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Treating COVID-19: What We Know Now

SCOTT DETROW, HOST:

It's hard to believe that doctors have been treating the coronavirus for less than a year. There's still a lot we don't know about the disease, but there have been small breakthroughs. Of course, there have also been false hopes. Dr. Abraar Karan has been seeing patients with the disease since March at Brigham and Women's Hospital in Boston. He's also a global health expert at Harvard Medical School.

Dr. Karan, welcome.

ABRAAR KARAN: Thanks so much, Scott. Happy to be here.

DETROW: What's been the most helpful practical thing that you have learned since the pandemic started?

KARAN: So in terms of the sort of clinical course of things, there's two real aspects to this. And, you know, we've seen this ongoing with sort of viral illnesses and the way they interact with the immune system even before - right? - with things like SARS and MERS. And so the key here is that you have a virus that sort of infects your body, and then your body responds to that with your immune system.

And so the first part of the equation is to try and stop the virus from replicating too much in your body. The second half of that is that once your body does respond, that your immune system has a good balance because when you have too much of an immune response, you can actually get even more damage. And that actually can be what ends up killing people.

DETROW: So can you give a specific example of things you do differently when a patient comes in now compared to, say, early March?

KARAN: Yeah. So, you know, one trial, the ACTT trial, which was looking at remdesivir - it was a randomized controlled trial - essentially showed that when you start remdesivir in certain groups of patients that have abnormalities on their CT scans or require oxygen - that that actually can lower the number of days that those patients need to be hospitalized. And so, you know, for those patients, when we can access remdesivir, we would put them on that based, you know, largely, actually, on the results of that trial that was published in New England Journal of Medicine.

DETROW: When you're having conversations with patients through all of the protective equipment, have you noticed a change in their demeanor, in their fears or optimism about treatment now compared to in the early days in March?

KARAN: Yeah. I mean, Scott, you point out a really important thing here, which is that, you know, we're not used to having to wear masks the whole day and not have face-to-face contact with patients - I mean, not being able to see the expressions on our faces or on their faces. And that's so different than how things usually are, right? As doctors, we actually really value the amount of time we get to spend just sitting at the bedside with our patients and really getting to hear how they feel and seeing their expressions on their face, being able to hold their hands. Those are things we hadn't been able to do with COVID, and that made things really difficult.

I would say that I think now, as time goes on and I'm taking care of fewer patients but still seeing COVID patients, the sort of questions change a little bit in terms of, you know, patients will ask what we know about treatments, what we know about therapeutics. You know, I've had people ask about remdesivir. So clearly, the - even the drugs that are very familiar to us as doctors are becoming more familiar to the general public as well.

DETROW: I wonder, as you look forward to the next six months, do you feel any sense of optimism, or do you think that this is just going to be a really long slog of treatment and social distancing that there's no end in sight of?

KARAN: Well, I would say that I feel both optimism and I recognize that this is going to be a long, long response against COVID. I think that if you talk to most public health experts and doctors and scientists who kind of work on epidemics, COVID had all these sort of characteristics that would make us believe this was going to go on for quite some time and that this actually may just demand a different way of life, a different way of socializing. And that's a reality.

But there is optimism in the sense that every day we learn more about COVID. We learn more about how to treat COVID. We learn more about what effects it has. We learn more about how it is transmitted and where it's transmitted and what's safe and what's less safe. And so we work on these frameworks of sort of this continuum of risk. And we navigate those as effectively as we can while still trying to maintain some level of normalcy and striving to get back to life in whatever ways we can.

DETROW: Dr. Abraar Karan is an internal medicine physician and clinical fellow at the Harvard Medical School. He's also assisting with the epidemic response in Massachusetts.

Thanks so much for talking to us.

KARAN: Thanks so much, Scott. Transcript provided by NPR, Copyright NPR.