COVID-19 Update: Yale New Haven Health Doctors Talk Hydroxychloroquine, Remdesivir, Masks with Valves, Attending Church

On a Yale New Haven Health System press conference on Zoom, CEO Marna Borgstrom said as of Wednesday there hadn’t been as few Covid-19 positive patients in the system since the beginning of April.

She said at Greenwich Hospital cases peaked in mid April with 126 patients, and the hospital on Wednesday morning had about 20 cases, with discharges anticipated later in the day.

At Yale New Haven Hospital the peak was about 472 inpatients; on Wednesday that number was 182.

“We sadly lost almost 500 patients across the system, and those have been tragedies for all of us. Two of them were employees of the health system,” Borgstrom said, adding that despite the improved numbers, the patients being cared for are still very sick.

The majority of Covid-19 patients have been discharged to their homes or long term care facilities.

Asked about pharmacologic treatments, Dr. Tom Balcezak said the only drug that impacts the virus is Remdesivir.

He said studies have shown no benefit of Hydroxychloroquine against Covid-19, and that the shortages its use created endangered patients who are were already prescribed it for rheumatic arthritis. (Hydroxychloroquine has also been used for decades to prevent and treat Malaria.)

The FDA has warned against the use of Hydroxychloroquine for purposes outside of hospital settings or clinical trials.

Balcezak said the system had used Hydroxychloroquine for treatment, but removed it last week.

“We no longer recommend it and moved it from a possible drug to a not recommended drug,” he said.

Dr. Richard A. Martinello agreed, saying patients had developed complications, “We know it has significant toxicities associated with it. When we used it in the last two months, we’ve been very careful to monitor patients for Heart arrhythmia.”

On Wednesday he said Balcezak said as far as pharmacologic interventions, the only drug that is under emergency use authorization is Remdesivir, and the system does have adequate supplies.

“We’re using convalescent plasma therapy in our hospitals,” he said noting that the available limited data indicates it is not causing harm in patients and may have a modest improvement in all patients. “On balance it causes some improvement, and importantly doesn’t cause any harm,” Balcezak said.

“Regarding other drugs, we don’t have data on whether or not they are helping,” he added.

Balcezak said non-pharmacologic treatment interventions (NPI) include high tech interventions such as Extracorporeal membrane oxygenation (ECMO), heart lung machines and ventilators.

Reporters asked the health system doctors for advice for people who might want to go to church given that the President has declared houses of worship essential services.

“We know that singing, sneezing and projecting in any way should be avoided,” he replied, adding that while houses of worship vary in size, they require closer proximity and potential touching of shoulders.

“We’ve learned a lot about what safety measures we need to take when we gather. Masking definitely works. If you can distance 6 ft, that works. Make sure you use hand hygiene religiously,” he said, apologizing for the pun.

Lastly, he said people should not congregate if they are sick. If they are experiencing symptoms including cough, sore throat or headache, they should stay home.

“You can stem the spread in gatherings – if you go to the grocery store or work in an essential business or go to church – evaluate the situation you are in. Maybe you can administer the Sacrament if you do it behind a plexiglass shield.”

Balcezak talked about best practices Connected has adopted after the first wave of Covid-19 in other states and countries.

“Since the World Health Organization put out their reports from Wuhan, China we have adapted what we are doing – not just in the care of patients, but how we assign staff and how we address PPE for our staff and where we use it,” Balcezak said, adding that the system is on its 8th iteration of patient treatment protocol. “We’ve adopted best practices – whether it be plexiglass shields to separate folks at front desk from patients in Emergency Room, or how and where we use our PPE. We scan literature and contribute to it.”

Dr. Balcezak commented on the effectiveness of masks with valves, given that they are being banned in some places.

He explained that the masks with plastic valves on them are primarily for environments where there is dust or some environmental contaminant, and enable the wearer to breathe in pulling the air through the filtering part of the mask.

“When you exhale, the valve opens and the air goes directly out into the environment,” he said. “If you’re wearing it to protect yourself, it’s probably doing a great job – as long as it’s fitted to your face correctly. But if you’re wearing it as ‘source control,’ a theoretical risk is that when you cough or breathe, and if you have the virus, the air escapes through that valve.”

“In my opinion, it’s better than nothing and probably works for source control and definitely works to protect the wearer,” Balcezak said.