THE GENERAL definition of a mass casualty situation is one in which an incident or incidents overwhelm the medical resources, personnel, equipment, and supplies available to respond to these events. In many parts of the United States and around the world, this is exactly what is happening with COVID-19 cases that result in hospitalization and deaths.
For anyone who has ever been in the military, especially medics, this is a familiar situation in which they have been trained to respond in a rapid fashion. Incident commanders are taught to assess the overall situation, respond to limit further casualties, triage patients, and treat and transport victims as rapidly and effectively as possible with the resources they have on hand. In the old days, for combatant commanders, this was called the “come-as-you-are war.” From the medical perspective, this means that you use the treatments you have on hand, not those that need a randomized, prospective, double-blind study that may or may not give you the result you’re looking for in 2 to 4 years.
For much of the last several months, the U.S. health system has been responding to the surge of COVID infections and hospitalizations in much the same way, with one exception. There has been very limited, and in many cases non-existent, attempts to successfully prevent further cases. We have relied almost entirely, if not exclusively, on vaccinations as the only means of accomplishing this task.
Treatment options to prevent the progression of early cases into more severe illness have been severely limited to the occasional use of monoclonal antibodies. All attempts to use FDA-approved drugs that appear to have some effects in treating COVID, have been severely constrained by the federal government on down to the local level, simply because they are not FDA approved for this infection.
Even a local physician who heads the emergency department of one of the area hospitals had recommended that New Hampshire sanction practitioners who wish to try these drugs for COVID-19 treatment. If we were dealing with a new outbreak of some version of the old Spanish influenza, I can almost guarantee we would be handing out Tamiflu or similar drugs like candy.
Although anecdotal evidence should generally be avoided in making treatment decisions, there comes a point when so much worldwide use information on the effectiveness of certain drugs against a particular disease becomes available that practitioners should be allowed to use their own clinical judgement and do what they believe is right for their patients. This already happens with many drugs in the United States. Between 12% to 56% of all FDA drugs, depending on the particular drug category, are used “off label” to treat conditions for which they were not explicitly FDA approved. Even if these drugs are not 100% effective (no drug ever is), if they could reduce the number of cases progressing to severe illness by 50-60%, that would have an immediate and substantial impact on the current crush of hospital admissions and beds until more specific drugs are available.
This approach to treating COVID was advocated by a paper from the Yale School of Public Health, Department of Epidemiology, well over 18 months ago.
Therefore, I would respectfully urge all federal and state health departments to stop the efforts to prevent individual health practitioners from using all available pharmaceutical means to treat early cases of COVID-19, and help relieve the pressure on the hospitals throughout this state and the nation.