Lessons from the epicenter: How one N.J. hospital endured the worst of the pandemic and learned from it – nj.com

The dying patient just needed to hold on a little while longer.

Within a few hours, she would receive the new treatment. The placenta cells a therapy that showed promise in boosting the immune system were on their way to Holy Name Medical Center from another state.

It was April, and the coronavirus crisis was intensifying. The patient, an unidentified woman, lay dying of COVID-19 at the Teaneck facility, one of New Jerseys hardest-hit hospitals.

Everyone was anxious and was excited that we would treat her, said Dr. Ravit Barkama, a clinical researcher at the hospital. And the cells were basically on the way to Holy Name from Maryland.

It was an example of the hope and heartache doctors and nurses faced in the early days of the unfolding medical crisis. They rushed to treat a crush of patients flooding the emergency room, while clinical researchers studied the latest data and searched for anything in their arsenals to keep the infected alive.

While the first phase of the COVID-19 crisis is winding down, the pandemic and the health care establishments work are far from over. Holy Name is taking a hard look at everything its medical personnel learned in enduring those treacherous first three months.

The clinical researchers recently shared a report with NJ Advance Media outlining a series of medical takeaways: Everything theyve learned after treating hundreds of coronavirus patients since the crisis began.

Its an orderly account with dense detail and precise explanations a dramatic contrast to March and April, when more than 200 patients were dying on ventilators, one after the other. When the intensive care units were filled.

When there seemed to be no clear answers.

The researchers learned the ways COVID-19 affects the body, the various stages in which it manifests and consumes patients, the medications and therapies that show promise and the treatments that proved ineffective.

Like every hospital in the state, Holy Name was desperately looking for ways to combat the disease after the pandemic hit New Jersey.

Treatment was trial and error. It was a scramble, often necessitating learning on the fly.

The first few weeks, basically, almost every night was ... working with a lot of frustration, Barkama said.

She and her counterpart, Dr. Thomas Birch, have been working as a research duo of sorts, investigating possible therapies for a deluge of COVID-19 patients.

"How are we going to treat the patients? What can we give them? How can we make this better? How can we keep people from dying? How can we keep people off of the ventilator?" Birch said.

It was an exhausting sprint of confusion and dashed hopes.

Barkama and Birch recalled late nights poring over research and data. Barkama called counterparts in Israel and Europe asking what was working.

They found insights, if not epiphanies.

One of the hard-won lessons was COVID-19 is a disease of stages.

It follows a largely defined progression in the human body, from exposure and incubation (phase 1), to the showing of symptoms (phase 2), to the virus impact on the lungs (phase 3) to the decrease of lung inflammation (phase 4).

We basically realized certain interventions might be effective in certain phases and not effective in others. And so thats the key, said Dr. Suraj Saggar, infectious disease specialist at Holy Name.

Early intervention is crucial. Antiviral drugs likely work best during the first phase when used as a pre-emptive therapy, the report said.

The antiviral drug, remdesivir, seems most effective during phase 2, the stage when the initial symptoms emerge. Convalescent plasma may also have some benefit during this stage.

The third phase is what makes COVID-19 different, the report said. This is when symptoms like shortness of breath, persistent fever and pneumonia develop. Severe inflammation begins to batter the lungs, blood vessels and organs.

The bodys overreactive immune system not the virus does most of the damage. It is why inflammatory drugs and immunosuppressive appear to help during this period.

The final stage, or the convalescent phase, is when the inflammation begins to subside and the lungs and other tissues clear the debris from inflammation, injured tissues and fluid, the report said. The stage can span three to six weeks, delaying the time when the patient can be weaned from the ventilator.

It is possible placenta-derived cells may further reduce inflammation, according to the report.

It was a tremendous amount of reading, a tremendous amount of reviewing patient cases and seeing what was going on with them clinically, their symptoms, their physical exam findings, the laboratory and imaging, said Birch, who is also an infectious disease specialist. How they responded to some of the therapies that were being used, and how we might use them more rationally.

When potential treatments emerged, such as placenta cell therapy or remdesivir, it offered hope after weeks of anguish at Holy Name.

It was no different in April as they tried to help the dying woman.

The doctors and researchers waited April 11.

The cells would arrive in just a few more hours, they were told.

The findings on placenta cell therapy were still preliminary, but the treatment championed by a company in Israel was showing promise. Six critically ill coronavirus patients in Israel had shown signs of improvement after taking it.

Some saw it as a possible dream treatment.

But then an alarm blared over Holy Names loudspeakers. It was a Code Blue, an emergency calling for the CPR team.

"It goes 'Code Blue ICU,' and then, of course, I knew that something was very wrong," Barkama said.

Her heart dropped. She rushed to see who it was.

It was the dying woman.

"A few hours before we were supposed to give the treatment, she desaturated and passed away," Barkama said.

The loss devastated her.

"When I saw it was her I must say that it was emotionally very difficult to lose a patient a few hours before the so-called 'dream treatment,'" Barkama said.

While the researchers remain hopeful about placenta-derived cell therapy, only four patients have been treated at the hospital thus far. Its too early to assess the results.

Remdesivir has also shown promise, but research remains ongoing. The National Institutes of Health has found positive results, and Gilead, the maker of the drug, said in a statement earlier this week that it found encouraging data from a recent trial, especially if used as an intervention therapy.

Holy Names staff hope the lessons pay dividends for New Jersey hospitals in case they again encounter chaos like they did in March.

Looming in the back of everyones mind is the possible resurgence of the virus in the fall, after already claiming 11,880 lives and causing 162,068 infections in New Jersey.

There is, of course, a good chance that there will be [another phase], and were not looking at this as a historical episode, Barkama said.

The research continues. Hospitals were caught flat-footed, often forced to learn and sift out new techniques on the fly, revamp old ones and apply them in new ways.

We obviously hope, just like everyone else, that it will never hit us so hard again, Barkama said. But were going to be prepared in case it does.

Spencer Kent may be reached at skent@njadvancemedia.com. Follow him on Twitter @SpencerMKent. Find NJ.com on Facebook.

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Lessons from the epicenter: How one N.J. hospital endured the worst of the pandemic and learned from it - nj.com