Wuhan Dispatch: Part 2: Sharing Best Practices Around Testing and Treatment

Jeffrey Reeves
Vice-President of Research for the Asia Pacific Foundation of Canada

On April 8th, more than 50 physicians, logisticians, and head administration officials from Vancouver Coastal Health and from across British Columbia had a conference call with doctors and nurses from Central Hospital in Wuhan, China – arguably the first responders on the front line of the global war against COVID-19.

The informal call was the second of a series organized for Vancouver health-care professionals to learn from China’s experience around pandemic response and mitigation. Over the course of one hour, Canadian and Chinese doctors and nurses spoke about the challenges, best practices, and experiences they have had in dealing with the coronavirus outbreak.

The following notes outline the main discussion points between British Columbia-based health-care professionals (Canada side) and their Chinese counterparts (Chinese side).

In contrast to the first call (see Wuhan Dispatch: Part 1), the second call focused more on best practices around clinical treatment, including when to introduce different methods of ventilation support and what types of medication have proved effective in treating COVID symptoms.

In general, the Chinese side described a progressive form of treatment that started with low-flow oxygen, included awake proning/repositioning, moved to high-flow oxygen, non-invasive mechanical ventilation, and ultimately, intubation. When asked, the Chinese side suggested moving from one treatment method to the other as needed, as quickly as a matter of hours when necessary.

The Chinese side noted a similar experience with both pulmonary compliance phenotypes and concurred with the Canadian doctors’ assessment regarding treatment variation. For both the Canadian and Chinese sides, this understanding of pulmonary compliance and treatment differed from earlier approaches, which prioritized mechanical ventilation for all patients with pulmonary distress.

The discussion then moved to the effectiveness of anti-viral medication in the treatment of COVID-19 patients. The Chinese side noted some possible success in treating COVID symptoms with Chloroquine, although noted such treatment must be used carefully in patients with cardiac conditions. Barring this caveat, Chinese doctors found Chloroquine potentially useful when administered at an early phase of treatment.

Conversely, the Chinese side did not see much benefit from using Remdesivir in COVID patients. Indeed, the Chinese doctors noted that they had used Remdesivir in a small clinical trial with 180 subjects and found the anti-viral’s effects underwhelming.

The Chinese side did, however, note some success with immune suppression treatments, primarily steroids (Prednisone). The Chinese side described a treatment of 40 mg of steroids for one to two days after which, if the patient responded positively, they would increase the dose for three to five days. Chinese health-care providers have used immune suppression treatments to treat respiratory trouble and fever in a small population of patients suffering from over exaggerated immune responses to COVID-19 infection.

The Chinese side specifically pointed to some irregularities around testing results that have caused them some concern.

The Chinese side currently employs a three-part approach to testing that includes positive/negative testing for COVID infection, COVID live virus, and COVID serological antibodies (immunity) tests. Until recently, the Chinese side believed this testing regime allowed them to say, with near certainty, who has the COVID virus, who has recovered from COVID, and who is immune to the virus. This approach to testing has determined who can return to work, for instance. In recent days, however, the Chinese side has observed mixed testing results that draws their understanding of COVID into question.

Notably, issues around reinfection have also emerged in economies like South Korea and Italy, both of which have responded with more robust testing regimes. Both the Canadian and Chinese sides expressed similar confidence in COVID testing’s overall effectiveness but noted that challenges remain at this early stage of the pandemic. The Canadian and Chinese sides did, however, expect to develop greater certainty around COVID going forward.

“Cross-posted with permission from the author. This article was original published on APF Canada website dated 16 April 2020”