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COVID-19 Data: Survival Rates for Patients on Ventilators
From the UK’s Intensive Care National Audit and Research Centre (ICNARC): Report on 775 patients critically ill with COVID-19
The report looks at 165 COVID-19 patients whose status was resolved — they died or were discharged — out of a population of 775 COVID-19 patients who were admitted to intensive care by reporting hospitals.
Of these 165 resolved patients, 52% were discharged alive and 48% died in the hospital.
Of the 165 resolved patients, 60% of them required advanced respiratory care (ventilators or similar).
Of the 60% requiring advanced respiratory care, 34% survived and were discharged, 66% died.
Of the 40% not requiring advanced respiratory care, 80% survived and were discharged, 20% died.
Half of the patients who survived were in intensive care for between 2 and 7 days, with a median of 3 days.
Half of the patients who died were in intensive care for between 2 and 6 days, with a median of 2 days.
Since this report includes only resolved cases, it is biased toward cases that resolve quickly; the remaining cases in ICU may not resolve in the same proportions of favorable and negative outcomes.
Favorable outcome by age distribution for the 165 individuals whose cases were resolved are:
16-49 years 76% survived
50-69 years 60% survived
70+ years 27% survived
The report contains an interesting graph that appears to cover the larger population of 774 cases admitted to critical care, and to show the status of those cases over a span of approximately four weeks. I’m not sure how to interpret the assumptions implicit in the graphic, but it appears to show that: after one week, approximately 20% have recovered and ~ 12% have died; after two weeks, those numbers are roughly 40% and 30%, respectively; after three weeks, approximately 58% and 38%, respectively; and that those remaining in critical care past three weeks show slow change moving forward.
Published in General
Yes, that’s the graph. Thanks for finding it. I am assuming that the entire graphic is based on actual data, and not on projections. But I wasn’t sure about that, hence my comment about assumptions implicit in the graph. I took the confidence intervals as an acknowledgement that data may arrive at irregular intervals, and so there’s an error bar associated with any given point.
Note: last night I looked at the doh website in my hometown. It included the disclaimer: “recovered case count is not reliable due to difficulty contacting patients listed as recovering at home.” (The vast majority are in that category.)
Yes and I don’t see much data on the anti0-virals and their effects. The NEJM has a more recent report of 23 cases and says 7 got anti-virals, including remdesivir used but no results. Hydroxychjloroquine is probably much better used early but I had hopes for remdesivir in advanced cases. It would be nice to see some results.
https://www.nejm.org/doi/full/10.1056/NEJMoa2004500?query=featured_home
Regarding antiviral interventions, 7 patients received compassionate-use remdesivir, but we have insufficient information to report associated outcomes.
Not well. It seems that most severe cases have pre-existing conditions. Also, that NEJM report mentions the use of inhaled steroids being a big no no.
Three patients with mild asthma had received systemic glucocorticoids within 1 week before ICU admission, as outpatients, for presumed asthma exacerbation while they had symptoms of Covid-19. These 3 patients then presented to the hospital again, with severe respiratory failure requiring invasive mechanical ventilation. Previous studies have shown that glucocorticoid treatment for phylogenetically similar viruses, SARS-CoV (2003) and Middle East respiratory syndrome coronavirus (MERS-CoV), was associated with a higher subsequent plasma viral load, longer duration of viremia, and worse clinical outcomes.17-20 These findings are in contrast to those of a recent nonrandomized observational study that suggested that glucocorticoids may be associated with improved clinical outcomes in patients with Covid-19 and ARDS.21 Further research is necessary to determine the role of systemic glucocorticoids in patients with Covid-19 infection.
We are in a similar position to the rollout of Obamacare which I described as building the airplane while taking off.
I found a misleading article on this issue from NPR, posted on Thursday (here). It makes the same mistake regarding the ICNARC data previously noted, by reporting that “among 98 ventilated patients in the U.K., just 33 were discharged alive,” without realizing that there were an additional 420 ventilated patients whose outcome was not yet known.
It does provide two additional sources of data.
This small study from Washington state reports on 24 patients admitted to the ICU, 18 of whom received mechanical ventilation. Nine (50%) of those receiving ventilation had already died. Four (22%) had been discharged from the hospital. Two (11%) appeared on a good course, having been discharged from ICU into acute care and no longer requiring ventilation. Three (17%) remained in ICU on mechanical ventilation. This is a discouraging report, though the study is small.
This study from China is also discouraging. It’s also relatively small, 52 patients. 37 (71%) required mechanical ventilation, of whom 30 (81%) had died by 28 days. This is also a discouraging report, though the study is small and I’m not sure whether Chinese levels of care are comparable to the US.
It remains early, but there are certainly strong indications that mechanical ventilation is not a panacea. My preliminary estimate is that about 50% of patients receiving such ventilation will die.
