1 year later, Manitoba doctors explain how they're treating COVID-19

Dr. Anand Kumar remembers what it was like treating some of the first patients with COVID-19 in hospital in Manitoba.

"All of the same things that I might have used to describe H1N110 years agoin terms of the patients coming in extremely ill, unable to get their breath, turning blue, having to immediately go onto ventilatorsit was all very, very similar," said Kumar, a Winnipeg intensive care physician and infectious disease specialist

"It's just the numbers with COVID-19 were just so much more substantial and so much more frightening."

One year later, he's seen how treating COVID-19 patients has evolved. That includes when patients are put on a ventilator, and how clinical trials some of them done here in Manitoba have helped determine which drugs to use and when.

"If you look at the numbers that were published early on, to the numbers that we're seeing now for survival, it's markedly improved," said Kumar.

Ventilator useshifts

One of the things learned early on in the pandemic was when to use a ventilator.

"We saw that a lot of patients would tend to deteriorate relatively quickly and so we were intubating them right away," said Kumar.

"Now part of that was also because of the concern about the spread of infection, that is to say that once you have them intubated they're not coughing so much and they're less likely to spread it to other people."

He said that a lot of patients with COVID-19 put on a ventilator were unable to be taken off of the mechanical breathing machines and died.

WATCH | How treating COVID-19 patients has changed in the last year, according to Dr. Anand Kumar:

Manitoba doctor talks about treatments for COVID-19 patients in hospital

4 years ago

Duration 4:21

Dr. Anand Kumar explains how treatment for COVID-19 has changed over the last year.

Different techniques were developed to help oxygenate COVID-19 patients, and while ventilators are still used, they are a last resort, according to Kumar.

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Doctors discovered that simply changing the position of the patient in bed putting them on their stomachs instead of their backs made a big differencein their oxygen levels.

"So that became very much a standard of care, and early intubations became something of the past," he said.

More treatment options

Kumar saiddoctors have also used a device called a membrane oxygenator to oxygenate a COVID-19 patient's blood outside the bodywhile they are on a ventilatorto try to give their lungs a chance to recover.

Fighting COVID-19also comes down to discovering which drugs can help a patient get better.

A steroid called dexamethasone was introduced early on and is now being used more often,Kumar said.

"Back in 2009, we actually found that steroids were not good for influenza pneumonia and so the inclination with COVID was initially to go away from that," said Kumar.

"Some people thought it might be well to test it because COVID is a different virus and it may act differently and so it was tested ... steroids, dexamethasone in particular, were shown to be helpful in people who progressed to the point they needed intubation."

Kumar referred tothe blood thinner heparin as a game changer in the treatment for COVID-19. That's where Winnipeg hematologist and critical care physicianDr. Ryan Zarychanski comes in.

"When we knew we were in the midst of a pandemic with no specific therapies, obviously there was quite an imperative to move quickly," said Zarychanski.

Zarychanski said Manitoba has been involved with a number of clinical trials in the last year whether it's been by developing them, launching them or participating in them.

There was a point, he said, that he was involved with seven clinical trials related to COVID-19, happening in Manitoba at one time.

A global study led by Zarychanski has shown a benefit to giving hospitalized COVID-19 patients a full dose of heparinwhich also has anti-inflammatory propertiesbefore they get critically ill with the disease.

COVID-19 has led toinflammation in the organs of some patients, which can result in complications such as stroke,lung failure andheart attack.

The study, which involved more than 300 hospitals acrossfivecontinents,showed 20 per cent of patients given the full dose of heparin required ICU admission, compared to about 30 per cent of those who received the smaller dose.

"We have shown that an inexpensive, widely available drug can reduce mortality and progression to ICU," Zarychanski said.

Zarychanski said that some of the clinical trials, such as one done with hydroxychloroquine, can also show when drugs don't work. That benefits patients too.

WATCH | COVID-19 clinical trial models could shape how these trials are done in the future:

Manitoba doctor explains how clinical trials involving COVID-19 could shape future research

4 years ago

Duration 1:31

Dr. Ryan Zarychanski explains how the model used for clinical trials involving COVID-19 could shape future studies.

"We had all this early faith in hydroxychloroquine and other drugs that people just thought might work," said Zarychanski.

"If we didn't do those studies, we'd still be using them right now. We'd think we were doing good when it turns out we weren't."

Zarychanski said the workdone to understand how to treat COVID-19 in the last year has been incredible.

"It's inspiring and it's never been done before," he said.

"It will change the way we do clinical research forever. I think that we've shown the importance and the practicality, really, of embedding clinical research into clinical care each day. "

Health Canada has now approved fourvaccines for use against COVID-19, and Manitoba's timeline suggests that anyone who wants a vaccine will be able to get one by the end of June.

WATCH | Doctors discuss next steps in research, patient care and long-term impacts of COVID-19:

Manitoba doctors talk about what's next for COVID-19 research and patient care

4 years ago

Duration 2:07

Dr. Anand Kumar and Dr. Ryan Zarychanski say there's still much work to be done when it comes to research and developing treatments for COVID-19.

Butboth Kumar and Zarychanski said that research about COVID-19won't be stopping any time soon.

"Two residual questions in my mind are where's the specific anti-viral medication that works ...for this specific virus," said Zarychanski, adding the other is looking at the consequences forthe body after someone has been sick withCOVID-19.

"We're going to be dealing with COVID and its manifestations for years to come," said Kumar.

He, likeZarychanski,predicts research will start to look at long-term health impacts of COVID-19 and how to treat them.

He also said it's unknown what role COVID-19 variants will play in the coming months.

Manitoba doctors explain how they're treating COVID-19, one year later

4 years ago

Duration 2:54

A Manitoba ICU physician and infectious disease expert says while vaccines against COVID-19 are becoming more widely available research around COVID-19 continues.