- Deaths from COVID-19 in ICUs have dropped by about a third since the start of the outbreak.
- Though the decline is substantial, health experts say the mortality rate for ICU patients with COVID-19 is higher than what’s observed with other viral pneumonias.
- Health experts think better treatment and more resources may explain the mortality drop.
New research from the United Kingdom suggests the overall mortality rate for patients with COVID-19 in the intensive care unit (ICU) has dropped by about a third since the beginning of the pandemic.
The study, published in the journal Anaesthesia, tracked mortality in COVID-19 ICUs and recorded a decline from above 50 percent in March to 42 percent in May.
The findings are consistent across the globe — from Europe to Asia and North America.
Health experts suspect the drop is due to a few factors: Criteria for ICU admission has evolved, doctors have a better understanding of how to treat COVID-19 symptoms and complications, and healthcare facilities have more resources, compared with the start of the pandemic when the world was underprepared.
Though the decline is substantial, health experts say the mortality rate for ICU patients with COVID-19 is higher than what’s observed with other viral pneumonias.
“While we are certainly glad the mortality rate has declined and not as high as some of the earlier reports, this still represents a dangerous disease with regards to risk of death as well more long-term risks of disability,” said Dr. Jonathan Siner, a Yale Medicine pulmonologist, critical care physician, and medical director of the medical ICU.
More patients in the ICU are surviving
To better understand how the mortality rate amongst patients with COVID-19 in the ICU has changed, the researchers conducted a systematic review and meta-analysis looking at 24 observational studies.
They examined the health outcomes of 10,150 patients and identified a massive drop in the mortality rate recorded in ICUs across the globe.
The rate fell from above 50 percent at the end of March to 42 percent at the end of May.
According to the researchers, the findings are consistent around the world, despite continental differences in treatments being administered and ICU admission criteria.
The mortality rate is dropping, but it’s still high
Doctors are optimistic that the mortality rate is dropping, but say the current mortality rate of 42 percent is still high.
For comparison, the mortality rate for other viral pneumonias treated in the ICU is about 22 percent, the study states.
“It’s definitely still high, twice the usual mortality in ICU for viral pneumonia,” said Dr. Eric Cioe-Pena, the director of global health at Northwell Health in New Hyde Park, New York.
Additionally, acute respiratory distress symptom (ARDS) — a severe lung complication some patients with COVID-19 experience — is known to have a mortality rate of 40 to 60 percent, according to Siner.
Siner says the mortality rate for patients severely ill with COVID-19 — and ARDS — is influenced by how severe the lung damage is, if other organs like the kidneys and brain are injured or inflamed, and whether the patient has other health problems.
Why the mortality rate dropped
Doctors now have a better grasp on how to treat COVID-19 and the complications it causes, compared with the start of the pandemic.
Back in February and March, COVID-19 was a new disease and doctors were in the early stages of experimenting with different treatment options.
Months later, doctors have identified a few drugs, like remdesivir and corticosteroids, that improve the course of the disease.
Doctors also have a better idea of who should be admitted to the ICU and how to best manage their symptoms with oxygen support and ventilators.
Cioe-Pena says the greatest effect has been the optimization of supportive care protocols in the ICU.
Furthermore, healthcare systems previously were underprepared for the unexpected surge in patients.
“Hospitals were overwhelmed and makeshift ICUs were created,” says Dr. Mangala Narasimhan, the regional director of critical care medicine at Northwell Health in New Hyde Park, New York.
Some hospitals had to build out their ICU wards to accommodate the influx of patients, others had to request more ventilators and respirators, and healthcare providers lacked the proper personal protective equipment (PPE).
Because of this, several patients weren’t treated by ICU doctors, which further contributed to the high mortality rate seen in March.
Hospital and emergency department overcrowding have a well-established mortality associated with them, says Cioe-Pena.
The shutdowns enacted in COVID-19 hot spots also allowed hospitals to catch a break from being inundated.
“There is no doubt that having a hospital (and community) that is not overwhelmed would allow an ill patient to receive the best possible care, and looking at what has happened internationally and in the U.S., there is no doubt that capacity and ability to handle these large volumes of patients has improved with planning and is improving outcomes,” said Siner.
As cases have gone up, so have hospitalizations. It’s possible the mortality rate will continue to drop. Although as some hospitals reach capacity, it could put strain on the health system again, affecting the ability for doctors to properly care for patients.
However, Siner expects the mortality rate will continue to drop.
“We are continuing to improve capacity and knowledge, and the benefits of steroids and remdesivir seem real, and both are going to be used pretty uniformly going forward,” Siner said.
He believes doctors will soon get a better handle on how to treat the blood clots many patients with severe cases of COVID-19 are experiencing.
“I think this will also help reduce mortality,” Siner said.
Though we’ve learned a lot about COVID-19 and how to treat it, there’s a lot more we need to uncover before we’ve got a good grasp on the outbreaks.
“Like everything in infectious diseases, usually the more experience we have with something, the better we get at treating it,” Cioe-Pena said.
The more we understand COVID-19, the better off patients who wind up in the ICU will be.
The bottom line
New research from the United Kingdom suggests the overall mortality rate for patients with COVID-19 in the intensive care unit (ICU) has dropped by about a third since the beginning of the pandemic. Experts suspect the decline can be attributed to doctors knowing more about how to admit and treat people with COVID-19 and hospitals being more prepared to treat the influx of patients. As we learn more about COVID-19, health experts expect the mortality rate to continue to fall.
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