Scientists at the University of Oxford are working on their COVID-19 vaccine, but the immediate onset of the virus has raised fears among some clinical and medical experts that millions more will die. John Cairns
By caring for patients with COVID-19 in the early days of the pandemic, Leora Horwitz felt like an 18th-century doctor, desperately seeking to be more informed about a new disease to know how to prevent others from dying.
“We couldn’t tell how temporarily other people would deteriorate, what kind of deterioration they would have had, or when they would have left the forest,” says NYU clinical researcher Langone, a college medical center in New York. “We had no idea. “
This week, the coronavirus pandemic took a disturbing step, with an official death toll of 1 million worldwide, nearly a portion of those in the United States, India and Brazil. The immediate spread of the virus has raised fears among some clinicians and physicians. On Friday, he announced that U. S. President Donald Trump had tested positive for the virus.
Romelia Navarro, on the right, is comforted by a nurse sitting by the bedside of her dying husband, Antonio, in California. The death toll in the United States by COVID-19 exceeded 200,000.
However, according to the World Health Organization, the mortality rate may simply decrease due to increased health care. Countries facing a new outbreak of infections expect doctors to have figured out how to keep more patients alive. hospital with COVID-19 higher than 66% in March to 84% in August, according to the International Consortium of Severe Emerging and Respiratory Infections.
Horwitz says the contrast between New York neighborhoods in late March and is like “day and night. “Even taking into account demographic differences between patients treated in his hospital, he found that their chances of survival were 22 percentage points higher in August. than in March in studies that have not yet been peer-reviewed.
We don’t have a vaccine. And we have no cure for COVID, but the more we understand, the more lives we can save.
– Heather Pierce, Association of American Medical Universities
But some scientists remain skeptical about the actual decline in the mortality rate, and wonder about the quality of the data, and argue that if it decreases, it has more to do with the increase in the number of young people who are sick.
“The highest right now, or at least one of them, is [if] the COVID-19 mortality rate is declining, or is simply declining,” says Jonathan Slotkin, a leading physician at Contigo Health, who is part of Premier, an organization of more than 4,000 U. S. hospitals.
David Battinelli, a leading medical officer at Northwell Health, New York State’s largest fitness service provider, says it’s simple for others to see how temporarily hospitals in the city have flooded with patients.
“We went from 0 in our physical care formula to thousands of hospitalizations in 30 days [with] about 1000 patients on our nursing equipment on a vent. We didn’t have an effective remedy and almost an overwhelming number of patients,” he said. adding that many other formulas were overwhelmed.
Hospital staff tried to use medications that can also: antivirals, plasma from cured patients, and steroids. If a patient improved, he said doctors may also be “easily convinced” that it was a cause and effect, the upcoming trials would possibly show otherwise.
One vial of experimental redesivir, a drug, is visually inspected in a Gilead production in the United States.
The months that followed did not bring successful advances in drug treatments. Remdesivir is the legal antiviral drug in the United States to treat COVID-19, but its benefits are moderate: It can speed a patient’s recovery, but there is no evidence that it has reduced the number of deaths.
The recovery trial, led by the University of Oxford, found that the generic steroid dexamethasone reduced the number of deaths in patients receiving respiratory assistance and the drug was widely followed worldwide. “I think dexamethasone turns out to [provide] the greatest advantages we have. right now,” says Amesh Adalja, principal investigator at the Johns Hopkins Center for Health Safety in Baltimore.
Even without a “miraculous” drug, Horwitz believes there are “dramatic” differences in our understanding of COVID-19, especially the devastation it can cause the body, from the center to the toes.
Patients can be pre-diagnosed and follow protocols based on what has been learned: when administering blood thinners, how to turn patients into a maneuver called “proning” (place them on their abdomen toward the oxygen source), and when to stop others as well. early towards the fans.
Heather Pierce, senior director of the Association of American Medical Colleges, said the move “is a breakthrough. “
“We don’t have a vaccine. And we have no cure for COVID. But the more we understand, whether it’s new therapies, techniques or [care] support, the more we can help save lives,” he says.
Outside of hospital treatment, public fitness measures can play a major role in reducing the mortality rate. In the United States, about 40% of deaths were similar to those of nursing homes, so measures to prevent spread within those services help, Adalja says.
The New England Journal of Medicine published a commentary in September suggesting that dressing in a mask could simply decrease the severity of the disease. “For me, it doesn’t have to be said,” Slotkin says, “but I don’t think it might turn out to be true. “
Others, adding Professor Sunetra Gupta, a theoretical epidemiologist at the University of Oxford, recommend that some regions would possibly achieve collective immunity with a much lower than expected infection rate.
