For more than a year now the world has been battling with the global COVID-19 pandemic, and although there has been many a time where hopes that the virus spread may be easing, many countries have faced second and third waves causing tighter restrictions to be put in place. News of new mutations and strains of the virus has been cause for concern and led to tighter precautions. There are no words for the devastation the global pandemic has caused to countless lives, from those who have lost loved ones, to those who have lost their livelihoods. There has, however, been moments of hope and cause for celebration.
For one, Scientists across the world have successfully developed several vaccinations, in record time, which are being rolled out in vaccination program. Recently, a new study was published that demonstrated a decrease in COVID-19 mortality in intensive care units, credited to the medical professions increased understanding of the disease and advances in treatment.
The study was published in the medical journal Anesthesia and based on 52 studies around the world, covering 43,128 patients and analyzed the mortality of COVID-19 patients in intensive care units (ICU’s). The study was led by Professor Tim Cook, an esteemed authority in critical care, from the Royal United Hospital in Bath, with four other authors, all specialists in intensive care or anesthetics.
The summary of the study entitled, ‘Mortality in patients admitted to intensive care with COVID‐19: an updated systematic review and meta‐analysis of observational studies’, opens with the statement: ‘the COVID‐19 pandemic continues to cause critical illness and deaths internationally. Up to 31 May 2020, mortality in patients admitted to intensive care units (ICU) with COVID‐19 was 41.6%. Since then, changes in therapeutics and management may have improved outcomes. Also, data from countries affected later in the pandemic are now available.’
The report revealed that the proportion of those worst affected by the disease, who would need to enter into ICU, had a mortality rate of 60% at the end of March 2020. By the end of May 2020, this rate fell by 18% to a mortality rate of 42%, decreasing further still to 35.5% by October 2020. However, it does highlight that since these findings, ‘the decrease in ICU mortality from COVID‐19 has reduced or plateaued since May 2020 and note the possibility of some geographical variation. More standardization in reporting would improve the ability to compare outcomes from different reports.’ However, adding that: ‘overall, mortality in all studies is lower to the end of September (35.5%) than when we reported this to the end of May (41.6%).’
The study notes that the emergence of new variants that lead to more people becoming critically ill could increase death rates, the authors writing: “Our analysis includes studies published only up to October 2020. Since then, several variant viruses have emerged and in some countries transformed the trajectory of the pandemic through December 2020 and into January 2021. This has increased the demand on ICU in those locations and will merit further analysis in due course.” However, at the same time, the rollout of the vaccination program could see the number of people needed treatment in intensive care reduced.
At this time, mortality in most areas of the world is between 30%-40% on average. Some areas boast a lower rate, with the Victoria State in Australia (including Melbourne) at the extremely low rate of 11%. And others show an unusually high rate of COVID mortality – the four countries studied in the Middle east revealed a 62% mortality rate.
To explain the decreasing trend of mortality rates, researchers wrote: “In the last few months, several studies have clarified which treatments do and do not provide benefit in the ICU management of COVID‐19. Steroids (particularly dexamethasone) were shown in early June to improve survival in patients who are oxygen‐dependent or receiving mechanical respiratory support, while other drugs including chloroquine, azithromycin, lopinavir/ritonavir, and remdesivir have been shown to have no clear mortality benefit. Management of COVID‐19 has also likely evolved over the year with changes in approaches to oxygen therapy, fluids, and anticoagulation management.”
The report argues that further analysis of these figures is hampered by the lack of standardization or definitions in reporting COVID mortality rates, for example, mortality rate is lower in reports from registries than from non-registries. In some areas there were limited availability of reports and as stated above, since the study was conducted the mortality rates have plateaued and are subject to changes due to the everchanging nature of the pandemic.