INDIANAPOLIS– In the spring, when COVID-19 was still mostly a mystery to the medical community, health departments and hospitals across America scrambled to find enough ventilators to treat the anticipated surge of seriously ill coronavirus patients stricken by the debilitating disease.
Within weeks, Indiana’s number of available ventilators climbed by 50% to nearly 3,000 devices as unused units were discovered or repurposed for the surge and General Motors opened up its Kokomo Assembly line to produce the devices.
On April 8, the Indiana State Department of Health reported 69% of its ventilators were available and 18.2% of those in use were treating COVID-19 patients.
Today, the Indiana State Department of Health (ISDH) reports 80% of the state’s ventilators are open and only three percent are currently treating coronavirus patients.
“We learned how to better care for these individuals,” said State Health Commissioner Dr. Kristina Box. “Early on the kind of knee-jerk automatic reaction was to intubate these patients, this was how we thought we could best take care of them was the advice we had gotten from other countries that had been a little bit ahead of this curve than we were.
“We have had lots of opportunity to network as physicians across the state,” said Dr. Box. “We have learned tremendous amounts of things.”
Governor Eric Holcomb said he, too, is often questioned about the surprising availability of ventilators which were once feared to be in short supply.
“Some investments that we made and lines that we changed on the fly,” he said. “This is not just with ventilators but with masks, sanitizer, etc., that’s gonna serve us well into the future.”
At IU Health Methodist Hospital, doctors combined evolving drug applications with aggressive physical therapy and alternative oxygen treatments to reduce the number of patients subjected to the lifesaving but potentially harmful impact of being intubated and assisted by a ventilator.
“We were seeing patients who were expending an extreme amount of time on the ventilator and when you do spend a long period of time on the ventilator, you can become deconditioned because you are sedated when you are on mechanical ventilation and you’re spending a lot of your day, if not all of your day, in bed,” said Dr. Warren Gavin of IU Health. “Mechanical ventilation is a good thing when you need it but if you don’t need it, it’s a good thing if you can ward it off.”
Leaving patients in the prone position, on their backs and intubated raised the potential for infection, said Dr. Gavin, and made them vulnerable for deterioration as opposed to recovery.
“When you’re on the ventilator, you’re sedated and not moving around as much and not sitting up to eat and you may not be working with physical therapy to maintain some aerobic activity,” he said. “Patients can move around a lot more, they can work with physical therapy, they can sit up and do a lot of extra that prevents that deconditioning that we see with mechanical ventilation.”
Dr. Gavin said physicians now have a better understanding of the impact of drug combinations on assisting patients in their battle against the coronavirus.
“The medications have definitely changed since things started in March so now we’re using a number of other medications,” he said. “We’re also giving serum, convalescent plasma, from patients.”
During a weekly briefing with Governor Holcomb, Dr. Box said she feared another surge in patients in the coming month as students from the elementary to college level return to class and the Labor Day holiday looms.
“I will say that the ventilator usage and the ICU bed usage is up and that’s because I hear from my friendly doctors who are in the emergency room all the time that people who are coming in now are pretty sick and some of them have put off getting their heart checked or getting other health conditions taken care of and so consequently they think the severity of patients that they’re seeing in the hospital has been elevated also.”
Dr. Gavin said advancements in treatment have prepared hospitals for another potential uptick in coronavirus patients.
“We are still prepared for another surge if it happens but I do feel we’re equipped if that happens,” he said.