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NNadir

(33,368 posts)
Wed Dec 23, 2020, 11:36 AM Dec 2020

Decreased COVID-19 Mortality--A Cause for Optimism

From the JAMA newsfeed, invited commentary:

Decreased COVID-19 Mortality—A Cause for Optimism

Excerpts:


After a hard year, good news related to coronavirus disease 2019 (COVID-19) is welcome. In this issue of JAMA Internal Medicine, Asch and colleagues1 provide a reason for optimism that our health care system has improved in our ability to care for persons with COVID-19. The authors performed a national analysis of COVID-19–associated mortality that spanned 955 US hospitals, representing nearly 40 000 patients. Using administrative claims data from a large national health insurer, they found that a hospital’s risk-standardized event rate (a composite of hospital mortality or referral to hospice) because of COVID-19 had significantly decreased. Specifically, the risk-adjusted mortality decreased from 16.56% to 9.29% in the early period of this study (January through April 2020) compared with the later period (May through June 2020).

Similar improvements in mortality due to COVID-19 have been seen in other studies. A study using national intensive care unit data from the UK2 found a reduction in mortality from 41.4% in March 2020 to 24.8% in June 2020, and a study of patients with COVID-19 in a single hospital system in New York City, New York3 reported that hospital COVID-19–adjusted mortality dropped from 25.6% to 7.6% between March and August 2020. These improvements in mortality likely represent multiple clinical, health care system, and epidemiologic trends...

...Asch and colleagues1 found that mortality rates were higher when the community prevalence of COVID-19 was higher. One likely reason for this finding is that hospitals do not perform as well when they are overwhelmed. In particular, patients with a precarious respiratory status require expert, meticulous therapy to avoid intubation; those who undergo intubation or have kidney failure require nuanced and timely expert care with ventilatory adjustments and kidney replacement therapy, which are difficult to perform optimally when hospital capacity is strained.


Bad news for rural hospitals in the mask adverse Republicastan regions.

...A more speculative possibility of why mortality has decreased is the possibility that larger infective doses of COVID-19 may lead to more severe illness than smaller inoculums.7 In the beginning of the first wave, there was very limited use of face masks and social distancing. As 2020 progressed, more people wore masks and distanced themselves, which may have decreased the infecting inoculum. The finding by the authors that the strongest risk factor for a hospital’s standardized event rate was community prevalence of COVID-19 is consistent with this hypothesis, although the connection between inoculum and severity is far from certain.8


The full Asch paper to which the commentary refers can be found here: Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic (Asch DA, Sheils NE, Islam MN, et al. Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic. JAMA Intern Med. Published online December 22, 2020. doi:10.1001/jamainternmed.2020.8193)
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