoors and increase transmission. Compared to March and April, a lot of people aren't scared anymore — I think they see a lot of people who get better. The people dying from COVID-19 aren't right in front of them, even though we're losing the equivalent of people we lost from 9/11 every day. A relatively small number of people don't believe the virus actually exists, but a larger number of people believe the measures taken to slow the spread are too dramatic. A large number of hospitalized COVID-19 patients we're seeing now fall into that group, or anti-maskers. The virus itself hasn't changed much, though there are a few different strains we know of. What's changed is the public's behavior.

We're better at treating the disease now, with more experience, though what we know is still just the tip of the iceberg. There are still very few drugs that work well for everyone, but we've learned more about the course of the disease and have been able to administer medications more effectively.

In March and April, we were ventilating a lot more people than we normally did. We probably intubated COVID-19 patients a lot sooner than now — we've realized  noninvasive interventions are probably better for most. Now there's more testing and positive cases, so I'm not sure if the number of people ventilated has really dropped that much, or it just seems like less because there are so many more cases. We also have more ventilator supply and capacity than the spring, so all those things could be factors. 

The most common COVID-19 symptoms we're seeing are shortness of breath and a dry cough, followed by fever, myalgia and malaise.  

What to expect is all dependent on our behavior. We clearly saw a post-Thanksgiving surge.  About a week after the holidays, we typically see cases increase, then hospitalizations rise another week later, and rising deaths the next week. Using that logic, I think there will be some COVID-19 peaks in mid-January. The vaccine is not going to blunt any of this right off the bat, but I'm hoping by late summer there may be some sort of normalcy. 

More articles on clinical leadership & infection control:
Nurses: The most trusted professionals in America
26 states where COVID-19 is spreading fastest, slowest: Dec. 23
Trump requests changes to relief bill; US secures 100M more Pfizer doses — 5 COVID-19 updates


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