Fewer coronavirus deaths in ICUs suggests care is improving

A COVID-19 patient receives medical care on a plane equipped as an ICU unit on the way to Santarem, Brazil, on Wednesday. | AFP-JIJI

Bloomberg

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Jul 16, 2020

Fewer COVID-19 patients are dying in intensive-care units, researchers have found, indicating that hospitals are getting better at treating severe forms of the pandemic disease.

Overall mortality of COVID-19 patients treated in ICUs had fallen to just under 42 percent at the end of May from almost 60 percent in March. That’s according to the first systematic analysis of two dozen studies involving more than 10,000 patients in Asia, Europe and North America.

The fast spread of the SARS-CoV-2 novel coronavirus, as well as the high caseload and proportion of patients requiring breathing support, placed “unprecedented demand” on ICU services, researchers wrote in a study published Wednesday in the journal Anaesthesia. Countries in later phases of the pandemic may now be coping better, they said.

“It may reflect the rapid learning that has taken place on a global scale due to the prompt publication of clinical reports early in the pandemic,” wrote the authors, led by Tim Cook, an anesthesiologist and intensive care physician in Bath, England.

“It may also be that ICU admission criteria have changed over time, for example, with greater pressure on ICUs early in the pandemic surge.”

The World Health Organization is collating data from across countries to identify elements that reduce mortality, with a goal to create a toolbox of treatments that will enable doctors to provide better care for the full range of COVID-19 patients. The new study will add to the cumulative knowledge, said Sylvie Briand, the WHO’s director for global infectious hazard preparedness.

“This is critical information that will help us to refine our strategy for reducing mortality,” she said.

A COVID-19 patient receives medical care at the Santarem Field Hospital in Santarem, Brazil, on Wednesday. | AFP-JIJI

The review found ICU mortality didn’t differ significantly across regions, despite apparent variations in treatments and other areas, suggesting that no specific therapy reduces ICU mortality, the authors said in a statement.

Last month, the inexpensive anti-inflammatory dexamethasone was found to reduce deaths by a third among patients receiving mechanical ventilation, and there is hope this will improve survival further, they said.

Critical illness associated with COVID-19 can be prolonged. About a fifth of ICU hospitalizations in the U.K. lasted more than four weeks, and 9 percent persisted for more than 42 days. Mortality in ICUs for COVID-19 is almost twice the typical 22 percent rate there for other viral pneumonias.

“The important message, however, is that as the pandemic has progressed and all these factors combine, survival of patients admitted to ICU with COVID-19 has significantly improved,” the authors said.