Today’s hefty Grand Rounds discussion may have been harder to follow for viewers of the popular series who do not have a medical background or are unfamiliar with medical jargon. Still, it offered important information for those willing to look up terms like “fantasmia” or what, exactly, dexamethasone is.
Chock-full of various studies surrounding COVID-19 treatment and prevailing symptoms in some patients, the presentation showed there may be light at the end of the tunnel for COVID-19 patients. Some promising drug treatments have appeared, but they’re not perfect. And other studies have shown that COVID-19 symptoms endure in some patients long after treatment is finished.
To kick off the discussion, Associate Professor of Medicine at UCSF’s Division of Infectious Diseases Sarah Doernberg delved into an analysis of what she called the “elephant in the room:” dexamethasone.
On June 16, the chief investigators of a UK study called RECOVERY (Randomised Evaluation of COVID-19 Therapy) issued a press release of their findings on the steroid’s ability to treat COVID-19. Buried in these results, Doernberg said, were the findings that overall, there is about a 17 percent survival rate increase for the 2,104 COVID-19 patients who were given dexamethasone versus the 4,321 patients who were not. The patients on mechanical ventilators experienced the greatest survival boost.
Now, before patients or the paranoid rush out to get their hands on a drug that Grand Rounds moderator Dr. Bob Wachter said “costs pennies, that has relatively low side effects for short term use,” they should note that patients who did not require oxygen or ventilators did not see a benefit from dexamethasone use. Doernberg was hesitant to proclaim these drugs the cure-all as the full data and study have not been released yet. When Wachter asked her about the cost of waiting to implement the use of a potentially life-saving treatment, she emphasized caution and preferred a case-by-case assessment for use.
Another study of note that was conducted by the same group also found hydroxychloroquine to be an ineffective treatment, the group announced on June 5 via press release. Neither study has undergone peer-review yet.
“Long haulers” and lingering symptoms in COVID-19 patients
The next few speakers discussed what those who recover from COVID-19 (with or without the help of dexamethasone) may have to endure once they finish fighting for their lives.
“We have talked about many of the surprises in COVID,” Wachter said, listing off several discoveries unearthed in recent months regarding COVID-19. The latest surprise? “A fair number of patients who make it through the acute phase of the illness continue to have lingering symptoms for weeks and sometimes months.”
Two of the panelists, both trained healthcare workers who were infected with the coronavirus, described an array of symptoms that they have been unable to shake through their several-month-long recoveries. Dr. Coleen Kivlahan, executive medical director of Primary Care Services at UCSF Health and professor of family community medicine, described “persistent perception of smelling forest fires,” which she termed “fantasmia.” Kivlahan tested positive for 10 or 11 swab tests over the course of 97 days.
Another panelist, Cliff Morrison, is a former nurse manager at Zuckerberg San Francisco General Hospital who now works as an administrator at a health care facility. He also experienced symptoms for an extended period of time — more than 10 weeks now — that sounded less-than-typical.
“My memory is just shot,” Morrison said. “I can’t remember people’s names, I forget detail, I had to relearn to use my computer. I was surprised at just how much from that cognitive standpoint that I felt that I had lost.” He also described experiencing a loss of appetite as well as intense cravings.
“My friends and colleagues were laughing at me. They said, you know, ‘you sound like you’re pregnant,’” Morrison said. “So that’s what I existed on— sorbet and watermelon.”
Researchers are trying to understand these symptoms: are they a direct result of the virus, or rather a product of immune response? Are they linked to certain age groups, genders, races, lifestyles?
Morrison is a participant in one of the studies discussed and hopes that it can help researchers understand why he is now having mood swings and experiencing depression since his diagnosis.
Studies look for insight regarding symptoms
Michael Peluso, a clinical fellow at UCSF who is working on the Long-Term Impact of Infection with Novel Coronavirus (LIINC) study, outlined several key questions the UCSF study is hoping to answer, including the prevalence of biomedical and psychosocial conditions from COVID-19 and if reinfection is possible. The study includes COVID-19 patients from diverse backgrounds, who are asked to answer detailed medical questionnaires and allow a variety of biospecimens to be collected at regular visits in the weeks and months following their recovery. Peluso noted that the study has found “a small but significant proportion of people who have persistent or recurrent symptoms” similar to Morrison’s.
Jeff Martin, a professor of epidemiology and biostatistics at UCSF, commented on the most important question regarding these symptoms moving forward.
“The question now is: just how frequent are these? Is this 10 percent? One percent? One in a thousand? Because we need to know this in order to tell patients what to expect long-term,” Peluso said.
The final speaker, Timothy Henrich, associate professor of Medicine and head of the Henrich lab under UCSF’s Division of Experimental Medicine, brought the discussion of ongoing symptoms to a microlevel, discussing the long-term effects that some pathogens can have after they are treated.
“Even when the pathogen has been treated appropriately with whatever anti-microbial or the virus is cleared, and there’s no evidence of replication, in a competent virus we can certainly see lasting immunologic, autoimmune or even neurologic symptoms that can persist for, again, weeks to months, if not longer, after some of these illnesses,” Henrich said.
Addressing why patients like Kivlahan might smell fire months after she was initially infected, Henrich guessed that the body has “a lot of different regulatory mechanisms” working in a “multifactorial process” that can be perturbed by this “very, very inflammatory, very invasive virus.”
In other words, the body is complicated and the virus is fierce.