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Minnesota recorded its first case of the novel coronavirus on March 6, and in the four months since, the state has experienced its share of peaks and valleys in patient deaths, hospitalizations and new infections.

In February, or even in March, nobody was an expert in COVID, said Dr. Andrew Olson, a medical director at Bethesda Hospital in St. Paul, which was fully converted into a 90-bed COVID-19 facility over the course of two weeks. When this started, there were no protocols.

What has the medical community learned about COVID-19 in the short time since? Humility, for starters. Flexibility and collaboration, too.

That which we held as dogma or truths has been challenged, said Dr. Mark Sannes, an infectious disease specialist and senior medical director with Bloomington-based HealthPartners.

Sannes pointed to early recommendations from the Centers for Disease Control and Prevention advising the general public against wearing masks, which it said needed to be prioritized for hospitals. By late March, that advice was outdated.

Before we learned that COVID could be spread by people who did not have symptoms, the mask recommendations were a logical policy, Sannes said. Then we learned COVID could be spread without symptoms.

By April, the CDC had changed course and urged everyone to mask up when not at home. Sannes pointed to the CDCs about-face on masks as an important example of being willing to learn on the fly during a time of crisis.

I think thats an uncomfortable place for a lot of people, Sannes said. And its been played out under the scrutiny of the public eye.

Theres more crash-course learning to come.

Theres still no vaccine against the virus, but doctors and scientists say theyve already made important progress when it comes to treatment regimens, clinical trials of promising drugs and even basic interventions such as turning patients struggling to breathe onto their bellies to expand their lungs.

Thats one of the good lessons of COVID for us to be flexible, especially when the literature is evolving, said Dr. Timothy Sielaff, chief medical officer for Allina Health.

Whats more, geneticists around the world have sequenced the virus, meaning they can write out a book-length code to describe it in scientific terms, a key step toward tracing its origins, spotting mutations, developing better virus detection and hopefully creating a vaccine.

On the front lines at Bethesda Hospital, Olson said providers are focused as much as ever on the basics: checking fluid levels, monitoring kidney function and using blood-thinning anticoagulants to avoid blood clots, which are common with COVID patients.

None of those things are novel and new. But theyre terribly important, he said. Theres no silver bullet for treating this. Yeah, dexamethasone helps. Remdesivir helps. But the mainstay of treatment is good standard supportive care.

Around the world, some in the scientific community were once optimistic that an arthritis and anti-malarial medication known as hydroxychloroquine might help the sickest of the sick.

Clinical trials led by the University of Minnesota, which were focused on patients with known exposures, aimed to determine whether the drug could even help prevent illness from taking root in the first place.

But what works in a sterile lab environment doesnt necessarily have the same impact on the human body.

After reports of heart complications, the medical community has taken an about-face on hydroxychloroquine, and the U.S. Food and Drug Administration officially revoked the drugs emergency use authorization in mid-June.

Experts say theres still plenty of reason to be optimistic on the drug front. In fact, around the world, more than 2,000 clinical trials are underway on potential COVID-19 treatments and preventative vaccines.

Two drugs in particular have shown special promise. Clinical trials in the United Kingdom recently found that dexamethasone, an anti-inflammatory steroid, fights lung damage caused by the virus, reducing mortality rates among critically ill patients by 20 percent to 33 percent in tests.

We were not giving it early on, and now its a recommended treatment, Sannes said.

Remdesivir, an anti-viral medication, has also become standard treatment. It shortens the duration of the illness, Sannes said. Its not a knockout punch by any means.

In intensive care, a specialist might turn a patient struggling to breathe onto their belly to take pressure off the lungs. The low-tech technique has never been thought of as routine procedure outside of ICUs, at least not before COVID-19 hit.

Now, the belly flop is being credited with saving lives.

A very practical thing we learned in the first month or so, having them lay on their stomach in a hospital bed turned out to be a very important intervention, Sannes said. That really allowed a lot of patients to avoid a ventilator.

