After 15 days of being sick with COVID-19 this fall, Jim Finley wasn’t getting any better. He followed his doctor’s advice, staying home, monitoring symptoms and taking over-the-counter pain medication.

Every day he would wake up and tell himself he was getting better, only to feel terrible by the end of the day.

“I was struggling so much, I couldn’t even hold a conversation on the phone,” said Finley, of Livermore.

Considering his age, 65, and symptoms – shortness of breath, loss of taste and smell, fatigue, 104-degree fever, neurological problems often referred to as “brain fog” and fatigue – doctors recommended he go to the emergency department. Once he checked in at Maine Medical Center in Portland in October, Finley’s odds of recovery were better than if he had caught COVID-19 in April.

Treatments for COVID-19 have improved substantially since the pandemic first hit Maine this spring, and hospitalized patients have a better chance of recovery.

“We’re in a very different place than we were in March, April and May,” said Dr. David Seder, chief of critical care at Maine Med. “You’re more likely to be much better off if you get a bad COVID-19 infection now than in May. The gut response is to throw the kitchen sink at the virus. But now we know which things help and which things don’t, and we are only employing things that help.”

Some of the changes include:

• New drugs have come on line, including steroids and anti-virals.
• Scientists have learned what is the optimal time during the illness to take the medications. Some drugs are better to take earlier in the disease’s progress, while with others it’s best to wait until later.
• New therapies have been developed, such as injections of antibodies and convalescent plasma.
• Scientists have also made improvements in supportive protocols, such as waiting longer to place patients on ventilators.

Researchers are still studying the mortality of COVID-19, and it’s difficult to compare last spring with the fall for many reasons, including that patients – even hospitalized patients – are now skewing younger and healthier. Treatments that have become more widespread include the steroid dexamethasone, anti-viral drug remdesivir and convalescent plasma infusions. And a new antibody treatment will become available in the coming weeks.

Since the pandemic began in March, 8,639 Maine people had fallen ill with COVID-19 as of Friday, 566 had been hospitalized and 162 had died. COVID-19 has surged this fall in Maine and throughout the United States.

COVID-19 cases among Maine people in their 20s and 30s have increased from about 20 percent of all cases in May to about one-third of all cases in November, according to data from the Maine Center for Disease Control and Prevention.

“It is true we are seeing more and more younger and healthier patients, but it is also true older patients with risk factors and underlying conditions end up not as severely ill because we have more therapeutic options,” said Dr. John Alexander, chief medical officer at Central Maine Healthcare in Lewiston.

The research on improvements in mortality for hospitalized patients with COVID-19 is still in the early stages, but the U.S. Centers for Disease Control and Prevention noted that 6.7 percent of hospitalized patients died in April compared to 1.9 percent in September. A study published in October in the Journal of Hospital Medicine found that age and how healthy patients were could not fully explain the drop, although more research is needed.

“We found that changes in demographics and severity of illness at presentation did not fully explain decreases in mortality seen over time. Even after risk adjustment for a variety of clinical and demographic factors, including severity of illness at presentation, mortality was significantly and progressively lower over the course of the study period,” according to the study.

Dr. Andrew Pavia, a fellow with the Infectious Disease Society of America who works in Salt Lake City, said in a conference call with reporters that two of the most common medications – dexamethasone and remdesivir – are “important additions, but they are not home runs. They are modest in terms of improvements we are seeing.”

He said hospitals overall are better prepared for COVID-19 patients, and know how to treat them.

But even with advancements in treatment, without a cure or a vaccine COVID-19 is still deadly to patients and can cause long-lasting health problems. These can include lung scarring, neurological problems and clotting.

Finley, the Livermore patient, checked into Maine Med on Oct. 5, where he quickly underwent a battery of tests and evaluations. A chest X-ray showed he didn’t have any clots in his lungs, which was a promising sign, as a common complication from COVID-19 is lung clotting and scarring. But he did have pneumonia in both lungs.

He received dexamethasone steroid medication and blood thinners. Despite having shortness of breath, his lung functioning was good enough that he didn’t need to be on oxygen.

He said within 12 hours, he started feeling better, which he partly attributes to the medications.

“By the early evening, I could feel myself starting to turn,” Finley said. Two days later, he was out of the hospital, with a seven-day prescription for dexamethasone. A week or two after that, he was mostly back to normal, although he said he is still fatigued.

Finley’s story is just one of many among the 6,248 Mainers who had recovered from COVID-19 through Friday.

