Ready for Some Good Covid-19 News? Doctors Saving More Lives
Covid-19 death rates are down among people who are hospitalized, but infection rates are still high. Doctors explain the trend.
A fall in Covid-19 death rate
In the relentlessly glum picture of Covid-19, one small glimmer of hope emerges: Two studies—from both sides of the Atlantic—find that the Covid-19 death rate has declined dramatically since the beginning of the pandemic.
So just how good is this news? It’s heartening that fewer people are dying of a virus that has, so far, killed more than 230,000 Americans. But it’s not so good that you can let your guard down, especially as the country enters a coronavirus winter surge.
“Yes, mortality is down and that is great news,” says Christopher M. Petrilli, MD, assistant professor of medicine at NYU Grossman School of Medicine in New York City. “But what we don’t fully understand is what happens to these patients long term who have had Covid.”
In other words, infections may be less deadly at the moment, but could still have a long-term impact on a patient’s health that’s not yet fully understood. And it’s possible that if cases rise enough that health-care systems are overwhelmed, the mortality rate could go back up. Don’t miss what scientists are learning about Covid-19 long haulers.
Why the research was done
Covid-19 caught the world by surprise earlier this year with its rapid, stealthy spread. And scientists have been racing to gather information even as they try to cope with the worst health crisis in a century. It’s like learning to fly a plane while you’re building it, as one expert put it.
Researchers, including Dr. Petrilli and his team, were seeing a decline in death rates. “We wanted to understand what was driving that,” he says. Specifically, were patients younger and healthier, giving them a better chance of recovery—or was it something else?
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What the researchers did
The U.S. study, published October 23 in the Journal of Hospital Medicine, looked at electronic medical records from four hospitals and an orthopedic surgery hospital in New York City from March through August.
New York City had one of the early surges before control measures dramatically reduced the spread. The researchers counted all confirmed Covid-19 deaths, making note of age, gender, and various risk factors for death (like obesity and an underlying condition).
The U.K. researchers, whose study appears pre-publication in medRxiv and has not yet been peer-reviewed, searched hospital databases in England, identifying all Covid-19 critical care admissions and deaths from March through June.
What the research found
Both studies ended up with similar findings. In the U.S. study, the mortality rate among 5,121 total hospitalizations dropped from 25.6 percent in March to 7.6 percent in August—even after taking into account risk factors.
The U.K. study found that the mortality among almost 15,000 patients in critical-care units peaked in early April before trending down through August. In the intensive care unit (ICU), 41.5 percent of patients in the ICU died. In August, that number was down to nine percent. The next question: Why?
Better patient care
Even though patients admitted into the hospital were by and large younger, that didn’t account for most of the change, says Dr. Petrilli. The more likely reason was that doctors got better at treating Covid-19.
“This virus was not on U.S. soil before 2020 so this is absolutely a novel virus for us,” says Dr. Petrilli. “Experience with the virus has definitely helped. We absolutely learned a lot.”
One deceptively simple practice, in particular, may have helped: “Proning,” which means putting patients on their stomachs. Intensive care units have used it for decades to help patients with severe lung distress. These patients get oxygen, explains Robert Glatter, MD, an emergency physician with Lenox Hill Hospital in New York City. Learning how to recognize symptoms earlier may also have helped, he adds.
More medications available
At the beginning of the pandemic, physicians relied largely on “supportive care,” meaning easing Covid-19 symptoms, like cough, shortness of breath, and fever, and providing oxygen if needed. Then came more effective treatments.
A large study out of the U.K. published in July in The New England Journal of Medicine (NEJM) changed the game when it found that dexamethasone, a commonly used steroid, cut death rates in severely ill patients. “The steroid use was probably the biggest mortality benefit of all the drugs that were used.” The antiviral drug remdesivir also sped up recovery in some Covid-19 patients, according to an October study in the NEJM. And anti-cytokine treatments helped quell explosive immune responses.
Hospitals less stressed
During the first surges of Covid-19, hospitals were completely overwhelmed by patients, with some facilities having to scramble to find more ICU beds. In the U.K., for instance, hospital beds were at or above capacity in early April. Then came masking requirements and social distancing (see below) and cases started to decline. Hospitals could breathe a little easier.
“Potentially one of the biggest reasons for the decline is the decline in the number of patients,” says Dr. Petrilli. “Hospitals were overburdened essentially in March and April, in New York.” In any business, if all of your customers come in an expected or staggered fashion, they will get better care.
Mask wearing and social distancing
In the early days of the pandemic, no one knew to mask up or practice social distancing. “All of that led to higher significant boluses of patients that were coming into the hospital,” says Dr. Petrilli.
Once they knew what they were dealing with, some officials, including Governor Andrew Cuomo of New York, implemented strict control measures: staying at home, wearing masks, washing hands, keeping your distance from others.
These measures can actually prevent Covid-19 from spreading; even if a person does get sick, they’re likely to have a lower viral load.
“If you don’t wear a mask and someone coughs in your face, you’re going to absorb more of the virus,” says Dr. Petrilli. “Patients who wear a mask are inoculated with less virus. Those are the patients that won’t be as sick.”
One other possibility: Patients treated during earlier periods in the pandemic were infected with a deadlier circulating strain of the virus, adds. Dr. Glatter.
The gains that have been made in medical treatments hopefully won’t go away. The number of cases, hospitals, and deaths are another story. If people don’t wear masks, social distance, and take other basic precautions, that caseload could increase, says Dr. Glatter.
That means hospitals bursting at the seams once again and an uptick in death rates.
“If hospitals go to 100 percent or above their typical capacity, I would hypothesize that, yes, we would see an increase in death rates,” says Dr. Petrilli. “We are getting better at social distancing and masking so keep it up.”
- Johns Hopkins University: "Coronavirus COVID-19 Global Cases"
- Christopher M. Petrilli, MD, assistant professor of medicine, NYU Grossman School of Medicine, New York City
- Journal of Hospital Medicine: "Trends in COVID-19 Risk-Adjusted Mortality Rates"
- medRxiv: "Improving COVID-19 critical care mortality over time in England: A national cohort study, March to June 2020"
- Heart & Lung: "Proning during covid-19: Challenges and solutions"
- Robert Glatter, MD, emergency physician, Lenox Hill Hospital, New York City
- Centers for Disease Control and Prevention: "Information for Clinicians on Investigational Therapeutics for Patients with COVID-19"
- New England Journal of Medicine: "Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report"
- New England Journal of Medicine: "Remdesivir for the Treatment of Covid-19 — Final Report"
- Critical Care Explorations: "Role for Anti-Cytokine Therapies in Severe Coronavirus Disease 2019"