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Survival rates have increased thanks to medical advances and less overcrowded hospitals, according to studies, but the latest record outbreak of infections can undo progress.
By Roni Caryn Rabin
The coronavirus hit the United States this year with devastating force; in April, he killed more than 10,000 people in New York; by early May, nearly 50,000 nursing home citizens and their caregivers across the country had died.
But as the virus continued to spread over the summer and fall, infecting nearly 8. 5 million Americans, survival rates, even critically ill patients, gave the impression that they were improving. , the mortality rate had fallen to 3% until the end of June.
English doctors have observed a similar ending. ” At the end of March, four out of ten people died in intensive care. At the end of June, survival was more than 80%,” John M said. Dennis, researcher at the Universidad. de the Exeter School of Medicine and the first author of an article on how to achieve better survival rates in Britain, accepted for publication in critical care medicine magazine. “It was pretty dramatic. “
Although the virus evolves slowly as it spreads, and some have speculated that it has a more fluid transmission, top scientists say there is no falsified evidence that it is less virulent or more virulent. However, as the elderly took refuge indoors and took precautions to prevent infections, more inpatients were younger adults, sometimes healthier and more resilient. By the end of August, the average patient was under the age of 40.
Was the decrease in mortality rates simply an effect of demographic adjustments or a reflected picture of actual advances and medical advances in treatment that mitigated the effect of the new pathogen?
NYU Langone Health researchers, who focused on this topic, analyzing the effects of more than 5,000 hospitalized patients in the 3 formula hospitals from March to August, concluded that the improvement is real, not just in reaction to demographic changes, even when they controlled the differences. In terms of age, sex, race, underlying fitness disorders, and the severity of Covid symptoms, such as blood oxygen grades at admission, they found that mortality rates had dropped significantly, to 7. 6% in August, from 25. 6% in March.
“It’s still a maximum mortality rate, much higher than we see for flu or other respiratory diseases,” dr. Leora Horwitz, Director of the Center for Health Care Innovation.
Other doctors agreed: “Mortality rates have declined a lot now,” Dr. Robert A said. Phillips, Houston Methodist’s leading medical officer and a letter of study to JAMA comparing the first and time outbreaks of Covid-19 patients in Houston. He is under pressure that the disease remains “not only fatal – probably 10 times more fatal than a severe flu – but also carries long-term complications. There’s no such thing as the flu. “
Although studies have assessed the mortality rate, they have assessed the burden of what Dr. Phillips called “post-Covid syndrome,” which leaves many patients with long-term respiratory and neurological problems, heart headaches and other persistent problems.
“It’s relatively simple to measure mortality, but it doesn’t take into account all other fitness problems,” said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan. Many hospitalized patients face prolonged and exhausting recoveries and may require a lot – long-term care, while even those who have had mild episodes of illness end up with persistent problems, such as headaches, chronic fatigue or cognitive problems. “It will take a long time to perceive the full clinical spectrum of this disease. “
And even if mortality rates drop, the gross number of deaths is expected to increase, due to the increase in cases across the country. in the United States it can exceed 6,000 until November 7, and cumulative deaths can be successful at 250,000 through November 21.
The England study analysed the effects of 14,958 intensive care and intensive care patients in hospitals across England from 1 March to 30 May, each week after the end of March for intensive care and intensive care patients (the English test did adjust the severity of Covid-19 disease upon admission).
A combination of points helped hospitalized patient outcomes move forward, the study authors and other experts said. As doctors learned how to treat the disease, by integrating steroid use and non-pharmacological interventions, they were better at controlling it.
Researchers also identified increased awareness of the network and patients seeking care earlier in the course of their disease. The effects could also have been taken a step forward as the burden on hospitals has eased and pressure on doctors has decreased, either outweighed by an influx of patients in the spring.
“We don’t have a miracle cure, yet we have many, many small things that are loaded,” Dr. Horwitz said. “We feel better when other people want to wear respirators and when they don’t, and what headaches to watch. for, such as blood clots and kidney failure. We know how to monitor oxygen grades before patients are in the hospital, so we can get them to the hospital sooner. And of course, we perceive that steroids are useful and some other medications. »
For doctors fighting the disease, caused by a new unknown pathogen before it gave the impression in Wuhan, China, overdue last year, the learning curve was steep. Doctors shared data and collected data from an avalanche of shared studies at an unprecedented rate. however, there were also false steps. Initially, the concentrate was on the effects of the disease on the lungs; Understanding the harmful effects on other organs has gone further.
At first, doctors placed patients in mechanical fans to help them breathe; Over time, they learned to put patients face down and supply them with oxygen by less invasive means, and to postpone ventilation absolutely if possible.
By mid-June, clinical trials in England had shown that the remedy with a reasonable steroid, dexamethasone, reduced respirator deaths by one-third and deaths of patients receiving oxygen supplements by one-third. But the first recommendations from China and Italy were “not to use steroids, even though many of us thought it made sense to use them,” Dr. Gita Lisker, extensive care doctor at Northwell Health. “I think it makes a big difference. But when we started with that in March, knowledge and recommendations from China and Italy said, “Don’t use them, steroids are bad. “
Doctors also did not initially know that Covid-19 disease caused by the new virus caused life-threatening blood clots. Patients now get anticoagulants at the beginning of the remedy if necessary.
But the other challenge in the spring was that hospitals in hard-hit spaces like New York were overwhelmed: doctors who had not worked in extensive care for many years were hired to treat critically ill patients, nurses were under staffed and lacked equipment. “Tidal that went beyond the health care system,” Dr. Lisker said. “You had extensive care sets through doctors who hadn’t provided extensive care for 10 years, if ever. “
She added: “There is no doubt that if he lived or died in April in a component of the unit in which he landed. “
In fact, he said, “the very concept of flattening the curve to avoid overwhelming the health care system. “
Medical experts are concerned that outbreaks across the country may also oppose or oppose these benefits. The number of patients hospitalized by Covid has increased by up to 40% in the following month, and more than 41,000 patients are now hospitalized in the United States. Utah and Kansas City, Missouri, have warned that they are almost full. Some have refused ambulances and others are planning to ration care if they run out of beds and have said they would possibly be forced to move patients to services. in other states.
“Compared to the number of other people dying from a hundred diagnosed cases in the United States, it is clearly particularly lower than in the summer and much lower than in the spring,” said Tom Inglesby, director of johns Hopkins University’s Health Security Center.
But he added that the reduction in the mortality rate was not guaranteed to remain stable, given the increase in the number of cases. “If hospitals that are not ready for a large number of other people have to deal with a huge influx of Covid patients, or if small hospitals are trained in them, unfortunately we expect mortality to replace,” he said. It’s a warning. “
Although some have speculated that the virus is less virulent than it was before, experts say there is no evidence that this is the case. Improvements in survival are “a testament to health care,” said Dr. Howard Markel, a physician and medical historian. university of Michigan.
“The virus remains as stealthy and harmful as before,” Dr. Markel said. “We’re in your management. “
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