When the novel coronavirus first began to worry the staff at Berkshire Health Systems, doctors knew little about the illness caused by the virus. It was not clear who was most at risk from COVID-19, what treatments would work best, or even how serious the illness really was.
In early March 2020, the first confirmed case of community spread in Berkshire County, and the state, went unidentified for days amid stringent testing guidelines. That spring, the first surge of the virus hit a hospital system that had to learn on the go, relying on a surge of new research from across the country and the world.
A year after that first case, doctors know the disease more intimately. They have more tools and therapies to help people who fall ill. And they have deep understanding of the toll that a pandemic can take without a unified national response.
“It’s the nature of something new,” said Dr. James Lederer, chief medical officer and chief quality officer at Berkshire Health Systems and an infectious disease specialist. “You just have to live through it.”
Lederer spoke with The Eagle about the scientific developments that emerged from the virus, the early failures of the country’s health infrastructure and his takeaways from one year of COVID-19.
Q: What has the medical community learned this year?
A: I’d like to say we learned a lot, and we have, but there’s still a lot we don’t know. We’re still waiting on validation of the vaccines’ efficacy not just in preventing disease, but in preventing asymptomatic transmission.
But, we have learned a lot about this illness. We know more about the immune response, particularly in young, healthy hosts who can mount an overwhelming response. We’ve learned a lot about new platforms for vaccinations. We’ve never before had an mRNA vaccine. That’s brand new, by virtue of COVID-19.
Q: How much did we know about COVID-19 this time last year?
A: Many of our assumptions of transmission route, many of our assumptions about the illness needed to transmit enough volumes of viral particles to make it to the next patient, were wrong. We didn’t really have that knowledge at the outset.
What we knew in March was years’ worth of other coronavirus infections. They were largely relatively symptomatic and nothing to be really worried about. The old coronavirus infection was a “Who cares?” infection. It was a runny nose.
So, what we were faced with was a brand-new set of circumstances that redefined how aggressive a coronavirus could be. We had a hint from SARS. We had a hint from MERS. But, those didn’t self-sustain, and they weren’t much beyond localized epidemics.
Q: What did you learn about treating patients?
A: We knew early that our normal approach to supporting ventilatory needs in our patients was probably the wrong approach. Intubating patients, the tried-and-true standard therapy, actually did more harm than good. So, we intubated fewer patients. We used higher-flow oxygen. We repositioned patients to their prone position, on their stomachs.
It was an entirely new approach. We’d proned patients before. We had always done that in very high-risk situations. But, now it became kind of the standard. I think that knowledge quickly got out and was shared among professional societies so people knew what to do.
Q: What was the most notable thing that happened this year, from your perspective as a doctor?
A: It was the rapidity with which the academic institutions, the research institutions, quickly took up the challenge to develop vaccines. It was the rapidity with which they developed the monoclonal antibodies to be a therapeutic option when, prior to that, we didn’t have any.
Now, there are Phase Two [clinical trial] drugs out there that show marked definition in lessening the viral burden, which leads to much shorter illness stays. So, we’re staying tuned to see what happens with these drug therapies. There are pharmaceutical therapies that are going to be available for coronavirus in the very near future.
Vaccination is not a new thing. Antibody therapy is not a new thing. We’ve had all these therapies for a long time. But, we were rapidly able to look to the past and take the best of what we knew and formulate it for the present, and we ended up with some incredible wins.
Some of the new medicines are not unlike the medicines that are HIV-related. So, it’s fortunate that coronavirus infection came along today and not 20 years ago. I think we’d have been in a horrible mess, and we wouldn’t have been able to achieve anything like we did this past year.
Q: Early on, there were shortages of personal protective equipment, and many fears about medical rationing. Did we learn something this year about investing in health infrastructure?
A: Well, I hope so. The national supply chain, I hope what we’ve learned, is very fragile and tenuous.
When the outbreak occurred, we had an administration that didn’t want to take the lead in defining what it is we needed to do. When we first knew something was happening, we should’ve been making sure we had the supplies we needed to go forward. Some organizations had leftover [gear] from Ebola, some from the avian flu. But, if you didn’t address stockpiles on your own, you weren’t going to get anything. We were at odds with each other and with the federal government.
Why didn’t we institute the Defense Production Act much sooner? We could’ve had tens of thousands more masks on a daily basis being developed and manufactured, if we pulled out the stops to make it easier. Some people say they don’t think big government is a good thing, but it is, in big things like a pandemic.
Q: What about our local health infrastructure?
A: What we’ve learned in Berkshire County is that the more we are integrated, the more we come together, the better off our patients are. Particularly when we talk about Berkshire Health Systems and Berkshire Healthcare Systems [which operates nursing homes across the county].
The reason we’ve done so well with the monoclonal antibody therapy use is, Berkshire Health Systems owns all the testing. … We assess every positive patient, make determinations if the therapy would benefit the patient and provide infusions if we can. It’s a soup-to-nuts kind of approach.
We’re not at odds with other health care providers, we’re not at odds with governmental agencies, we’re not at odds with other distribution networks. We are the hospital, the medical staff, the nursing staff, the long-term care, home care, hospice, rehab. We have all of that inherent in the Berkshire Health Systems medical complex. Same for the vaccine collaborative.
Q: What do you wish you could go back and tell yourselves in March 2020?
A: Anything I say is finding fault with the testing strategies, or finding fault with the supply chain and distribution. These are just things that were inherent in the medical system at that time. I couldn’t have changed them like I would’ve wanted to.
I think awareness would’ve helped, but I would have still had to deal with the fact that I didn’t have N95 masks. I would have had to deal with the fact that testing was slow in evolution, that we were gonna be behind many days in getting our answers in the early phases.
It’s the nature of something new. You just have to live through it. What I look back on and take great pride in is that we, as an organization, rapidly came together, and at the community level with our partners out there. We approached it the Berkshire way.
Everyone in Berkshire County is someone’s loved one, family member, friend, colleague. Everyone knows someone, and everyone is something to someone. We’re a community of Berkshire residents taking care of Berkshire residents.