By LISA EISENHAUER
Looking back on the year that has passed since he treated the first U.S. patient confirmed to have COVID-19, Dr. George Diaz finds reasons to be encouraged even as the pandemic continues to rage.
Diaz is an infectious disease specialist with Providence St. Joseph Health based at Providence Regional Medical Center Everett in Washington state. He has been among the leaders guiding the system's response to the pandemic. At 49, he has been practicing in his specialty field since 2005.
He and his colleagues in Everett not only successfully treated that first patient, including making use of the antiviral remdesivir for COVID treatment for the first time in the world, they helped develop the system's protocols for COVID treatment.They have taken part in clinical studies for other promising drugs and been part of a vast expansion of telehealth that's allowed many more patients to get medical care without leaving their homes.
"I think that, at least within our health system, we're proud of the way that we've dealt with this pandemic," he said.
Ready early on
As of Feb. 2, the United States had surpassed 26 million cases of COVID and more than 440,000 Americans had died from the virus, according to the Centers for Disease Control and Prevention. A year earlier, the nation had no idea what was to come.
Dr. George Diaz and other members of the infection control team at Providence Regional Medical Center Everett in Washington state take part in a moment of silence on Jan. 19. The event marked the one-year anniversary of when the first patient confirmed to have COVID-19 in the nation came to a Providence clinic for care.
Diaz said Providence St. Joseph Health jumped into action early on. The system started prep work for caring for COVID patients as the novel coronavirus that causes the illness was spreading elsewhere in the world. His hospital stocked up on personal protective equipment, made plans to activate a special isolation unit and ran simulations so everyone would know their roles and proper practices.
On Jan. 19, when a man who had recently returned from the virus' epicenter in Wuhan, China, turned up at a Providence clinic in Everett with a potential COVID infection, clinicians were ready. "He was very upfront about his symptoms and his travel, and so at the clinic, they were able to get him appropriately isolated," Diaz recalled.
The clinic's staff alerted the Snohomish County health department, which in turn contacted the CDC. Officials there told the clinical workers what samples to collect. The patient went home for the night and the samples were flown to Atlanta for testing. The next day the CDC confirmed that the test was positive and asked Providence to admit the patient for observation.
"At that point, we activated our special pathogens unit to be able to house a patient with a highly communicable, infectious disease, which is essentially a unit that we created for patients with Ebola," Diaz said. "There's a lot of operational pieces to stand up a unit like this. It requires having enough facilities ready, the staff ready, all the equipment and other supplies, to get it all in place."
The patient at first had a mild case of the illness. Over the next four days, however, his condition escalated to pneumonia and he needed oxygen.
Diaz and his colleagues saw that the trajectory of the man's illness paralleled reports coming out of Wuhan of COVID patients who developed pneumonia and then suffered severe lung damage. They conferred with the CDC about experimental therapies and doctors there pointed to remdesivir. The antiviral had proven to be safe for use but ineffective against Ebola. In later animal tests, it had shown promise against other types of coronavirus, including MERS.
While the patient was hospitalized, a protocol for remdesivir's use to treat the new virus was approved by the Food and Drug Administration. Providence Regional Medical Center Everett became the first hospital in the world to use the treatment for COVID when Diaz and his team administered it to their patient.
"The protocol was actually designed for a 10-day course of therapy," Diaz recalled. "Our patient had a fairly prompt response to treatment and he got better over the course of five days."
Providence St. Joseph Health has since taken part in two later studies of remdesivir — one to confirm that the drug itself worked against COVID and another on whether the five-day protocol was equally effective. The results in both cases were positive, Diaz said, and the studies were published in The New England Journal of Medicine. The revised protocol has become a standard of care for COVID pneumonia in the U.S. and became the first FDA-approved treatment for COVID pneumonia.
Better medicine, practices
After that first patient recovered and went home, the isolation ward was briefly empty. But in the months since Diaz and his colleagues have treated hundreds of COVID patients and taken part in several more clinical studies. One is of an immune modulator called tocilizumab that is made by Roche and already in use in England. Early findings show that the drug blocks hormones that cause inflammation and can help keep COVID patients' illness from progressing to the point where they need ventilators.
"We're hopeful that our results will match what's been seen in England, that tocilizumab is going to be effective in reducing mortality in critically ill patients with COVID pneumonia, and hopefully that it will also become standard of care over the next few weeks to months," Diaz said.
In addition to advances in medications, Diaz has seen the standard of care for COVID improved through new practices. He pointed to the use of proning, turning patients onto their stomachs, to improve breathing and to better techniques to manage the flow of oxygen and keep patients off of ventilators.
The biggest improvement in practices in Diaz's view has been the expansion of telehealth. Through the use of virtual visits and devices such as oximeters, care providers have found that patients' conditions can be monitored while they stay at home.
"That program has also allowed us to avoid being overrun with patients in the hospital, because we can safely manage very large numbers of patients at home through telehealth who would otherwise potentially need to be admitted, and then consume resources like PPE and nursing staff and hospital beds," Diaz said.
While he's proud of how Providence St. Joseph Health and other systems have responded to COVID, Diaz said that the early federal response to the crisis had clear shortcomings. One is what he called the "misalignment with messaging" between officials in the Trump administration and public health experts. He pointed to masking as an example. Even though the use of face coverings was shown to reduce the spread of COVID, the practice was scoffed at by some and led to wider spread of the virus.
"Because of this mixed messaging that was coming from the prior administration, I think that has allowed certain states to avoid the measures that are really needed to prevent deaths in their state," Diaz said.
He also thinks there is room for improvement of the COVID vaccine rollout and for countering disinformation about the vaccines' safety and effectiveness. "That's been a big problem with people not even wanting to get the vaccine, even if they really qualify for it," Diaz said.
He has done his best to dispel the vaccine falsehoods, giving interviews to the media in hopes of assuring the public that the shots are safe. He does some of those interviews in Spanish to reach an even wider audience.
He makes those appearances at the request of Providence St. Joseph Health, a system he, as a Roman Catholic, is especially proud to work for because of its mission to serve the poor and vulnerable.
If he could give a nationwide public service announcement right now, Diaz said it would be to urge everyone to get a vaccine. "I would really strongly suggest that people use trusted sources of information to get information about the vaccine, and if possible, receive it, so that all of us can be safe, and move past the pandemic."
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