The Chinese study showed considerably higher survival rates for younger patients, though only reported results for all 52 patients and not separate age-related results for the 37 who received ventilation. Of those under 50, 75% survived (9 of 12), including all of those under 40. In the 50-69 range, 67% died (20 of 30). Over 70, 90% died (9 of 10).
Why a heated topic? Because Orange Man Bad?
No, technical arguments over whether certain reports had demonstrated effectiveness. I was on the “no” side, though I think that HCQ is promising. There were no control groups in most of the reports.
Roderic, no, as Jerry observes above, it’s heated for non-political reasons.
And it’s a worthy debate. It revolves around standards of testing, and about what we should deem sufficient before rolling out a new treatment.
The triggering aspect is that those who try to make a defense of conventionally rigorous studies under normal circumstances, while defending the utility of accumulating anecdotal (and slightly better) evidence in a crisis, can easily be mistaken as putting either too much or too little emphasis on medical-science-done-right. I think the majority of us really agree on the need to bend the rules right now, but to do so cautiously and temporarily.
The Orange Man Bad thing is a different discussion entirely, and I haven’t seen much of it on Ricochet since mid-month when this thing took off.
Is remdesivir an oral drug or IV?
https://www.foxnews.com/science/coronavirus-new-york-blood-center-plasma-donations-recovered-covid-19-patients
new york blood center plasma donations from recovered patients
I think that my own position was a bit more nuanced. I wasn’t insisting on a normal, conventional, rigorous study. What I’d like to see is some field-type randomization.
For example, if I were a treating doc in these circumstances, I’d tell my patients that I have a potentially promising treatment, but that we don’t know whether it is effective and it does have some side effects. The side effects are relatively minor, because the drug has been approved for other uses. I’d ask and encourage the patients to volunteer for a controlled study, giving them a randomized 50% chance of getting the experimental drug, or not.
I’d give each patient the choice to decline to participate in the study, and for each patient so declining, I’d allow them to select the treatment, or to reject it. I’d only randomize within the group that agreed to participate in the trial.
This would give us better data, which could be immediately shared with the world.
is it ethical to give your patient a placebo especially in this environment?
A reasonable assumption but the challenge with that statement is we are unaware of what limiting conditions these patients were dealing with that distorts the mortality outcome. For example we don’t know how many of these patients had immune compromised conditions or suffered from other respiratory issues.
The fundamental challenge is the core data is only being presented and defined within the parameters of having COVID and not specifying any pre-existing conditions that would complicate or exacerbate COVID.
That’s absolutely true. Given the prevalence of comorbidities in the elderly population most vulnerable to this illness, the matrix of health statuses represented by any small-N sample population is probably pretty densely populated. That makes meaningful correlations, if any, hard to tease out. As the sample population size increases this becomes less of a problem. I suspect we now have enough experience in the United States to get a solid ratio of favorable and unfavorable outcomes with enough members to average out the comorbidities. (A US-only sample population might also represent a more consistent standard of care.)
It also has to do with panicky belief in a magical object rather than the reality, which a complex subsystem that cannot be scaled up rapidly:
I’m not a doctor (of medicine), and I’m not an expert on medical ethics.
I think that the formulation of your question is part of what led to the strange spat over the HCQ issue. I could turn it around. Is it ethical to give a patient an experimental drug of unknown effectiveness, in this or any environment?
I don’t think that either of these is the proper formulation of the question.
See, it’s complicated. My answer is nuanced, as you quoted above.
The strange thing that I observed here at Ricochet was that a number of people were absolutely clamoring for HCQ, insisting that it had been proven effective (which it has not), and reacting with hostility toward any skepticism. I found it odd. It’s hard for me to understand psychologically. Perhaps there’s just a desire for some cure in a time of fear. Perhaps there’s a political aspect, as President Trump’s reference to HCQ as a promising treatment caused political polarization on the issue. Perhaps people are misled by media reports, form an opinion, and are then hostile to anyone challenging that opinion. Perhaps there was an ideological objection to government regulation of pharmaceuticals.
As I think that I’ve made clear, I think that HCQ is promising but unproven. It would be nice if we had better data to evaluate effectiveness. I am very critical of the doctors who presented their results in a sensationalized fashion, without having done even a relatively quick-and-dirty study with a control group.
There is mounds of it on Facebook. The argument resembles the advent of antisepsis in surgery.
First, HCQ is an old drug and has been well documented as to risk (LOW). There are now about 6,000 patients described without controls but with good effects listed. The alternatives, unless remdesivir has very good results, are not much. The convalescent serum is going to take as long as a vaccine to get any volume and the control issue is the same. We can argue that research should have continued on SARS but it didn’t.
Ethical decisions are individual not collective or bureaucratic.
If it were me, as long as the experimental drug was safe and my doctor thinks I’m a good candidate, why not? risk is low, reward could be high
I have a supply and have provided my children with enough for a 5 day course if they get exposed or develop symptoms. My younger son is a paramedic and an insulin dependent diabetic.