Using proven treatments and developing new methods crucial to fighting COVID-19

UW Health clinicians are using current respiratory treatments on the disease caused by SARS-CoV-2; and the University of Wisconsin School of Medicine and Public Health is working together with UW Health on clinical trials for several novel therapies.

For patients who become hospitalized from a COVID-19 infection, there are current treatments that are effective, many utilizing the approved protocol to treat acute respiratory distress syndrome (ARDS), according to Lynn Schnapp, chair of the Department of Medicine at the UW School of Medicine and Public Health.

"We have tools that work when people become infected with this virus," she said. "As much as it seems everyone is focused on vaccines to prevent the disease – understandably so – we still must treat those who become sick the best ways we can."

That includes the ARDS protocol which covers how best to use a ventilator, how much intravenous fluid to give, medications that can help patients (and those that do not help), and how to best position the patient for better breathing.

In dealing with a pandemic driven by a new disease, health care systems can't rest on just existing knowledge. Researchers must look for new treatments to help increase the speed of recovery, said David Andes, professor of medicine in the infectious disease division and principal investigator at the UW clinical trial site for a drug called ruxolitinib that is being tested to treat cytokine storm in COVID-19 patients.

Cytokine storm occurs when a person's own immune system overreacts to what it perceives as invading pathogens, such as viruses.

In addition to ruxolitinib, UW Health and School of Medicine and Public Health have clinical trials underway to study the safety and effectiveness of convalescent blood plasma from people previously infected with COVID-19, and REGN-COV2, an antibody cocktail to trigger virus-killing antibody development in infected people. UW Health has also been using Remdesivir, an antiviral drug approved early in the pandemic to treat a person with a more severe COVID-19 infection.

Beyond the trials underway and treatments in use at UW Health, a clinical trial examining the use of steroids in hospitalized patients receiving oxygen therapy or invasive ventilation was recently published. The trial showed dexamethasone resulted in lower 28-day mortality rate among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.

These results led to UW Health now recommending the use of dexamethasone for these patients, Schnapp said.

All treatment clinical trials follow the same three-phase federal Food and Drug Administration process for verification and approval as vaccine trials.

• Phase 1 is a human trial that tests a vaccine for any major side effects.

• Phase 2 is another human trial that tests a wider population to better understand its dosage and effectiveness.

• Finally, Phase 3 clinical trials test the vaccine on a large group of people, sometimes several thousand, to ensure it is both safe and effective for a population.

"COVID-19 is new and we are learning so much so fast, and it will help us develop better ways to make patients healthy, faster," Andes said. "But, these ways can't come at the cost of incomplete approval or a rush to put them into practice."