By Tim Carpenter and Sherman Smith
Tribune News Service
TOPEKA — Kansas Army National Guard Col. Lee Norman said the military prepares for war in times of peace.
And, to a degree, so do civilian hospitals.
Norman, who also leads the Kansas Department of Health and Environment, said crisis standards for care would guide medical decisions as coronavirus infection surged in Kansas.
This playbook of sorts will assist physicians whenever demand spikes for intensive-care beds, ventilators and medicines, even drugs not yet clinically proven effective against COVID-19.
What should a Kansas doctor do with two seriously ill patients and access to one ventilator?
“We know, for example, that an 80-plus-year-old that gets on a ventilator with coronavirus is very unlikely to survive,” Norman said. “Does that mean we abandon that patient? Heavens, no. We try to do the best we can with the most people. We’ve not gotten into that bad situation, yet. I’m optimistic we won’t.”
Kansas has surpassed 100 confirmed cases of COVID-19. KDHE estimated Kansas infections could range from 300 to 900 by April 1, which would put greater strain on personnel, equipment and supplies at hospitals in Kansas.
Health facilities in urban centers — more than half Kansas’ known infections are in Wyandotte and Johnson counties — would become magnets for the sick.
“We think we’re two to three weeks away from really accelerating,” said Steven Stites, chief medical officer of the University of Kansas Health System in Kansas City, Kan.
On Tuesday evening, Wyandotte County/Kansas City, Kan., health officials reported the county’s second death related to COVID-19.
The third fatality in Kansas was identified as a man in his 70s. He tested positive March 18, was discharged from a hospital Friday and entered the hospital again Sunday. He passed away Monday.
“We offer our prayers and thoughts to the family and friends of the deceased. Their sadness is our sadness. Our own family and friends are precious to us, and so I call on each one of us to protect one another and stop the spread of COVID-19,” said David Alvey, mayor of the unified government of Wyandotte County and Kansas City, Kan.
Surgeon and former Kansas Gov. Jeff Colyer and physician Daniel Hinthorn, director of infectious disease at the University of Kansas Medical Center, made the case in a Wall Street Journal for treating coronavirus with the antimalarial drug hydroxychloroquine, also known as Plaquenil, and the upper-respiratory infection drug azithromycin, with the brand name Zithromax Z-Pak.
The combination showed promise in a small number of patients in France who were reportedly cured with a six-day treatment, the Kansas doctors said.
“One lesson that should inform the U.S. approach: Use this treatment cocktail early, and don’t wait until a patient is on a ventilator in the intensive-care unit,” Colyer and Hinthorn said.
They said hydroxychloroquine, with or without a Z-Pak, should be a first-line treatment of patients testing positive or presumed to be infected. The federal government should contract with manufacturers to ramp up production because the drug is in short supply, they said.
Both were pleased President Donald Trump touted hydroxychloroquine as a potential treatment.
“We don’t want to peddle false hope,” they said. “We have seen promising drugs turn out to be duds. But the public expects an answer, and we don’t have the luxury of time. We can use this treatment to help save lives and prevent others from becoming infected.”
Dana Hawkinson, director of inpatient critical care at the KU hospital and an infectious diseases specialist, said there was anecdotal evidence in the Kansas City area of rapid growth in demand for Plaquenil.
He said coronavirus patients at KU were receiving the drug in a “very regimented manner,” but expressed concern about potential shortages.
“I need to stress: These are not benign drugs,” Hawkinson said. “There are still people who are really sick with conditions for which they are approved and need these drugs.”