Advances In ICU Care Are Saving More Patients Who Have COVID-19

Sep 20, 2020
Originally published on September 20, 2020 10:11 am

If you think all the coronavirus news is bad, consider the uplifting story of Don Ramsayer.

The 59-year-old man from Cumming, Ga., is living evidence that doctors in intensive care units quickly figured out how to help more patients survive.

In early August, Ramsayer was helping his son pack up the car for his freshman year at The Citadel, the Military College of South Carolina. Ramsayer had been having night sweats and wasn't feeling that well, but he tried to play it down.

"We got the last box packed and it was ready to go in the car, and I finally succumbed to my sister and kids, who said 'Dad, something's wrong. Go to the hospital.'"

Ramsayer, a software designer and self-described gym rat, had been diagnosed in November with a slow-moving form of leukemia. But the doctors at Emory Johns Creek Hospital, northeast of Atlanta, ran a few tests and concluded that his new symptoms were actually from COVID-19.

He was admitted to the hospital and got sicker and sicker over the weekend. Ramsayer recalls the doctors phoned his sister and told her to prepare for the worst, "because they did not think I was going to make it."

As his health declined, doctors "basically threw everything in the kitchen sink at me," he says. "Almost like Sherlock Holmes. 'What can we try here? What can we try there to get in front of these things?' "

Doctors gave him a newly available antiviral drug, remdesivir, as well as an experimental treatment called convalescent plasma. That involves transfusions of blood plasma from people who have recovered from COVID-19 and carry antibodies that might help fight the virus.

He also ended up on a ventilator for nine days, under heavy sedation.

Don Ramsayer and his sister Melanie Ramsayer speak over FaceTime on August 30. He'd been off the ventilator for 10 days and was finally recovered enough from COVID-19 to be moved out of the ICU.
Don and Melanie Ramsayer

Ramsayer himself rather unexpectedly ended that phase of his treatment.

"Somehow I got out of the straps," he says in an interview from his hospital bed. "I completely unhooked myself ... and pulled the breathing tube out. And here's the really funny thing. I'm obviously pretty doped up. They had me on all kinds of stuff and how I was even conscious, they aren't even sure of that. The first thing I do is I say, 'Can I have a Coke?' "

He says doctors at first considered reinserting the breathing tube, but they saw he could breathe on this own well enough.

"I continued to improve from that point forward," he says.

Ramsayer's story is remarkable, considering his cancer and the complications of his case. But this story is far from unique.

"We have very much replicated what's been seen worldwide, which is over time the mortality in ICUs have decreased," says Dr. Craig Coopersmith, director of the Emory Critical Care Center. He oversees ICUs at five hospitals in the Emory system, including Johns Creek.

The decline in mortality related to COVID-19 varies month to month. At Emory it has been in the range of 20% to 50%. Coopersmith says there are lots of reasons for that.

A big one is that, when the first wave of Covid-19 hit Atlanta's hospitals in April, doctors had no experience with the disease. Medical management of these patients is now, by comparison, routine.

"There's certainly nothing routine about the pandemic," Coopersmith says, "but in terms of how we're managing it, once you have taken care of something for the tenth time, it is normal."

Doctors can better handle common and serious complications like blood clots. They realized that patients do better if they aren't lying on their backs all the time. Patients in Emory hospitals are encouraged to spend some time lying on their stomachs. That simple effort sometimes is enough to keep them out of the intensive-care unit.

A poster filled with photographs in Don Ramsayer's hospital room — a reminder of those at home cheering him on.
Don and Melanie Ramsayer

Ramsayer found it uncomfortable to sleep on his stomach — he says he has a couple of blown disks as a result of his days as a powerlifter — but he did sleep on his side when he could.

And while no medicine can cure COVID-19, a series of studies showed that steroids can benefit the sickest patients.

Emory, like many medical centers, had not been using steroids such as dexamethasone routinely to treat COVID-19 until a major study from the United Kingdom showed that these drugs reduce the risk of death among seriously ill patients.

"So that's a tremendous success story," Coopersmith says. "In just a few months we have a drug which is easily available everywhere and quite cheap, and which improves survival significantly in the ICU patient population."

Indeed, steroids were part of Ramsayer's treatment.

The trend in improving survival has been documented in intensive care units around the world. Even so, people treated in the ICU for COVID-19 are at higher risk of death than is the case for other viral lung diseases. Across the United States, hundreds of people still die daily from COVID-19.

Coopersmith credits some of the improvements in treatment to scientific advances, as was the case for steroids. He says it also helped that, for the past six months, all the attending physicians shared their observations and ideas with one another on a daily text chat, "and in that we find the art of medicine."

