New Data on COVID-19 vs Other Viral Infections (Ventilator Outcomes) (Lecture 49)
Welcome to another MedCram Covid-19 update. We are now officially over 1 million cases confirmed. The United States is well on its way to a quarter of a million cases. If Europe was a country, then it actually would be number one in the world in terms of infections.
Keep in your mind the chart of what is going on here with Covid-19. We have here on Day Zero infection and then the infection persists for about 5 days of incubation, between day 5 and day 12 is the symptomatic period of growing and build. And this is of course an average, and 80% of people in this period will exit out of this cycle without any further intervention, no need for oxygen, no need to visit the emergency room, no need to be admitted.
But it’s about 20% of those people here that need to be hospitalized. And of course some of those will just need supplemental oxygen, maybe some observation. But again, some of those may need to be put on a ventilator. I know ventilators intimately well. I’ve trained for most of my educational life on how to run a ventilator and how to control a ventilator. The ventilator is a major tool in my toolbox of pulmonary treatments.
So you have to understand that there was a little bit of disdain when I saw this article titled Ventilators Are No Panacea For Critically Ill Covid-19 Patients. And I have to say deep down. I know this is true for the flu. And for these viral pneumonia is, in general. Often, we see a tremendous precipitous down trend in patients who are admitted in shock and intubated and within hours are being coded on the ventilator.
And this article goes through some of the data on this. The first sentence of the story says quite a bit. Most coronavirus patients who end up on ventilators go on to die, according to several small studies and many of the patients who continue to live can’t be taken off the mechanical breathing machines. And they cite a number of articles for it. Probably the most comprehensive article is related to the United Kingdom.
And this report that was just published a few days ago is a report by the Intensive Care National Audit and Research Centre in London, England. And what they did was took information from intensive care units across the United Kingdom and looking at the demographics of these patients that were being admitted and looking at them within the first 24 hours and categorizing them.
For our benefit, here’s a diagram of the demographics. The mean age at admission was around 60 years of age. There is definitely a predilection of male versus female here in terms of those patients being admitted to the Intensive Care Unit.
And here when we look at the body mass index remembering that a body mass index of 25 to 30 is deemed to be overweight and greater than 30 is deemed to be obese, you can see that the majority of the patients are definitely in the overweight category, with approximately 70% of the patients being admitted to the Intensive Care Service being overweight.
Here we can see a breakdown of admission what the age of the patient is. And you can see it in relation to male versus female. Just about every category males outnumber females in terms of admission to the Intensive Care Service.
Perhaps however, this is the most interesting table. In the First Column, we’re looking at the data from just Covid-19 patients. But in the second column, we’re looking at non Covid-19 viral pneumonia patients. So there are other viruses that can also cause pneumonia. These of course could be influenza or respiratory syncytial virus. In the past non Covid-19 patients, patients with pneumonia, 77 percent of them would leave the Intensive Care Service alive. Here 52% of Covid-19 patients are ending up leaving the Intensive Care Service alive and a whopping 48 percent are dying in the Intensive Care.
The thing that’s interesting at least in the United Kingdom is whether its length of stay or the duration of organ support. When you look and compare to other viral pneumonia, the critical care time, either in survivors, nonsurvivors, advanced respiratory support, total respiratory support, total cardiovascular support or renal support, seems to be less time in Covid-19 and more time in non Covid-19, meaning that things perhaps are getting better quickly or getting worse quickly in this situation.
Here’s an interesting table in terms of critical care outcomes by patient subgroup. And you can see here that the majority of the patients that are being admitted are in the 50 to 69 age group when they are discharged alive from critical care, but when they died in critical care, the majority of those patients are coming from the 70 plus. When we look at females they have a sixty two point five percent chance of being discharged alive from Critical Care, whereas the males typically have a 50/50 chance of surviving ICU care.
Interestingly, in terms of BMI, those who are in the obese range tend towards more chance of dying in critical care. And of course I wanted to make an acknowledgement here. So you have to realize that if you are ending up the hospital right here at the end, only a fraction of these patients will go to the Intensive Care Unit and end up on a ventilator. But if you do, it looks as though on average it’s about a 50-50 chance depending on what age group or demographic you’re part of and here is where you start to realize that you have symptoms of some sort of viral infection.
And you of course you can’t tell if you have Covid-19 at the onset of these symptoms. You probably have the virus for about 5 days and you’ve got a certain time period between the time of onset of symptoms until when you might need to go into the Intensive Care Unit. In my estimation, the time period between onset of symptoms and needing to go to the hospital is the golden period of time that you need to act to make a difference. And it seems as though increasingly more and more that this period here in the hospital is going to be a more difficult time to act.
However, I do have to acknowledge that this area here is where I am trained to do my best work, but we will tell you this. Whether or not we are looking at the prevention of the infection here at this point in the first phase, whether it is after your infection and in the early portions of the viral infection here in the second stage or whether or not it’s towards the ends where the patient is coming into the hospital with severe symptoms towards the third phase, we are going to look at all of these areas and bring you the latest information.
Thanks for joining us.