Romano Law Nurse Corner #16
COVID-19 CASES STILL RISING
The U.S. has nearly 2.6 million confirmed COVID-19 cases and over 128,000 COVID-19 related deaths. As all states continue phases of reopening, many are breaking new records for the number of newly identified cases and filling up ICU beds again. Florida is one of the latest hotbeds for COVID-19 with 8,530 new cases according to the Sun Sentinel on June 28, 2020. This is an alarming number and our concern is clear. Local Counties have decided to close their beaches for the upcoming July 4th holiday weekend. Mask wearing and social distancing remain our best defense.
In the states that mandate wearing masks in public — including New York, Illinois, and Michigan — new cases have fallen by 25% over the last several weeks. Other states that are less stringent but require mask-wearing by employees and patrons of certain businesses have seen an overall 12% drop in cases. Meanwhile, states that require masks only for employees of certain businesses have seen a 70% increase, on average, in new cases.
“Face masking is one of many pillars, including social distancing and proper hand hygiene, that we are using against the virus,” said Jade Flinn, nurse educator for the Johns Hopkins Biocontainment Unit. “Face masking is one of the more effective prevention measures because we contain viral particles that may be produced through simple activities like talking or breathing.”
GLIMMERS OF HOPE
We have found some glimmers of hope.!
For those seriously ill with COVID-19, on ventilators or requiring oxygen, there are some encouraging preliminary reports out of Oxford University indicating that dexamethasone, a corticosteroid, can be lifesaving. Most experts find these preliminary results encouraging since it is the first success we have seen, reducing mortality in patients that are on ventilators by about 1/3 and about 1/5 reduction for those patients only requiring oxygen therapy.
These results are from the group out of Oxford, whose study is called RECOVERY: Randomised Evaluation of Covid-19 Therapy. As part of this type of randomized clinical trial, patients who had the drug are compared to those who did not have the drug. This national clinical trial is meant to identify treatments that may be beneficial for people hospitalized with COVID-19. This is the biggest controlled trial of drugs against COVID-19 and is already producing results.
We, as nurses, have known about and administered dexamethasone many times, for a range of conditions. It is a good general help for severe inflammatory response. Dexamethasone acts on the immune system to dampen the response and reduce the body’s subsequent inflammatory response. For COVID-19, this excessive inflammation is in the lungs and heart, which are responsible for the respiratory and circulatory problems seen with the sicker patients.
Dexamethasone is an inexpensive medicine and readily available. It has been around since the 1960’s and has been listed in the WHO Model List of Essential Medicines since 1977. This could change our outcomes and save lives.
For the COVID-19 specific randomized trial, researchers studied the effect of the drug in 2,000 patients who received it and compared that to outcomes in 4,000 patients who did not receive it. While dexamethasone initial research is promising, we look forward to more data and vetting.
Using Plasma from Recovered Patients
Also new on the horizon are survivor plasma trials, some of which are being conducted by the University of Wisconsin-Madison. The idea is that plasma from patients who have recovered from COVID-19 should contain virus specific fighting antibodies which, when injected into sick patients will help their bodies fight off the infection. Early smaller studies along with anecdotal evidence showed that these treatments are safe.
However, in a new study of 20,000 patients hospitalized with severe cases of COVID-19, researchers examined a very large and diverse group of patients- nearly 40% of the patients were women; 20% were Black, 35% Hispanic and 5% Asian. The results from this study, published in the Mayo Clinic Proceedings (https://www.mayoclinicproceedings.org/), only provide stronger evidence of safety and include a decent representation of minorities, according to William Hartman, assistant professor of anesthesiology at UW Health.
It is important to keep in mind that this study did not look at how effective the treatments are per se, however compared to earlier smaller studies, there was a significant change in death rates using this treatment. It is important to remember this type of treatment therapy is new and its use will continue to be studied given the continued COVID-19 pandemic. Expanded access to collect and distribute survivor plasma across the country is run by the FDA.
While this research is quite promising and provides those important glimmers of hope, it is important to note that this exciting announcement did not come with study details and it hasn’t undergone rigorous scientific scrutiny.
Some researchers, such as Dr. Kirsten Lyke, an infectious disease specialist at the University of Maryland School of Medicine, warn that we must be extremely cautious when rolling out treatments that have not been fully vetted. Given the need for some positive news regarding this pandemic, it makes sense that people rush to get any positive results out quickly, however vetting the study is an important part of the scientific process that cannot be ignored.
One very recent example of this rush to have an answer was Hydroxychloroquine. This drug therapy was big news as a possible treatment before it had a chance to stand up to scientific scrutiny. Once that initial excitement died down, the results did not show it as the miracle cure. Ultimately, both dexamethasone and plasma therapy are glimmers of hope for treatments to decrease death and ease suffering. Studying these and other possibilities continue on at very fast rates, somewhat like the virus itself. We look forward to more details and further research with both of these exciting new POSSIBILITIES.
My mask protects you, your mask protects me.
We are Susan Ramsey and Amie Goldberg, both practicing attorneys and nurses here at the Romano Law Group. Here is a little more about each of us:
Susan Ramsey is both an attorney and an RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools. During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts. She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force. Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional negligence, product liability and medical negligence.
Amie Goldberg is both an attorney and a certified APRN. After completing a Bachelor of Arts Degree at Whittier College, Ms. Goldberg attended nursing school at Emory University. Ms. Goldberg’s professional experience started as a Registered Nurse at Egleston Children’s Hospital taking care of children with congenital heart disease. After a few years, she continued working in all areas of the hospital while attending Kennesaw State University on weekends in order to get her Master’s Degree in Nursing with a specialty of Primary Care Nurse Practitioner/Family Nurse Practitioner. During her time as an APRN, Ms. Goldberg decided to attend law school at St. Thomas University in Miami, Florida. Since graduating, she has mainly practiced in the areas of personal injury and worker’s compensation, fighting for the rights of injured people. Since joining the Romano Law Group, Ms. Goldberg has been the Director of the Opioid Litigation Project. Ms. Goldberg also practices in the area of medical malpractice and nursing home negligence, bringing an inside perspective and knowledge to help get justice for our clients.