HMC Implements Early Treatment Protocol for Kupuna Diagnosed With COVID

Jon Martell, HMC Chief Medical Officer

The deadly outbreak of COVID-19 at Yukio Okutsu State Veterans Home has left the Big Island community stunned and devastated.

As of Thursday, 27 veterans have succumbed to the infection and a total of 71 residents and 35 employees tested positive for COVID-19 since the cluster was identified in August. In an effort to prevent future deaths at Yukio and other long-term health care facilities, Hilo Medical Center has begun to implement a new protocol that begins treatment for kupuna before they become severely ill.

The change in treatment was driven by the deaths at Yukio, said HMC’s chief medical officer Jon Martell Thursday afternoon.

“In my mind having witnessed the tragedy at Yukio I don’t think there’s an option to not offer this,” Marrtell said. “Clearly nursing homes are vulnerable and we want to be ready for the next one (outbreak).”

Martell began looking at initiating standard treatments earlier in the course of the disease last week. While the protocol was set to be in place starting next week, it started this week due to a cluster developing at the Life Care Center in Hilo.

There are currently three residents from Life Care who have been transported to HMC to begin early treatment. Two have mild symptoms and the other has none.

“What we’re looking at is to see if any of them develop severe disease,” Martell said. “We won’t know if the protocol works for two to three weeks — it’ll be more a study of how they do over the long term.”

The current standard of care for patients in a long-term care facility outbreak is to send moderately or severely symptomatic patients who are candidates for active care to a hospital for treatment but to keep asymptomatic, mild symptomatic and comfort care patients at the home for symptomatic care and monitoring.

“This strategy may be expedient but may also be fundamentally flawed if, as we are coming to believe, earlier treatment is more efficacious than later treatment of the disease,” HMC officials stated.

Early treatments that can be provided in the hospital setting but are not available in the LTC facility include convalescent plasma and administering an anti-viral drug called remdesivir.

“Remdesivir is clearly more efficacious if given early than later in the course of the disease, preferably before inflammatory lung disease develops,” officials stated.

After an elderly person tests positive for the virus, Martell said there is a week where doctors have an opportunity to stop the disease from progressing to deadly levels. Waiting till the old and debilitated individuals are sick enough to be hospitalized is a failed strategy, he noted.

“The trend in all our treatments, have all been pushed earlier and earlier with better results,” Martell said. “I have a fair amount of optimism that this strategy isn’t misguided.”

As of Thursday, there were 11 active cases among residents at the Life Care facility.

“We’ve been doing weekly testing since the first of September and in between if someone starts to exhibit symptoms,” said Life Care Medica Director Gary Johnson said. “We’ve moved to twice-a-week testing to try and catch things as early as we can.”

Johnson said he hopes by treating his residents early it will prevent them from progressing to more severe stages of the disease.

Martell said COVID testing is aggressively happening at Yukio.

“They (Yukio) do have certain indvidiuals who haven’t recovered and there could be one or two additional deaths in the coming days,” he added. “I think they got it under control, but the pandemic hasn’t died down so they could have a new event separate from the original event.”