Ramsayer also credits his own deep faith in God for getting him through the ordeal. When we spoke, he was getting ready to be discharged after more than five weeks in the hospital.

"I'm walking, sitting, I can get around. My only limitation is just my oxygen requirement," he says. He considers that a mere inconvenience.

He's eager to return to his work as a software designer, and to keep working with his doctors to figure out the right treatment for his leukemia.

"That's something we'll tackle once I get back on my feet."

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

LULU GARCIA-NAVARRO, HOST:

Now to the pandemic. Despite the grim number in this country of people who have lost their lives to COVID-19, doctors have made big strides in figuring out how to keep people alive in the intensive care unit. NPR science correspondent Richard Harris tells the story of one man's remarkable recovery.

RICHARD HARRIS, BYLINE: In early August, Don Ramsayer was helping his son pack up the car for his freshman year at the Citadel, a military college of South Carolina. Ramsayer wasn't feeling that well, but he tried to play it down.

DON RAMSAYER: We got him ready, got the last box packed. Everything was ready to go in the car. And I finally succumbed to my sister and my kids saying, dad, something's wrong. Go to the hospital.

HARRIS: Ramsayer, who's 59, had been diagnosed in November with a slow-moving form of leukemia. But the doctors at Emory Johns Creek Hospital northeast of Atlanta ran a few tests and concluded that his new symptoms were due to COVID-19. He got sicker and sicker over the weekend, and Ramsayer recalls the doctors called his sister with the sobering news.

RAMSAYER: Because they did not think I was going to make it. During this period of time, they basically started throwing everything in the kitchen sink at me, almost like Sherlock Holmes. What can we try here? What can we try there? Try to, you know, get in front of these things.

HARRIS: Among other measures, Ramsayer was treated with steroids, which have recently been shown to save the lives of some seriously ill COVID-19 patients. He got the antiviral drug remdesivir, as well as an experimental treatment called convalescent plasma. He also ended up on a ventilator for nine days under heavy sedation.

RAMSAYER: Somehow, I got out of the straps. I completely unhooked myself and completely excavated myself and pulled the breathing tube out. And then here's the really funny thing - is I'm really, obviously, pretty doped up. I mean, they had me on all kinds of stuff - how I was even conscious - they're not even sure of that. The first thing I do is I say, can I have a Coke?

HARRIS: Happily, doctors realized that Ramsayer could get along OK without the breathing tube.

RAMSAYER: I continued to improve from that point forward.

HARRIS: Ramsayer's story is remarkable considering his cancer and the many complications of his case. But Dr. Craig Coopersmith, director of Emory's Critical Care Center, says this story is far from unique.

CRAIG COOPERSMITH: We have very much replicated what's been seen worldwide, which is, over time, mortalities in the ICUs have decreased.

HARRIS: The decline in mortality varies month to month, but at Emory's hospitals, it has been in the range of 20 to 50%. Coopersmith says there's lots of reasons for that. A big one is that when the first wave of COVID-19 hit Atlanta's hospitals in April, doctors had no experience with the disease. Medical management of these patients is now, by comparison, routine.

COOPERSMITH: There's certainly nothing routine about the pandemic, but in terms of how we're managing it, once you're taking care of something for the 10th time, it is normal.

HARRIS: Doctors can better manage common and serious complications like blood clots. They realize that patients do better if they aren't lying on their backs all the time. And a series of studies showed that steroids can save lives.

COOPERSMITH: And so that's a tremendous success story. In just a few months, we have a drug which is easily available everywhere and quite cheap that improves survival significantly in the ICU patient population.

HARRIS: Science has rapidly been brought to bear. But Coopersmith says it also helps that for the past six months, the ICU physicians at the five Emory hospitals have shared their personal experiences and ideas with one another in a daily text chat.

COOPERSMITH: And in that we find the art of medicine.

HARRIS: Patient Don Ramsayer adds to the list his own deep faith in God for getting him through the ordeal. After more than six weeks in the hospital, he's finally getting ready to go.

RAMSAYER: I'm walking, sitting. I can get around. My only limitation is just my oxygen requirement.

HARRIS: He's eager to return to his job as a software designer and to keep working with his doctors to figure out the right treatment for his leukemia.

RAMSAYER: That's something we'll tackle once I get back on my feet.

HARRIS: Richard Harris, NPR News.

(SOUNDBITE OF KODOMO'S "CONCEPT 1") Transcript provided by NPR, Copyright NPR.