Two of the more common medications include steroids like dexamethasone, which was given to President Trump when he fell ill with COVID-19 in October, and remdesivir, a drug that can prevent the virus from replicating.

Seder said the research is leaning toward giving dexamethasone to hospitalized patients in more situations compared to the spring.

“We went from not using it to using it in just about everyone (who is hospitalized),” Seder said.

Dexamethasone works by preventing an overreaction by the body’s immune system to the virus. The overreaction that occurs in some patients is known as a cytokine storm, and it can lead to permanent lung damage or even death.

The anti-viral drug remdesivir is also proving to have some benefits, Seder said, and studies are showing that it’s crucial to not wait too long to give patients the drug. Remdesivir can prevent the virus from replicating in the body.

“The overall data on remdesivir shows it’s most helpful in patients who are medium sick and who have not had an infection for very long,” he said.

Convalescent plasma is another option for hospitalized patients, said Alexander at Central Maine Healthcare, and he can think of one case recently where the plasma treatment helped a severely ill patient who may have died in the spring. Convalescent plasma – used for its potential anti-viral properties – received emergency use authorization by the federal government in August, but research on it is mixed.

Alexander said it’s also important that doctors have learned what doesn’t work in treating COVID-19.

For instance, doctors now wait much longer before placing patients on ventilators because they have proven to be of relatively little value until the late stages of the disease, and they can cause complications in patients. He said for patients on oxygen, Central Maine Healthcare learned through its own observations, combined with study findings, that high-flow oxygen is not as helpful to patients as lower flows of oxygen maintained consistently.

As the pandemic has gone on, and the supply of protective gear remains relatively plentiful in Maine, doctors, nurses and others treating COVID-19 patients have become more comfortable and less fearful. That has led to better rapport with patients and lower stress levels among health care workers, which in turn leads to better care.

“The fear of the unknown has really subsided as we’ve gained experience and understand the disease more,” Alexander said.

Finley, the former patient at Maine Med, said the nurses were relaxed and chatted with him about baseball and other topics. Restricted visitation rules during COVID-19 meant he couldn’t have visitors.

“The nurses knew how to take the few extra minutes to sit with me and talk,” Finley said. “It can get pretty lonesome in there.”

Dr. Nathan Mick, associate chief of Maine Med’s emergency department, said as nervousness about COVID-19 has declined, the ED has learned how to best stabilize patients to give them time to fight off the virus.

“A lot of this is good old-fashioned blocking and tackling of traditional intensive care medicine,” Mick said.

Most patients will recover without needing hospitalization. In Maine, close to 90 percent of patients with COVID-19 have not been hospitalized.

For non-hospitalized patients, most of the treatment involves staying home, resting, isolating from others and monitoring symptoms. A new drug, an antibody cocktail called bamlanivimab, developed by Eli Lilly, will become available to Mainers in the coming weeks. The drug is for patients who are not hospitalized but in danger of needing to be hospitalized, said Dr. Nirav Shah, Maine CDC director.

Erin Sandler, 43, of Scarborough typifies the patient experience for many. She contracted COVID-19 in October but never needed hospitalization or any medications.

“It was nerve-wracking, because you didn’t know how serious it was going to get,” Sandler said. She monitored her symptoms with Southern Maine Healthcare’s telehealth program, and struggled with loss of taste and smell, shortness of breath and fatigue. Sandler said she passed the time in isolation by having many Zoom calls with family and watching Netflix shows.

“I feel very lucky to have come out of this unscathed,” she said.

Patients with COVID-19 who are not sick enough to be hospitalized are increasingly being seen in walk-in and urgent care clinics, to separate potentially infectious patients from patients going to see their primary care physician.

Stephanie Gray, director of walk-in clinics for Southern Maine Healthcare, which is part of MaineHealth, said there’s a “subset of patients feeling miserable who are sick enough to need a medical evaluation but don’t need hospital-level care.”

Those patients can receive a number of services at the clinics, Gray said, including COVID-19 tests, vital sign evaluations, X-rays, influenza tests and nebulizers. A nebulizer can help patients with breathing difficulties breathe easier.

“This second wave of COVID-19 has given us a larger numbers of infections, but the infections we are seeing (at the walk-in clinics) are not as severe,” Gray said.

For Finley, the medications helped, but he also went into the hospital with relatively good health. He wasn’t overweight and didn’t have diabetes or high blood pressure. Yet despite all of the factors in his favor, recovery was not a sure thing.

“Nobody gave me false hope,” said Finley, who is now back to work part time at the funeral home. “It was all very reality-driven, very honest, and I appreciated that.”

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