When COVID-19 reached the United States and Butler County this spring, preliminary data from China, ground zero of the viral illness, showed steroids were ineffective against the disease, if they didn't make patients' outcomes worse.

But, Dr. John Love, director of infectious disease at Butler Health System, said the most effective drug that hospitals have at the moment is probably dexamethasone — a corticosteroid.

As Americans have learned to live with the virus, doctors and epidemiologists have learned more about it as well, including more effective ways to treat it, and are on the path to learning how to prevent it from infecting people.

Since March, medical experts and laypeople alike have suggested medications to treat COVID-19 in patients with respiratory complications. For many of those drugs — hydroxychloroquine chief among them — evidence did not support the claims of efficacy.“As providers, we've gone through cycles where there's a new kid on the block that may have potential to it, we get it and it doesn't really pan out,” Love said.That doesn't mean, however, all hope is lost. Antimalarial drug hydroxychloroquine may not have panned out, but through clinical experience and clinical trials, some effective drugs have come to light.Love said data best supports the use of the corticosteroid dexamethasone as a treatment for COVID-19 patients, despite the early warnings from China that steroids are contraindicated in such cases.Specifically, he said, it has a positive impact on mortality — the likelihood of death on average decreases when a patient receives the steroid.The federal Food and Drug Administration has granted emergency use authorization to other drugs as well to treat patients with COVID-19 complications, and many of them have worked out.Remdesivir, an antiviral medication, received emergency approval in May, but has since become the first drug to receive full approval from the FDA to treat COVID-19, according to Love. Using convalescent plasma, transfusing blood from a person who has recovered from the disease to a hospitalized COVID patient remains approved under the administration's emergency program.Issues remain with these drugs, however, such as both requiring intravenous treatment and being directed at admitted patients. Love said medical providers “still don't have a magic bullet,” but progress has certainly been made on how to treat COVID-19 patients.

Not all treatment is drug-based, and the hospital has adjusted these protocols as well in light of new information and seeing how better outcomes are brought about.Karen Allen, BHS chief nursing officer, said the system currently has assigned fewer patients to nurses to aid in the proper care for COVID-positive individuals. Recent changes to the visitation policy too are aimed at slowing the transmission of the illness within hospital walls, she said, an integral part of fighting the illness.Patients who are able to lie on their stomachs, rather than their backs, appear to have a lower need to be placed on a ventilator due to respiratory complications, Love said. The illness also appears to be less severe in patients who routinely wear masks, although that is not a hospital intervention, he added.Between physical treatments and drugs, the state of medicine as it pertains to the virus appears to have improved outcomes for patients.“The data out there and published, at least, suggests that our fatality rate is improving as we get to know this disease better,” Love said. “A lot of it is therapeutics, but I think part of it is (health care workers) have learned how to treat these patients.”The increase in coronavirus knowledge doesn't mean, however, that the hospital system — or any hospital — can easily handle a surge of patients. More than two dozen patients are currently hospitalized at Butler Memorial Hospital due to the virus, a significant change from the two or three patients BHS had each day over the summer and early autumn, Love said. As such, the prevention of infection is the first line in the fight against this coronavirus.

American drug company Pfizer made waves this week when it announced preliminary data that showed it's vaccine is more than 90% effective at preventing COVID-19 infection.That's something to be hopeful for, Love said, and it's good news for researchers studying other coronavirus vaccines. Like the treatments doctors have learned about, however, he said it is not going to be immediately available.“I think it's going to be a little while until the general population can walk into CVS and get one of these,” he said. “The vaccine from Pfizer that was talked about this past week has some interesting logistical issues to it. It's a nucleic acid vaccine. It needs to be stored at very cold temperatures; it needs a second shot four weeks after the first one.”The Pfizer vaccine contains messenger RNA, which the body translates into proteins inside of its cells, triggering an immune response to the spike protein that is on the outside of the coronavirus, according to the company.It's a relatively novel idea for a vaccine, which Love called “exciting” — and also one that will likely be rushed into widespread production. One potential issue with this vaccine is the emergency situation in which it and other vaccines are being researched. Emergency authorizations, Love said, don't require the same stringent level of data that the FDA requires for regular approval.It's a delicate balancing act, ensuring safety and effectiveness while inoculating health care workers and those in high risk groups — and the population at large — as soon as feasibly possible. “I think what we're still waiting on is the safety data, and a lot of that may be after release. I don't think we're going to wait to see six months of safety after vaccination to move this forward,” he said. “I think the real question is: What safety level are we going to be comfortable with, or the FDA will be comfortable with, to let something be released?”