COVID-19: Lessons from the Pandemic

Insights from Temple Health

By Gerard J. Criner, MD, FACP, FACCP
Chair and Professor, Thoracic Medicine and Surgery
Lewis Katz School of Medicine at Temple University

As the COVID-19 pandemic took hold in Philadelphia, Temple physicians had already been in touch with international colleagues for months and knew it was crucial to share what we had learned. We formed the Temple University COVID-19 Research Group with the aim of analyzing and broadcasting key findings coming out of both clinical experiences and pivotal clinical trials taking place at Temple Health. As a high-volume respiratory care center and a prolific clinical research hub, with deep expertise treating high-risk and complex respiratory patients, Temple was primed to help physicians and other health systems worldwide respond to COVID-19.

The research group—an extensive collaboration between researchers and clinicians across multiple departments in the Lewis Katz School of Medicine and Temple University Hospital— made important findings relevant to patient care. More than a year later, we look back on a few highlights of this research effort:

  • Diagnostics: As hospitals worked to prevent outbreaks at the point of care, the ability to identify COVID patients who tested negative via a nasal or oropharyngeal swab became vital. The Temple COVID-19 Research Group demonstrated that high-resolution computed tomography imaging could fill a pressing need for additional diagnostic methods.1
  • Cytokine storm: A report by the Research Group outlined criteria for predicting the onset of cytokine storm (CS)—the dangerous immune response that causes many COVID-19 deaths—among hospitalized COVID patients based on laboratory results. This protocol allowed physicians to intervene earlier to potentially prevent or reduce CS intensity.2 Temple researchers also reported the successful first use of etoposide as a salvage therapy in a patient with severe COVID-induced CS that was unresponsive to anti-cytokine or immunomodulation therapies.3
  • Reducing intubation: Researchers found that using high-flow nasal therapy (HFNT) in COVID patients with moderate to severe respiratory failure reduced the likelihood that they would require invasive mechanical ventilation. There was lower mortality among patients treated with HFNT who did not progress to intubation.4 Temple has used HFNT as its primary treatment for patients with COVID-induced decision that appears to have contributed to better-thanaverage outcomes for COVID patients.5
  • COVID and COPD: Examining outcomes from COVID patients at Temple University Hospital, Temple researchers found that patients with emphysema/COPD did not have higher mortality rates or longer hospital stays when compared with similar patients without emphysema/COPD, suggesting that age and other comorbidities play a larger role in negative COVID outcomes. Emphysema/COPD patients were, however, more likely to require admission to the ICU and extra respiratory support.6 Another study outlined how COVID-19 interacts with COPD in CT imaging, finding a great deal of variation.7
  • COVID and VTE: Temple published one of the first reported U.S. studies on venous thromboembolism (VTE) rates among COVID-19 patients, finding that progression to invasive mechanical ventilation, D-dimer levels on admission, and mortality were higher among patients with confirmed VTE.8 Temple researchers also reported key research findings on COVID-19 and lung transplantation, which you can read about here.

Research-informed treatment influences patient outcomes Temple’s dynamic research program and experience with treating complex respiratory disease appear to have made a difference for our most vulnerable patients during the COVID-19 pandemic. Temple’s AAMC Medicare data for January through June of 2020 show:

  • 28% lower mortality rate from COVID-19 than national average (15% lower than other Pennsylvania hospitals), and 33% lower patient mortality within 30 days than the national average (32% lower than other Pennsylvania hospitals).
  • 9% fewer COVID patients with ICU days than the national rate (28% lower than other Pennsylvania hospitals).
  • 21% lower rate of mechanical ventilation than national average.

Temple treated a higher proportion of Medicare patients with COVID (13% compared with an average of 7% locally, 4% statewide, and 3% nationally) and served 33% more dual-eligible, 11% more Hispanic, and 107% more Black Medicare patients with COVID-19 than the national average.

The long haul

COVID-19 remains a disease threat in the United States and worldwide, and Temple is committed to responsive and innovative care for COVID patients. From vaccine trials to monoclonal antibody infusions for high-risk, COVIDpositive patients to a post-COVID recovery clinic for patients with persistent post-acute symptoms and for those who require lung transplantation, Temple Health continues to offer necessary and data-driven services that help prevent disease and give patients the best chance for full recovery. 

References
1 Patel, M., et al. 2020. “High Resolution CHEST CT(HRCT) Evaluation in Patients Hospitalized with COVID-19 Infection.” medRxiv (preprint) May 26. https://doi.org/10.1101/2020.05.26.20114082
2 Cariccio, R., et al. 2021. “Preliminary predictive criteria for COVID-19 cytokine storm.” Ann Rheum Dis. 80 (1):88-95. http://dx.doi.org/10.1136/annrheumdis-2020-218323
3 Patel, M., et al. 2021. “Etoposide as Salvage Therapy for Cytokine Storm Due to Coronavirus Disease 2019.” Chest 159(1): e7-e11. https://doi.org/10.1016/j.chest.2020.09.077
4 Patel, M., et al. 2020. “Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure.” BMJ Open Respir Res. 7(1): e000650. http://dx.doi.org/10.1136/bmjresp-2020-000650
5 Chowdhury, J.M, et al. 2021. “Outcomes with High Flow Nasal Therapy vs Invasive Mechanical Ventilation in COVID-19 Patients with Hypoxemic Respiratory Failure.” Am J Respir Crit Care Med. 203: A2637 (poster abstract). https://doi.org/10.1164/ajrccm-conference.2021.203.1_MeetingAbstracts.A2637
6 Marron, R.M., et al. 2021. “Impact of chronic obstructive pulmonary disease and emphysema on outcomes of hospitalized patients with coronavirus 2019 pneumonia.” Chronic Obstr Pulm Dis. 2021; 8(2): 255-268. doi: http://doi.org/10.15326/jcopdf.2020.0200
7 Tittaferrante, S., et al. 2020. “Thoracic Computed Tomography Features of Coronavirus Disease 2019 Patients with Emphysema.” Chronic Obstr Pulm Dis. 7(3): 290–296. https://dx.doi.org/10.15326%2Fjcopdf.7.3.2020.0166
8 Rali, P., et al. 2021. “Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center.” J Vasc Surg Venous Lymphat Disord. 9(3): 585-591.e2. https://doi.org/10.1016/j.jvsv.2020.09.006