COLUMBUS, Ohio – During the Thursday COVID briefing, Ohio Governor Mike DeWine said that he “took an oath to do everything to protect the lives and wellbeing of fellow Ohioans” and that the next three weeks will be the most critical in battling COVID.
DeWine then stressed the importance of Ohioans understanding and keeping an eye on hospital capacity in their respective communities.
Following his opening remarks, The Ohio Star asked DeWine about hospital capacity and what hospitals and his administration are doing to alleviate capacity pressure.
Two-part question regarding hospital capacity.
First, hospital workers are an issue – healthy doctors and nurses, along with sick, are being quarantined. We’ve known for almost 10 months there’d be need for more labor and space now, both that were drastically diminished from early policy decisions. We’ve known we’d need to re-open closed wings, utilize temporary units we created in the beginning, and keep caregivers working. What are hospitals doing about the need for labor and space and how are you holding their leaders accountable since 94% of Ohioans are masking, 97% social distancing?
Second, you called President Trump early in the pandemic about Battelle and got their technology approved. Will you get on the phone with the president and demanded that federal authorities change protocol on therapeutic drugs that have been shown to deter severe effects of COVID when administered early and get them to people on an outpatient basis?
The answer from Dr. Bruce Vanderhoff, Ohio Department of Health (ODH) chief medical officer:
First with your question about hospitals. It’s a very good question. It’s a question our hospitals and health systems have been looking at from the beginning of the pandemic.
Early on the issue really was an issue that related to the space and supplies that we needed to be able to safely care for patients with COVID-19. We rapidly responded and stood up a whole variety of capabilities. The Battelle capability is one of the great examples. It’s an example of incredible innovation in Ohio, and incredible cooperation across the state and across healthcare organizations in the state working with industry – in this case, Battelle.
As we’ve moved forward, you’re correct. The issue really is not with the space. Our hospitals have been able to activate units, repurpose units and physical capabilities very rapidly. It’s really been an issue of personnel. Here’s the challenge. Healthcare personnel are not people you take off the street and put at the bedside. Preparing healthcare providers of all sorts of definitions requires a lot of training, a lot of preparation, certainly more than can be accomplished in a matter of months. Organizations from across the state from the beginning of this pandemic have been working with educational institutions to accelerate training programs. We’ve been looking at innovations in terms of safely orienting health care providers at the bedside, cutting time off of that by using some innovative models to ensure that we do that safely. I could go on and on.
The issue really is about helping to prepare a workforce but doing it safely as we do it rapidly.
In terms of therapeutics. There’s actually been quite a bit of work going on inside the state looking at how we can take therapeutics that have been clearly demonstrated, and approved by the FDA for use in the outpatient arena and applying it there, I point today as the best example to the two monoclonal antibody therapies, which are available in Ohio. Which are being utilized pretty broadly across the state. Those are the therapies the research has shown very clearly are best suited to the outpatient arena.
Some of the other therapies we are using in the hospital, unfortunately, the research points to primarily their impact on sicker, hospitalized patients. The one thing we’ve wanted to do is avoid getting ahead of the research.
The doctor’s comment that space isn’t an issue comes after DeWine said Monday, “heads of hospitals have told me, it is unsustainable at this level. So, we’ve got to not only slow it down from going up, we’ve got to begin taking it down.”
There was no mention from Dr. Vanderhoff about a quicker resolution than getting new health care workers trained-up – hiring back those that have been furloughed or laid off.
As one nurse told The Star “it’s cheaper for them to pay overtime than to hire back an additional worker when you factor in benefits.”
Regarding drug therapies to effectively treat COVID patients early in order to keep them out of understaffed hospitals, Vanderhoff failed to address the issue of getting more therapies in the pipeline by aggressive support, like that provided early on by DeWine on behalf of Battelle.
However, Vanderhoff did discuss the monoclonal therapies that can be administered in a single dose, intravenously on an outpatient basis, according to the U.S. Food and Drug Administration (FDA).
In the FDA Emergency Use Authorization (EUA) announcement on monoclonal antibodies, use is approved for those with high risk for progressing to severe COVID infection/hospitalization. The EUA reports that for “patients at high risk for disease progression, hospitalizations and emergency room visits occurred in 3% on average compared to 10% in placebo-treated patients.”
It is not clear how widely used the treatment is in Ohio.
Hydroxychloroquine (HCQ) and Ivermectin – the first with over 70 years of use, the second with about 40, have also shown efficacy, particularly when administered early.
In an October 5, 2020 article published in National Center for Biotechnology Information, a systematic review of studies found that HCQ is effective – and consistently so when provided early – for COVID.
The study’s authors concluded, “because HCQ is inexpensive and widely available, we believe that future treatment will and should focus on HCQ.”
The Star reported that it is unclear what Ohio is doing with its two million dose stash of HCQ.
Ivermectin, an anti-parasitic drug, has shown to be effective as a prophylaxis and early treatment for COVID, as reported by Healio.
According to the New England Journal of Medicine, Remdesivir has shown to improve recovery time from COVID by 33%, with a mortality rate of 6.7% of those studied who took the drug versus 11.9% of those who took a placebo. But this study was for those already hospitalized.
However, a group of Cleveland Clinic Florida doctors addressed the study in a letter and concluded, “much earlier administration of Remdesivir would achieve a greater effect on survival.” A study is currently underway on the efficacy in an outpatient setting, administered early in the disease.
The Star contacted the ODH to determine how readily available and how easily prescribed are the aforementioned HCQ, Ivermectin and Remdesivir but had not received a response by press time.
Watch the governor’s full address:
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