Ore. FF battling COVID-19 given new life-saving treatment
After McMinnville Firefighter Bruce Sams did not respond to the usual treatments for the virus, doctors turned to a new option available
Albany Democrat-Herald, Ore.
MCMINNVILLE, Ore. — Bruce Sams is no stranger to fighting for his life and fighting to save others' lives. As a McMinnville firefighter, it's right there in his job description.
But the North Albany resident didn't expect to be fighting for his own life against one nasty case of COVID-19. Fortunately, for Sams, 55, landing in the intensive care unit of Good Samaritan Regional Medical Center meant being admitted to one of the few hospitals in the country using a brand new treatment.
Which saved his life.
The treatment is a Seraph 100 filter, which works in conjunction with a typical dialysis machine to filter out pathogens from a patient's blood. It's essentially a sealed plastic tube filled with tiny little beads that look like sand. The beads are coated with heparan sulfate, a type of carbohydrate that's common in human and animal cells.
A person's blood is removed from the body, run through the filter and then sent back into the bloodstream. The virus (and other contaminants) clings to the beads because it recognizes the coating, effectively filtering out SARS-CoV-2 from the blood.
Remarkably, doctors say that the filter does not remove medications.
The technology was designed by the U.S. military to treat sepsis and other blood infections, but once doctors discovered it also could successfully cull the novel coronavirus, its use expanded to COVID-19 patients. Studies in both the United States and Europe show that it can reduce mortality rates for serious COVID-19 cases by more than two-thirds.
Via an emergency use authorization, the U.S. Food and Drug Administration approved the use of the filter in spring of 2020, and so far, it has not received full approval. It's only used in the most serious COVID-19 cases: people in the intensive care units who are not responding well to other treatments like Remdesivir, the only FDA-approved treatment for COVID-19.
A local case
Sams fit that bill. He needed oxygen the first day he was admitted, on Aug. 10. He was undergoing the usual treatments for COVID-19, including Remdesivir, but his condition was deteriorating.
Sam was intubated and underwent treatment with the Seraph filter on Aug. 13. Within 24 hours, he had turned a corner.
"The earlier you apply the Seraph filter the better," said Dr. Brian Delmonaco, Good Samaritan's Medical Director for Samaritan Pulmonology and Critical Care.
"We've seen the most success if you give them this treatment within 60 hours of being in the ICU," added Delmonaco, who oversaw Sams' treatment.
Sams said that he's not vaccinated and unaware of where, specifically, he contracted the virus. As a paramedically trained firefighter, he is often interacting with coronavirus-positive patients.
In fact, he estimates that of the 25 or so daily calls to which he was responding before he himself fell ill, five or six of them were COVID-19-related calls. Not that they don't wear protection on the job — Sams said that they wear even more protective gear when responding to those kinds of calls.
By Aug. 8, Sams was coronavirus-positive. He came down with the disease prior to the statewide vaccine mandates for firefighters, though Sams said that, at the time, others at his fire station were also testing positive.
Despite being sent home from work on July 31, he was not sure if he was sick enough to need to go to the emergency room.
"As a paramedic, one of the things that really bothers me is when people go into the ER when they aren't sick enough to not be able to take care of themselves," he said. "So I was really in that phase of debating whether I should go in."
He said he checked with his primary care doctor, who told him to go the ER. He was admitted at Good Samaritan Regional Medical Center on Aug. 10, but truth be told, Sams said he doesn't remember those days at all.
Instead, it fell to his wife, Julie Sams, to talk with the nurses and doctors and make the decisions about Sams' care. He went on Remdesivir right away but was getting worse, not better.
Having your spouse of 33 years facing such serious illness is harrowing enough, but Julie Sams also said the whole ordeal was made even more difficult because she couldn't visit her husband. With strict visitation protocols in place at the hospital, she had to keep in touch with Sams' nurses and doctors via texts and phone calls.
She didn't get to say a proper goodbye to him when he was admitted to the emergency room because he was in such a sorry state that the medical team promptly whisked him off for care.
"'I hope that's not the last time I see my husband,'" Julie Sams remembered thinking. "There were so many calls going on every day, every which way."
She's never even met face-to-face with Delmonaco, who recommended using the Seraph 100 filter shortly after Sams was admitted. To do so, Sams would have to remain perfectly still throughout the process, so they put him on a paralytic medication.
The problem is, paralytics shut down a person's diaphragm, meaning Sams had to be intubated not because COVID-19 was making it impossible to breathe but because he needed the assistance of machines while undergoing the treatment.
Within 24 hours of using the filter, his condition was improving. He stayed in the ICU for several more days because Delmonaco said he was delirious. He stayed intubated for days and needed high-flow oxygen.
Sams recalled coming to and not being able to recall his own name or where he lived.
Slowly, though, "it all comes rushing back to you," he said.
On Aug. 24, he finally made it out of the ICU. But it's been a long recovery ever since.
The road back
While recuperating at home, Sams initially had to use an oxygen concentrator at night. It's basically a machine that provides extra oxygen. He said he's been off the machine for a little more than a week now.
And Sams has returned to light duty at the McMinnville Fire Department over the past three weeks. That means he's working no more than 25 hours a week and he can't scale more than one flight of stairs in an hour or carry more than 10 pounds.
"But, if I'm being perfectly honest with you, I live on a farm, and I raise cows," Sams said during a phone interview. "So I'm out feeding the cows right now."
Still, he acknowledged he's not yet capable of carrying out the full range of duties required of firefighters day-to-day.
"If you tell me to go out and fight a fire right now, I would just fall on my knees," he said. "I can't do my job in that way yet."
Delmonaco said Good Samaritan has used the filter on 13 patients, most recently in November. Six of them survived, though Delmonaco emphasized it was COVID-19 symptoms that claimed the other seven, rather than complications from the treatment.
"The Seraph itself hasn't caused any complications that have caused harm to the patients," he said. "It's been very safe."
That doesn't mean everyone infected with coronavirus is an ideal candidate for the treatment, however. Targeted for the most serious COVID-19 patients — typically those who have been intubated or put on a respirator — blood filters are not recommended for people who are taking blood thinners or who have a low blood platelet account or heart arrhythmia.
Delmonaco said that the Corvallis ICU has been able to implement the Seraph filter because it's a small team that's "nimble" and able to easily adapt.
"Sometimes, in larger organizations, it's difficult to move fast," he said. "And when you have an emerging pathogen without treatment ... it takes a nimble team to do that."
The Corvallis team will even be participating in trial study of the filter, being one of multiple medical centers around the country to test the filter on patients with septic shock — the filter's original intended use.
In general, Delmonaco said the filter has provided a new and useful tool for combatting what's been a draining and deadly pandemic.
"It is exciting and has a lot of promise," he said. "In the two years we've been in this pandemic, it's been very challenging and with not a lot of bright spots."
Even still, he added, "I would be glad if I never have to use this filter again."
Importance of time
For the Sams family, this new treatment made all the difference. It means that the couple can get together with their four children and four grandchildren for Christmas this year. They praised the "excellent work" of the entire Samaritan team.
Although Sams and his wife are grateful for the medical professionals who saved his life, coronavirus is still impacting the holiday season: Sams' father, who was 73 years old, died of COVID-19 just weeks after his son was let out of the hospital.
Sams said he was fully vaccinated, though he had recently underwent heart surgery following a cardiac arrest.
Sams himself said that, while he wouldn't say the near-death experience "deepened" his relationship with his family, it certainly added new weight to the time he has with them.
"It's different in that you realize ... if it had been just one day later, (Julie) could be talking here by herself," he said.
(c)2021 Albany Democrat-Herald, Ore.