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UPMC: Making Progress in COVID-19 Battle
By Kevin Brown

UPMC continues to fight the COVID-19 pandemic along with other health care providers throughout our region and around the world. At a press briefing on Sept. 3, UPMC officials provided an update on their progress in the treatment of patients with COVID-19 along with research into effective treatments to better manage COVID-19.

UPMC officials speaking at the briefing included Donald M. Yealy, M.D., senior medical director and chair of the Department of Emergency Medicine at UPMC; Oscar Marroquin, M.D., UPMC’s chief healthcare analytics and data officer; and Derek Angus, M.D., M.P.H., UPMC’s chief healthcare innovation officer and chair of Critical Care Medicine at the University of Pittsburgh School of Medicine.

Dr. Yealy spoke about the importance of learning to adapt to COVID-19 to better care for patients. “As we've been saying for many months, COVID-19 came to all the communities that we serve here at UPMC. And it's not going away. Everyone, that's all of us in our communities, including the medical professionals, is learning how and adapting to living with this virus, something that we will continue to do for many months.”

Based on what has been learned about COVID-19 by health professionals, progress is being made to better manage patient care. “Why are we seeing the better results today compared to what we saw in March and April? Well, first, we have better treatments, including steroids, and more effective clinical protocols,” Dr. Yealy said. “And, we know better how to use all of the care steps for patient care, including positioning and breathing support. We are seeing from our own data, as well as data from other locations, that suggestions exist that the virus is changing in important ways. People are now experiencing less frequent bouts of severe virus impact. Perhaps that means that the virus is less virulent than we once thought or experienced.”

Dr. Marroquin reviewed several key data indicators about testing for COVID-19 and the positivity rates of those being tested. “We are, in fact, testing 2.5 times more COVID patients per day in the last two months compared to the prior period, and this positivity rate is only slightly higher at 5.28 percent currently compared to this spring, which was 4.94 percent, suggesting that the people we serve are mostly taking the right precautions to protect themselves,” he said

He also reported that, while testing has grown dramatically, the number of hospitalized patients has not. “The average daily number of patients hospitalized with COVID-19 since July is approximately 2.8 times higher than in this spring,” he said. “But, daily discharges are three times higher. Our discharges are outpacing our hospitalization rates. Patients are getting better. And they're getting better faster, at least a day faster as a matter of fact, than before. The best news of all is that in-hospital mortality rates are trending down.”

Dr. Marroquin explained that the reason, in part, is in the way they have changed care for these patients. “As Dr. Yealy noted, for instance, our data show that more than half of patients since the end of June have received dexamethasone or other steroids, while the use of remdesivir has declined. And we are more judiciously using mechanical ventilation,” he said.

Dr. Angus spoke about UPMC’s participation in the REMAP-CAP global trial studying the use of corticosteroids for treatment of COVID-19 patients. A report released on Sept. 2 in the Journal of the American Medical Association announced that the trial found a week-long course of intravenously-delivered hydrocortisone, a corticosteroid-like dexamethasone, provided a 93 percent better chance of improvement for critically-ill ICU patients compared to patients who did not receive it. REMAP-CAP stands for “Randomized Embedded Multifactorial Adaptive Platform – Community-Acquired Pneumonia” and is a specialized type of trial that is highly effective in testing multiple therapies at the same time.

“We have found a commonly available, inexpensive class of drugs called corticosteroids considerably reduces the odds of adverse outcome, death and or duration on life support in critically-ill COVID-19 patients,” Dr. Angus said.

“This is only possible because of a global community of physician scientists coordinating across different languages, different countries, working together and sharing data at a speed and a level that I think has been unprecedented in order to generate definitive answers,” Dr. Angus said. “I feel incredibly proud that UPMC and the University of Pittsburgh were absolutely the center of that initiative.”

In a further scientific development, UPMC announced on Sept. 13 that University of Pittsburgh School of Medicine scientists isolated the smallest biological molecule to date that completely and specifically neutralizes the SARS-CoV-2 virus, which is the cause of COVID-19. This antibody component, which is 10 times smaller than a full-sized antibody, has been used to construct a drug—known as Ab8—for potential use as a therapeutic and prophylactic against SARS-CoV-2.

“Ab8 not only has potential as therapy for COVID-19, but it also could be used to keep people from getting SARS-CoV-2 infections,” said co-author John Mellors, M.D., chief of the Division of Infectious Diseases at UPMC and Pitt. “Antibodies of larger size have worked against other infectious diseases and have been well tolerated, giving us hope that it could be an effective treatment for patients with COVID-19 and for protection of those who have never had the infection and are not immune.”

Researchers from a number of other universities in the U.S. and Canada participated in the research study, including teams from the Galveston National Laboratory, University of North Carolina, University of Saskatchewan, and the University of British Columbia.

“The COVID-19 pandemic is a global challenge facing humanity, but biomedical science and human ingenuity are likely to overcome it,” Dr. Mellors said. “We hope that the antibodies we have discovered will contribute to that triumph.”

For more information about UPMC and COVID-19, visit the UPMC website at www.upmc.com, or call 1-800-533-UPMC.

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