The theory is based on the concept that the virus is much more likely to infect a subset of other vulnerable people, and that past exposures to other coronaviruses may protect some, but Battinelli dismisses it as “pure speculation. “
Many question the concept that the mortality rate is declining, attributing any obvious improvement to more tests that reveal more cases and the increased underlying fitness of a new wave of younger patients.
Laureen Hill, chief operating officer at New York Presbyterian Hospital, says it’s hard to separate points that can help reduce mortality rates. She has been practicing extensive care medicine for 30 years and says she has followed the same old steps. COVID-19 manual, so there have been no drastic adjustments in the way they care about people.
In contrast, the difference between mortality rates in the first few months and is now possibly due to a greater understanding of the number of other infected people. A mortality rate is the proportion of instances shown to die, so the count of instances shown is essential.
“At first, we don’t check as many patients as we do today. So when you look at the rates, it’s very much based on the denominator, the number of checks done,” Hill says.
The data are asymmetrical and poorly monitored in some countries and difficult to compare between regions and borders. Even counting a death is not easy, especially if the patient had other ailments or died at home. Deaths also occur weeks after an initial infection.
In the United States, the Centers for Disease Control and Prevention has replaced the way they report the COVID-19 mortality rate. In July, the overall rate of 0. 65, consistent with percent. Knowledge is now broken down by age, the maximum likely to die – those over the age of 70 – with a mortality rate of 5. 4%.
Douglas Rothman, a professor at Yale Medical School, is adamant that, given the age of patients, mortality rates have not decreased. It estimates that the mortality rate in the United States in September is around 0. 69%.
In his own study in Arizona, one of the solar belt states affected by a wave of COVID-19 infections in the northern summer, he found that, adjusted by age, the mortality rate of the population at the end of July was about the same as the national one. estimate by spring 2020.
He accuses some doctors of “false optimism” and “sun effect,” where they are likely to focus on their successes, and argues that more independent studies are needed. People who are inflamed and admitted to the hospital now have a tendency to be younger, as older or more vulnerable, other people are more likely to take protective measures such as social estating.
Yoko Furuya, medical director of infection prevention at the New York Presbyterian, says the younger population can mask medical advances. “We are seeing a major replacement in epidemiology that can overshadow some of the minor settings that result from the remedies that we are learning is effective,” he says.
It is unthinkable at this time last year that a new virus can make doctors feel as lost as their ancestors were when they were fighting infectious diseases.
As CASES of COVID-19 reappear in many European countries and in more than part of US states, coVID-19 has reappeared. In the U. S. , some doctors expect new remedies to save more lives. Monoclonal antibody remedies can affect patients even before they arrive at the hospital.
Pharmaceutical company Eli Lilly recently published positive Phase 2 results, it appears that the remedy, artificially developed from the maximum effective antibodies of healing patients with COVID-19, has reduced the rate of hospitalization.
“I’m cautiously excited about the promise of monoclonal antibodies because, first of all, it seems they could be promising to treat other people who only have mild symptoms and this can keep them from getting si sick more,” Furuya said.
Horwitz is less hopeful that researchers will notice an antiviral that can prevent the virus from replicating. “We don’t have drugs for viruses,” he says, adding that only two viruses have been effectively fought: hepatitis C and HIV, which has been controlled but not cured. “After a hundred years, we no longer have an effective remedy for influenza. “
Sudden increases would possibly reduce the risk of a higher mortality rate due to overcrowded hospitals, especially if they seek to cope with COVID-19 at the same time as seasonal influenza, and even in the same patient, as it is not yet known whether situations can coexist.
A vaccine can make a significant dent in the RATE of COVID-19 infection and therefore in absolute mortality figures, but even if a vaccine is effective and is urgently approved in the coming weeks, it is unlikely to be widely available until next year.
It was unstoppable at this time last year that a new virus could make doctors feel as lost as their ancestors were when they fought controlled infectious diseases for a long time. Models have trouble predicting long-term deaths more than 4 weeks in advance; however, the CDC says the average of about 44 models is expected to be between 2,700 and 8,600 deaths in the week ending October 24 in the United States.
One style tries to wait until early next year. The University of Washington Institute of Health Assessment and Metrics expects the death toll to reach 2. 5 million by January 1, a number that could be reduced to 1. 8 million with universal masking, or increase to 3. 3 million if restrictions are further eased,” he said. “This virus hasn’t finished killing people yet,” says Adalja.
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