Experts say the belly maneuver allows the back of the lungs to more fully expand and improves oxygen levels.

The technique has reduced but not eliminated the need for ventilators, which were in high demand in the early days of the pandemic, and it has helped avoid some of the lung damage that can be caused by mechanical ventilation.

Early on, there was this notion you needed to intubate everybody immediately, said Allinas Sielaff. It was pretty clear in a relatively short period of time that actually early intubation was not a good idea.

While intensive care units throughout Florida and Arizona are now overwhelmed with COVID patients, hospitalizations in Minnesota peaked on May 28 and have since declined. So have deaths, which recently fell to single digits in daily counts.

Were doing OK in Minnesota, and were all really proud of that, Olson said.

Its evidence, say experts, that low-tech public health measures are vital.

Physical distancing, masking, those things work, Sielaff said. Thats why we didnt see such a spike in public health cases in March and April, which is what had been predicted.

In other parts of the country, as people get away from understanding that, its causing increased number of cases, he added. Thats why we havent turned into Houston, or New York City, or Alabama or Arizona.

Sannes agreed.

To some degree, we get to try to control our destiny by doing all the little things that the health department is asking us to do, he said.

If we can do those things well, we can hopefully stay open and avoid the situation playing out in the southern United States, where theyre now facing a shortage of hospital beds, he said.

COVID-19 has put stress on the nations health care system, and experts say thats brought existing cracks to the surface, including the degree to which poverty, obesity, housing instability and a lifetime of stress play into poor health outcomes.

COVID does not target our population evenly, said Dr. Bradley Benson, chief academic officer and a professor of internal medicine and pediatrics with the University of Minnesota Medical School. Underlying conditions like hypertension, diabetes, your age play a role. But weve also seen social determinants of health.

In particular, Blacks make up 6 percent of the general population of Minnesota, but 20 percent of the states positive coronavirus cases detected to date.

Nationally, the mortality rate the number of deaths per 100,000 Americans is more than twice as high for Blacks as for whites.

We have a terrific health care system when youre sick, but now we see housing really matters. Poverty really matters, said Dr. Deneen Vojta, executive vice president of research and development with the UnitedHealth Group. The public health community has been ringing this bell for a long time. When youre overweight and obese, that causes a lot of inflammation in your body, as does stress. When they get exposed to a virus like COVID, all of a sudden they are at super high risk.

The U.S. has long been criticized for having a fragmented health care system, which makes it difficult to pull off national clinical trials like those in the United Kingdom that led to the widespread adoption of dexamethasone as a COVID treatment.

Nevertheless, some medical experts say theyve been impressed by the level of collaboration between health networks in Minnesota over everything from vacant beds and virus testing equipment to clinical research.

The CEOs of the major hospital systems met on a regular basis actually early on a daily basis to make sure we had a similar understanding of what we were projecting our ICU needs to be, and how we were going to pitch in and play a part of that, Sielaff said.

The state, through the Minnesota Department of Health, and the Minnesota Hospital Association have been key coordinators.

Sannes noted the Department of Health has done a nice job of getting the message out to clinicians across the state and promoting collaboration.

Most experts agree that Minnesota is currently enjoying a lull in COVID-19-related deaths and hospitalizations, which peaked in late May, taking some pressure off demand for empty hospital beds. Thats a good thing, but the same experts warn that a resurgence could quickly wipe out those gains.

Now is the time to prep.

Were going to need to be on the ready for the peaks-and-valleys approach of this virus, Sannes said. We got through what I think is the first big wave of this, but probably 90 percent of the population hasnt seen this virus after the first wave.

We also need to make sure weve got our supplies in order as best we can, he added. During this smaller lull, the valley of new cases, now is the time to think what are we doing to preserve those resources, or recycle things like masks?

If we look at that peak number of patients hospitalized at the end of May, when we were stretched for hospital beds, if we were to go back to that in two weeks time or three weeks time, are we ready?

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Its been four months since Minnesota recorded its first case of COVID-19. What have we learned? - TwinCities.com-Pioneer Press

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