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Ask the expert: What have hospitals learned already about COVID-19?

A UAMS doctor says hospitals have learned fast, but continue to have a healthy respect for what's still unknown.

LITTLE ROCK, Ark. — A "second peak" of cases is leading to new heights in how many Arkansans are or will be hospitalized with COVID-19. Doctors leading the fight at the University of Arkansas for Medical Sciences say they have learned quickly, making that prospect less frightening.

"While we've learned a lot, we've still got a long way to go," said Dr. Bob Hopkins, director of Internal General Medicine at UAMS.

The professor and pediatric specialist divides the accumulated knowledge of the coronavirus into two categories: inpatient and outpatient.

"We've learned that there are a fair number of folks that are floating around out there that have coronavirus that don't necessarily have symptoms," he said. "They may be a source for infection for others."

That fact is why he and other public health experts right up to state secretary of health Dr. Nate Smith urge everyone to take care while going back out and about.

Asymptomatic carriers also helps explain why early projections about how many would need to be hospitalized have been tempered.

Back in March, a study out of China indicated 80% of cases would be mild, 13.8% would be severe and 6.1% would be critical. Dr. Hopkins and others note that we can't make apples-to-apples comparisons, but our pie chart looks better in Arkansas.

Severe cases, defined as admission to a hospital, are at 10%, and critical cases, as measured by those who go on ventilators, are less than 2%.

But once in the hospital, health care providers have learned the virus gives patients much more than pneumonia.

"The coronavirus, while most of the time we think of in the lungs, it also affects most of the organs in the body," Dr. Hopkins said. "We've started to find out about blood-clotting problems. We know many severe coronavirus patients often have cardiovascular dysfunction and often have kidney dysfunction."

When there are lung problems, traditional therapies are giving way to new ideas. In one case, it's as straightforward as flipping how patients lay in bed.

"We found that with the coronavirus, if you can have people prone, laying on their stomach, they may be able to ventilate and oxygenate better than on their back," Dr. Hopkins said.

Other advances include a better knowledge on how to stratify how patients are classified for care. Promise with the drug remdesivir is joined by theoretical success of plasma infusions from recovered patients to produce signs therapies could be developed ahead of a vaccine. 

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On the flip side, there is diminishing excitement over hydroxychloroquine as a treatment as more studies are done. That medicine is a part of a political debate after President Trump touted the drug and said he took it to keep the virus at bay.

It is also unclear how antibody testing can and should be used in the hospital. Some early studies pointed toward the possibility that people who had seemingly contracted the virus without showing symptoms could benefit those that got sick, but the subsequent data is now murky.

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"Things such as antibody testing had a lot of promise," Dr. Hopkins said. "At this point, we really don't know where to use antibody testing."

Whether antibody testing turns into a way to measure the virus in a community or a therapy develops that shortens hospital stays, doctors are still focused on simple measures we should all take: Wear masks, wash hands, keep your distance, and stay home if you're sick.

"If we're not doing those simple things, we will continue to have disease," Dr. Hopkins said. "Those are critical concepts when it comes to thinking about coronavirus."