Doctor explains why more covid patients than ever are surviving the virus

Growing fears of a winter lockdown amid record covid cases and a new, highly infectious variant grip the public, but more severe cases than ever are surviving.

Doctors have been fast on their feet to help patients and develop new treatments as they’ve raced against the Covid-19 virus and its mutations.

With each successive wave, more people admitted with severe Covid-19 have survived, according to top Liverpool doctors, giving cause for hope.

READ MORE:What you can and can’t do this Christmas as two-week lockdown plans ‘drawn up’

Dr Stacy Todd is an infectious diseases consultant at the Liverpool University Hospitals who has been involved in delivering covid clinical trials.

She said: “How did we feel at the beginning? I think scared, worried, that feeling of uncertainty, of just not quite knowing what to do.

“A frequent refrain I’ve heard from many, many of my colleagues is just, it was just the oddest disease.

“It just didn’t behave in the way that we expected from other things.”

By the time covid cases started appearing in British hospitals, the only information doctors had to go on came from early reports from China and Italy.

Those first cases were treated similar to a severe flu, with debates raging in hospitals about what treatments worked best for patients as clinical trials started to take off.

Dr Peter Hampshire, the clinical director for critical care and pain at Liverpool’s main hospital trust, remembers the first covid patient he treated in early March 2020, before the wave fully crashed on Britain’s shores.

Liverpool’s critical care boss said: “He was a sort of typical covid patient.

“He was in his mid-70s, and he had high blood pressure and type two diabetes, and they were the risk factors that we knew about.

“We intubated him, and he had all the treatment we knew about at the time, which wasn’t very much.”

Clinical Lead for Critical Care, Dr Peter Hampshire
Clinical Lead for Critical Care, Dr Peter Hampshire

He added: “At the time, we were trying remdesivir (an antiviral drug) when we could. That was the only real option that we had.

“And then it was, essentially, hoping that he would get rid of the virus himself, and keeping him going while he did that.

“We didn’t know what we were dealing with, so it was scary, but also, I guess people were interested, because it was a bit of an unknown.”

The man survived after spending several weeks in intensive car e, and he’s doing well now, according to Dr Hampshire.

But other patients weren’t so lucky in those early weeks, and capacity was running out as the first wave rolled on.

Without enough intensive care unit (ICU) beds for all the people who would need a ventilator, doctors had to try using CPAP masks, a tight type of mask that fits around patient’s face and keeps them awake.

This image shows a makeshift ICU area created when Liverpool's hospitals struggled to cope with the amount of covid patents
This image shows a makeshift ICU area created when Liverpool’s hospitals struggled to cope with the amount of covid patents

The masks, often used to treat sleep apnoea, blow air at a steady pressure into the throat to keep airways open.

Many people were sceptical, but reports from Italy suggested the masks worked as a treatment.

Dr Hampshire said : “Subsequently, that was shown to be an effective therapy in one of the trials that reported earlier this year, so in retrospect, it was the right thing.”

Clinical trials for covid recovery treatments started early in Liverpool, way back in April 2020.

Dr Todd has been a leading figure in the Liverpool University Hospitals NHS Foundation Trust’s trials.

These trials tested multiple drugs at a time, including steroids, hydroxychloroquine and HIV drugs, removing treatments that didn’t work and integrating those that did into routine care.

Much of the treatment was adapted through trial and error.

Hospital staff wearing face masks on a ward
Hospital staff wearing face masks on a ward

When it became apparent that covid causes blood clots, even in patients on blood thinners, doctors increased the doses.

Trials started to come through in July 2020 suggesting steroids like dexamethasone worked as treatment.

NHS England estimates this steroid saved 22,000 lives in the UK and one million worldwide by March 2021.

Rheumatoid arthritis drug tocilizumab joined the ranks earlier this year, entering use in hospitals in January.

These drugs treat the inflammation caused by the body’s immune response to Covid-19, which is “a lot of what’s driving the patient to get really sick and go to the critical care team”, Dr Todd said.

Medical staff put on their ppe and sanitise as they prepare to access an Intensive Care Unit during the second wave
Medical staff put on their ppe and sanitise as they prepare to access an Intensive Care Unit during the second wave

Dr Hampshire told the ECHO : “The interesting thing about steroids is that we thought they probably wouldn’t be effective.

“And I think the difference between covid and flu is probably that covid is much more about inflammation of your body.

“The covid virus seems to cause a lot of inflammation and a lot of formation of blood clots because of that, whereas the flu virus doesn’t seem to act in the same way.”

Finding the right dose to give is crucial.

Too high and doctors risk suppressing the patient’s immune system to much, making them more prone to other infections.

Inside the COVID wards and intensive care unit at the Royal Liverpool Hospital
Inside the covid wards and intensive care unit at the Royal Liverpool Hospital in 2020

Much of this wouldn’t have been possible without the patients who agreed to take part in trials.

Dr Todd said: “Patients are astonishing, like what they’ll agree to take part in, especially early days when we had no answers and we were all learning as well, and I think being able to understand why we needed these answers.

“Of course it’s not for everyone, and that’s fine.

“But we know, not just though covid, but other places, that places that are active in research – hospitals, trusts where there’s an active platform of research as we have, as the team in critical care have – have better outcomes for their patients.

“Being able to speak to people about that has been huge, but the generosity of patients to be able to take part, and their relatives, is striking.”

The willingness of patients to join ongoing clinic trials for covid treatments means doctors now have the knowledge to effectively treat the disease.

And they have the know-how to find new solutions when covid changes as people get vaccinated and the virus mutates.

Long gone is the total uncertainty of treating the unknown.

But the pandemic rumbles on and there’s been a “steady influx” of patients since mid-June, even without the massive surges of earlier waves.

The intensive therapy unity (ITU) at the Royal Liverpool Hospital where Dr Peter Hampshire works has had four or five patients at any one time since mid-June.

He said: “That’s around about a quarter of our beds, so that means those beds aren’t available for other patients to use.

“Particularly that means that patients who are having major surgery who would normally come to those beds, we’ve got to make other arrangements for them.

“That can mean sometimes cancelling their surgery, which obviously isn’t good for those patients, because they have to wait. And sometimes they can’t wait.

“And, you know, the ones who are there today, they’re in their mid-30s and mid-40s.

“These are not older patients. These are young people. And they don’t all survive, unfortunately.

“When we see young people dying of a disease like this, that doesn’t get normal. It doesn’t become normal. And the staff get really upset.

“That happening all the time, it’s pretty soul destroying.

“What we’re worried about is – we don’t know how severe Omicron is yet because it’s too early to say, but we do know that it’s really infectious.

“If it’s really infectious, it means that lots of people will get it, and even if it’s not as severe as the Delta variant, a few people of lots of people getting sick, is still a lot of people.”

The trials and tribulations of the last nearly two years have put doctors in a good position to deal with the surging wave.

Dr Todd told the ECH O: “It’s phenomenal what’s happened.

“It feels a very different disease now than it did a couple of years ago, but we still see patients, we’re still seeing people who are sick, and the disease changes.

“Something like ronapreve is an amazing drug, but with the Omicron variant, it might not work so well.

“That’s why it’s so important that we get people vaccinated, because actually that’s one of the biggest things that makes a difference, to try and keep people out of hospital, to try, once they’re here, to not be as sick.

“We’ve got all these drugs, and it’s fantastic.

“But without the vaccine, it makes our job, my job, Pete’s job, 10 or 20 times harder.”

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