Sanford Health and Essentia Health exemplify rock solid American Midwestern-Great Plains health systems on the front lines of the COVID-19 pandemic. Both health systems have embraced investigational therapies to treat a previously unknown, novel coronavirus as clinical investigators have scrambled for proven treatments to deal with an unprecedented modern-era health crisis. From Actemra and remdesivir to stem cell therapy and even the antiparasitic drug ivermectin—embraced in South America and parts of Asia—Great Plains’ health professionals work around the clock to help patients fight off this new and at times deadly pathogen.
Recently Duluth News Tribune’s Patrick Springer wrote a good summary of how researchers at Great Plains providers, such as Sanford Health and Essentia Health, scramble to find treatments that can help their patients beat SARS-CoV-2, the virus behind the COVID-19 pandemic.
TrialSite News offers a summary of the experimentation ongoing by researchers within prominent health systems across America, and the world.
Known as tocilizumab and atlizumab, the immunosuppressive drug called Actemra used mainly for rheumatoid arthritis (RA) and systemic juvenile idiopathic arthritis, is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicate in the pathogenesis of many diseases from autoimmune disease and multiple myeloma to prostate cancer. Developed by Roche and Chugai, the drug is the subject of a clinical trial led by May Clinic and includes Essentia and Sanford (as sites) to investigate the drug’s effectiveness in treating patients infected by SARS-CoV-2.
First investigated in China for patients combatting the cytokine storm associated with COVID-19—where the immune system overreacts, hence triggering responses that send the body into shock causing organ damage—Dr. Karol Kremens, a pulmonologist and intensive care unit director at Essentia Health, commented on Actemra: “We’re guessing that it might disrupt this cascade.” With severe side effects, this powerful immunosuppressant is used only for those in intensive care. On the risks, Dr. Kremens noted given the potentially severe side effects, “it shouldn’t be given lightly.”
Presently there are 38 studies worldwide investigating Actemra with COVID-19 patients.
The only drug approved for emergency use against COVID-19, Remdesivir has been shown to reduce the duration of COVID-19 illness by a few days. Developed to treat the Ebola virus, it is now being used to treat coronaviruses and is under investigation at Sanford and Essentia. While supplies are tight given the recent FDA ruling, hospitals receive the medication via allocations by state health agencies, reports Patrick Springer. Sanford, based in Fargo, North Dakota, received half of the state’s allotment. Thus far, there is no evidence the drug reduces mortality. On that topic, Dr. Doug Griffin, chief medical officer, reiterated, “I think it’s too early to say whether it reduces mortality.” Dr. Griffin and Kremens commented to the Duluth News Tribune that the drug appears to be most effective when administered during the early stages of the disease—even prior to the appearance of symptoms. Much like Tamiflu, which isn’t a cure, it can reduce the severity and duration.
Stem Cell Therapy & ARDS
Sanford Health is also involved with a stem cell therapy study deemed “very investigational” by Dr. Griffin. Investigational stem cell therapies are being tested to determine if they can impact highly at-risk patients who have developed acute respiratory syndrome (ARDS) or kidney damage. A search of Clinicaltrials.gov identifies at least 36 comparable studies around the world.
In what could be the first identified investigational use of Ivermectin in a major American health system, the Duluth News Tribune article identifies ivermectin, an antiparasitic drug TrialSite News has been following around the world as a potential treatment for mild COVID-19, as an investigational target for Sanford Health. Dr. Griffin reports that Sanford Health investigators are developing research protocols in preparation for an ivermectin study.
Sanford and Essentia are involved with convalescent plasma studies, such as the national effort led by Mayo Clinic. In these studies, recovered COVID-19 patients donate blood (plasma) that includes neutralizing antibodies. Dr. Kremens reports to the Duluth News Tribune that the supplies of the investigational product have improved as more patients recover from COVID-19. There are now at least 79 clinical trials involving convalescent plasma and COVID-19 patients, according to a search on Clinicaltrials.gov.
Dr. Griffin reports they have not been that impressed with the investigational use of this anti-malarial drug but they still use it on a case-by-case basis.
In cases where COVID-19 patients have difficulty breathing, Dr. Kremens reports the use of a practice called proning—a technique involving having the patients “prone” or lie on their bellies, 16 hours each day and spending the other night literally on their backs. Apparently this impacts the circulation of blood in the lung’s, reports Dr. Kremens. Some positive reports have ensued: an Essentia patient on a ventilator improved after just a couple days due to the proning. Dr. Kremens commented, “This is a treatment that we know works and there are relatively low risks for the patient.”
Sanford Health has its roots in the Dakotas at the commencement of the 20th century with Sioux Falls Hospital opening in Sioux Falls in 1894, and St. Lukes Hospital opening in Fargo in 1908. Over the next 8 decades, both hospitals grew in size and influence, becoming integrated hospital-clinics known as Sioux Valley Sanford Health in 2007 after Denny Sanford’s $400 million gift to the organization. By 2009, Sanford acquired MeritCare and additional mergers followed. The health system now has 44 medical centers, 482 clinics, over 200 senior living facilities, and over 190,000 plan members; the organization employs 48,622 as well as 1,382 physicians.
Essentia Health, based in Minnesota, Wisconsin and North Dakota, has over 14,000 employees, including 1,500 credentialed practitioners. The network includes 15 hospitals, 74 clinics and seven long term care facilities as well as assisted living centers. The health system was formed in 2004 as the parent company of a partnership between Benedictine Health System and St. Mary’s/Duluth Clinic Health System (SMDC). Since then, multiple acquisitions have added to its size.
Karol Kremens, MD, Critical Care, Pulmonary Medicine, Essentia Health
Doug Griffin, MD, Chief Medical Officer, Sanford Health
Call to Action: Follow the link to the source at the Duluth News Tribune for an excellent overview of investigational COVID-19 treatments at some prominent Midwestern health systems.