Editor’s note: This is the last of a three-part series
With the calendar now changed to 2021, good news may be on the horizon regarding the COVID-19 pandemic.
Just not immediately, according to Dr. Frank Gaudio.
“Cases and deaths will continue to rise until we have some aspect of herd immunity, which means 70 to 80% of the population needs to be immunized,” he said. “That’s when we’ll truly get a respite from this problem.”
Gaudio, a physician with more than 45 years of experience in emergency medical services, shared his expertise as part of the municipality of Bethel Park’s Live Well speaker series.
Of course, the path toward immunizations for hundreds of millions of Americans has started with the U.S. Food and Drug Administration’s authorizing two COVID-19 vaccines for emergency use. Gaudio, an Upper St. Clair resident, said two more are in the final phase of clinical trials.
Being administered now are the Pfizer-BioNTech and Moderna vaccines, both of which require two doses for peak efficacy. Each contains genetic material intended to trigger an immune response against the coronavirus.
Still in the trial phase in the United States is a vaccine developed by Oxford University and multinational biopharmaceutical company AstraZeneca. Already approved for emergency use in several countries, the vaccine is expected to be available to Americans in the spring.
Also undergoing trials is a single-dose vaccine under development by The Janssen Pharmaceutical Companies of Johnson & Johnson.
“They likely will all work about the same. They’re all very effective, and whichever one you can get first is likely the way to go,” Gaudio said. “Concerns will be: Is there enough to go around? How are we going to get the distribution done? And will people actually want to take the vaccine?”
While officials on a multitude of levels attempt to address such considerations, healthcare professionals continue to be tasked with the responsibility of treating COVID-19 patients, often under less than optimal conditions.
In that context, Gaudio reiterated the need for everyone to take precautions such as social distancing, wearing masks, cleaning frequently and practicing exemplary personal hygiene.
“Why do we do this? Because if we don’t, we get a spike. And when we get a spike, we run out of beds. We run out of ICU beds,” he said about hospital intensive care units. “We run out of ventilators.”
Breathing difficulties often accompany cases of COVID-19.
“Most of the patients, once they start to become very ill, have problems oxygenating. In other words, they don’t get enough oxygen into their body through their lungs that they need to sustain their vital organs,” Gaudio said. “And when that happens, you feel short of breath. You feel fatigued. You run into problems with your heart and kidneys.”
A relatively simple remedy is for patients to be placed on their stomachs, rather than have them lie on their backs, which “seems to improve the oxygenation dramatically,” he said.
Among the treatments granted emergency use authorizing by the FDA is administering the antiviral medication remdesivir.
“They did not find that it caused fewer people to die when they got the medication. What it did do is it shortened the hospital stay, and the less time you spend in the hospital, the better it is for most patients,” Gaudio said.
“Another approved treatment is a very old medication called dexamethasone, which is a steroid,” he continued. “When that medicine was used in patients who were sicker, it did decrease mortality.”
Other medications also are available to treat various symptoms, but their effectiveness varies depending on the conditions of individual patients.
“These really need to be done according to some kind of protocol. Whenever we find it just being used at a whim, it doesn’t do any justice to the patient. It doesn’t do any justice to figuring out whether or not this is something we should do,” Gaudio said.
“All of this really needs to be data-driven. I understand and I sympathize with people who are very ill, and they’re looking for whatever might work. And they might have the opinion of, I don’t care if it doesn’t work,” he said. “But really, some of these will actually have more of a negative effect.”
Emergency departments – such as Washington Health System’s, where Gaudio works – may opt not to admit people who display relatively mild COVID-19 symptoms and have conditions at home that allow them to quarantine at a safe distance from others for a sufficient period.
Gaudio provided a general time frame: “If you’re in isolation and you’re COVID-positive, 10 days after you’ve had your first positive test and you’ve got no subsequent symptoms, you’re safe to go.”
He said, though, guidelines related to the coronavirus are subject to frequent change, as more is learned about the disease and the battle against it, at the heart of which are actions by individuals.
“When we social distance, when we wear masks, we flatten this curve. Then we have enough beds in the hospital to take care of people,” he said. “And we have enough time to develop a safe, effective vaccine or two or three or four.”