Success is hard to define because it varies per person. A divorced millionaire may be considered a success by some and a failure by others, largely depending on how a person measures success.
So it is with COVID-19 treatments. There is no agreed upon definition of success. Some define it as whether they reduce symptoms or reduce hospitalizations. But reducing the symptoms of COVID-19 is different than preventing hospitalizations.
Even among patients hospitalized with COVID-19 the treatment options range wildly and are often defined regionally. Some parts of the country treat COVID-19 patients with steroids and oxygen while adding a repurposed anti-inflammatory medication. Some parts will do with just steroids and oxygen, focusing more on the symptoms instead of the underlying infection itself.
The variability in treatment around the country deserves more attention when discussing COVID-19 outcomes. While the CDC and FDA have done a great job educating the public about the benefits and risk of different COVID-19 treatments, healthcare policy experts have done little to educate the public about treatments available locally.
This is because most physicians are unsure of what treatment options are actually available – as odd as that may sound. Most healthcare facilities have established referral systems in which patients who present with COVID-19 are referred to tertiary medical centers, which are often academic medical centers that emphasize research based treatment.
Most consider this a good thing. After all, if you get sick in Boston, then you would rather be at Mass General than a local county hospital. However, different tertiary medical centers have different research protocols for COVID-19 patients. So the quality of care and the available treatments are different – and unfortunately, we do not yet know whether these differences are meaningful clinically.
In northern California, Stanford Health Center and University of California, San Francisco studied Hydroxychloroquine and Remdesivir and Azithromycin with steroids, monoclonal antibodies, and oxygen to treat patients. In the upper Midwest, University of Chicago Medical Center studied Azithromycin with steroids, monoclonal antibodies, and oxygen.
Most community physicians in private practice are unaware of the regional differences in COVID-19 treatment. When a patient presents with COVID-19, he or she is transferred to the closest tertiary medical center treating COVID-19 patients and care management is typically left at that. Most physicians could not tell you what treatment protocols are being used if asked. That information is difficult to find.
Instead we have general information available on all potential treatment options. When we review the CDC and FDA websites, we see a plethora of treatment options and the corresponding clinical data. But none of us actually know what medications will be available should we develop symptomatic COVID-19 and go to a local hospital.
This is a problem. For all the banter Ivermectin received, few can actually tell you where it is researched or currently utilized as a treatment option. The same goes for Remdesivir and other newer treatment options.
We do not know because healthcare systems are not proactive in sharing this information. Some more traditional clinical researchers argue that sharing this information would disrupt the studies. If one institution uses Remdesivir to treat patients and is studying its effectiveness, then by broadcasting the drug’s availability, it would influence the patient sample being studied.
But if we should ever find ourselves stricken with symptomatic COVID-19 and requiring hospitalization, then the available treatment options would be all that we care about.
Yet information is sparsely available on what treatment is available locally and what treatment options are being studied. We have to dig deep into the trenches of the CDC and FDA websites to find information on clinical studies and the drugs being studied.
The most comprehensive database on active studies is listed on the Department of Health and Human Services website. We encourage all readers to select the link below to learn what drugs are being studied in healthcare systems close to their residence.
Knowing where to receive treatment is often as important as the treatment itself. We saw firsthand during the early days of the pandemic what happened when access to care was suddenly interrupted.
Now in the latter stages of the pandemic, we cannot let up. We should remain vigilant for symptomatic cases and recognize what resources are available for patients who need treatment.
Years from now, when we reflect on the pandemic and the care we provided, we may realize that the best treatment was not the actual treatment itself, but the awareness of where to receive treatment.
Per capita national health expenditures from 1960-2020
The data categorizes expenditures as national health expenditures, health consumption costs, personal health costs, administrative costs, and public health activities cost.
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census.