By Dr. Anthony Policastro

People who do not practice medicine on a regular basis sometimes fail to realize how quickly things can change. That is true of treating COVID-19.

The most obvious example of that is the wearing of face masks. At the beginning the recommendation was that you needed to wear a face mask if you were ill.

Then we found that asymptomatic patients and pre-symptomatic patients could spread the virus. So since we could not be sure who was spreading it, face masks were recommended for everyone.

Some people thought that the medical people did not know what they were doing. That was not true. They changed their recommendation based upon new knowledge.

That same kind of thing has happened with treatment of infected patients. There have been many changes in our approach over the last six months. Most of those have come from new scientific findings.

The most obvious example of that is the use of ventilators in the ICU. Initially most sick patients went right to a ventilator. We later learned that it might be too much too quickly.

Therefore, we now use nasal oxygen for longer periods before having to step up to a ventilator. That has allowed some patients to recover without a ventilator.

It has allowed some to not suffer the complications we see with ventilated patients.

A second example is the amount of fluids patients receive. Usually patients with isolated lung disease receive as little IV fluid as possible. Dry lungs move oxygen better than wet lungs.

However, COVID-19 is not isolated to the lungs. It affects other organs like the kidneys. Not enough fluid will result in kidney failure.

That is to be avoided. So fluids are now used more judiciously.

Initially, there were no medications that helped treat the virus. Over time we found that remdesivir was helpful. It did not cure the virus. However, it did seem to help patients get better a little faster. So it is now being used more often.

Also on the medication front is the medication that is used to sedate patients on ventilators. We have found that tranquilizers seem to work as well as narcotics. So we are using less narcotics.

COVID-19 is as much an inflammatory reaction as it is an infection. For that reason, steroid medications appear to be useful in treatment. These are now added to the regimen.

COVID-19 patients appear to have an abnormal amount of clotting in their blood vessels. I wrote about that a few weeks ago. Blood thinners are being included in the treatment regimen.

Even patient positioning has changed. It was discovered that COVID-19 patients had better oxygen levels when lying on their stomach than on their back.

That is true both for patients just on oxygen and for those on ventilators. So “tummy time” is now part of the recommendation.

None of these things has cured COVID-19. However, taken together they are responsible for helping patients survive who would not have done so six months ago. As science changes, so do our medical treatments. Sometimes that happens very quickly.


Nationally new cases have remained between 36,000 and 62,000 daily since August 9th. This is lower than it had been running.

Some of the low numbers can be attributed to decreased testing. However, the fact remains that the numbers are not increasing the way they were.

The state of Delaware once again doubled its number of cases. However, this time it took 87 days to double. That compares to 37 days for the previous doubling. So the rate of rise in the state is slower as well.

Coronavac continues to be my favorite for the best vaccine. The studies so far showed positive antibodies in 92.4 percent of patients after 14 days and 97.4 percent of patients after 28 days.

Those numbers are great. The most common reaction was pain at the site of injection. Fever was less frequent that it has been with other vaccines.

I called Merck Pharmaceuticals last week. They make the MMR vaccine. I got put on hold for an hour and 20 minutes before they answered. I asked if they were looking at the MMR vaccine for possible use for COVID. They had a stock answer that they read to me. It said that two studies had been inconclusive.

I asked if one of those studies was the one in mBio the journal of the American Society of Microbiology back in May. They had not even heard of what appears to be the most complete study on the subject. I told them to read it.

They did decide to do one thing. I had told them that I got the MMR vaccine as a precaution.

They told me that they were going to write an adverse action report on a non-labeled use of the drug. No good deed goes unpunished. So much for Big Pharma taking action.