The 100th COVID-19 patient discharged from the St. Luke’s Anderson Campus walked through the doors last week, and doctors on Friday said their comfort level with treatment protocol is growing by the day.

Dr. Deborah Stahlnecker of St. Luke’s Pulmonary and Critical Care Associates, and medical director of the Anderson Campus intensive care unit, said her team has been working tirelessly to provide the best care possible for COVID-19 patients, and it’s paying off.

“We developed a comprehensive medication protocol based on the best evidence available that includes hydroxychloroquine, high-dose vitamin C, zinc, atorvastatin and steroids,” Stahlnecker said. “We also utilize noninvasive techniques such as high-flow nasal cannula and self-proning maneuvers, where patients spend up to 12 hours a day lying on their stomachs to help distribute oxygen more effectively in the lungs.”

The virus was unlike anything doctors had seen before, putting them in unchartered territory. Dr. Livia Bratis, chief of St. Luke’s Pulmonary and Critical Care Associates, said the original expectation was to be dealing with a viral pneumonia similar to what happens with influenza cases on an annual basis.

“We quickly realized the virus was acting much differently when it came to the patient’s immune system,” Bratis said. “That was attributed to the cytokine storm syndrome. Cytokine storm essentially results in an immune system, specifically T-cells, going rogue.”

The T-Cell is vital to an immune system fighting infection. When cytotoxic T-cells are activated, cytokines are released and T-cells replicate, in turn releasing more cytokines. Normally, Bratis said, there will be an indicator that tells the T-cells to stop when they are no longer needed. With a cytokine storm, however, that system fails.

“In these situations, bad cells are killed as well as healthy cells,” Bratis said. “That is what is causing the organ damage and is, quite frankly, what makes this deadly. We’ve never dealt with that before. The typical mortality rates in adults who develop the syndrome ranges from 50 to 80%.”

The medication protocol used by St. Luke’s includes high dose levels of vitamin C, known to boost the maturation of T-cells, and atorvastatin, aimed at preventing damage to the heart muscle and lowering the severity of COVID-19 in some patients.

Hydroxychloroquine was also listed, but Bratis said it hasn’t yielded consistent results.

“We’re seeing what the whole world is seeing when it comes to hydroxychloroquine,” she said. “It was originally touted as a great thing to use, but it really hasn’t had the positive results we’ve been looking for. We’re finding that it may be more helpful early on, but not what we’ve hoped for once a patient gets to the hospital setting or intensive care unit setting.”

Bratis said patients have welcomed the differing treatment ideas from St. Luke’s doctors.

“We usually meet with patients for the first time on the hospital floor, and we’re being up front and open,” she said. “We’re all in unchartered territory. We want to give them the best treatment possible to avoid them getting to the point where they need to go to intensive care.”

Across the Network, St. Luke’s has discharged about 450 COVID-19 patients who are now recovered or on the road to recovery.

Among the discharged patients are many who were on ventilators. Networkwide, St. Luke’s has extubated about 50 patients thus far.

The attitude of the health care worker is also evolving, Stahlnecker said. What started out as feelings of uncertainty is now becoming a new normal.

“I think the mindset has definitely shifted,” she said. “We were all very much in disbelief and discomfort at the outset. It was a fear of the unknown. Our safety is always second to that of our patients, and I think this virus really created a situation where we had to shift that thinking a little bit. I think we’re all a bit more optimistic now than we were at the beginning as we see more success stories.”

St. Luke’s has recently rolled out a program in conjunction with Miller-Keystone Blood Center to use convalescent plasma from a person who recovered from COVID-19, and transfer those antibodies to a critically ill patient.

“There is evidence those antibodies may provide a boost to someone else fighting the virus,” Stahlnecker said. “Patients can give that blood within 14-28 days of their own recovery, and that would be used for our sicker population.”

While the doctors said the raw data has yet to be analyzed, there is cause for optimism that social distancing is working.

“We’re in our little health care bubble here, and we are really at the mercy of what the community is doing,” Stahlnecker said. “I will say that we had originally projected a much larger number of patients. The fact that we’re not seeing the numbers we originally thought tells us that the community as a whole is doing their part to help flatten the curve. We’re very fortunate to have communities who are taking this seriously.”