COVID-19 cases have doubled at Life Care Center of Hilo, and one resident has been hospitalized at Hilo Medical Center, where that person is undergoing a new coronavirus treatment protocol.
As part of the new protocol, HMC is proposing to bring some long-term care residents who are newly diagnosed with COVID-19 to the hospital for a five- to seven-day treatment course that includes antiviral and convalescent plasma treatments and immune support with vitamin D, vitamin C and zinc, according to HMC Chief Medical Officer Dr. Jon Martell.
After treatment, if the patient is doing well, they will return to their long-term care facility.
Martell said those in long-term care facilities are the most vulnerable to COVID-19, for a myriad of reasons, and mortality rates for this group range from 10% to 60%.
“That higher range of deaths is tragic, absolutely tragic, so the real question is what can we do about this that might make a difference,” Martell said.
When looking at how COVID treatments have changed over the past six months, Martell said they’ve learned that earlier treatment is better than later treatment.
“A lot of initial treatment strategies that were used when patients were sick enough to be in intensive care units didn’t work very well, but those same strategies, when applied to patients who were less sick and earlier in the course of the disease, have actually shown benefit,” he said.
Gary Johnson, in-house physician at Life Care Center of Hilo, said “we are very supportive of this treatment approach.”
As of Wednesday, 12 Life Care residents and five employees have been diagnosed with COVID-19, compared to six and four, respectively, on Tuesday. One resident and two employees have recovered.
Johnson said the facility will use the new HMC treatment protocol on a case-by-case basis.
“It’s wonderful to be able to have something we can offer to our patients and families, because up to this point, basically all we can do is offer symptomatic and supportive care and hope for the best, and that’s pretty much the way it’s been nationwide.”
Martell said the treatments in the protocol are well-established.
“There is nothing new about this except that we are starting in early, and the reason we’re staring in early is (that) from our experience at Hilo Medical Center, by the time long-term care patients get sick enough to get hospital attention — that is that their oxygen levels are low and they are clearly ill — by the time they’re that sick, they’re very, very sick and their outcomes are very bad.”
According to Johnson, the patients who will receive the treatment protocol will depend on their underlying conditions and treatment preferences.
“Many of our residents are obviously very old, very frail with advanced dementia for whom an approach like this would most likely not be helpful,” Johnson said. “Then we have our younger patients, or patients who are older but more functional and whose medical conditions would permit this treatment. … So the latter group of people would be the ones that we would be approaching about this.”
HMC’s effort comes as the number of COVID cases in Big Island facilities continues to rise, including a large outbreak at Yukio Okutsu State Veterans Home.
“Really, it was the tragedy at the veterans home that informed this decision,” Martell said. “Looking at that, we really had to do some soul searching about what we might possibly have done better. After thinking about it, this is really what we have to offer that we think is reasonable.”
As the number of cases climb at Life Care Center, Johnson said the facility, which has just over 200 residents, is taking other steps to mitigate the outbreak.
Weekly testing began in early September in response to a potentially exposed employee, Johnson said.
In May, the facility established a COVID-19 unit divided into zones based on severity: red zone for those who are COVID-positive, yellow for those under investigation, and green for those being monitored.
When any residents have symptoms, a rapid antigen test can be done on-site, which provides results within 15 minutes, he said.
Those who test positive are moved to the red zone, while those with negative tests are moved to the yellow zone, after which another test is performed to confirm the result.
Email Stephanie Salmons at firstname.lastname@example.org.