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As COVID-19 cases increased, the patient died at a lower rate



As the number of people admitted to hospital with COVID-19 begins to rise in Los Angeles County earlier this summer, officials warn that a huge increase in the number of deaths is inevitable. They predict the record number of cases that could lead to a record number of deaths.

But almost two months later, that has not come true. The coronavirus continues to kill hundreds of people every week in LA County, but the death toll is still lower than expected.

This trend is partly due to the fact that young people get sick, as well as better control of the spread of the disease in high-risk settings, such as nursing homes.. But the doctors say there is another factor driving the survival rate up: better treatments.

Said Dr. Armand Dorian, ER doctor and medical director of Verdugo Hills Hospital at USC. “We now really have very useful treatment regimens. … Since the beginning of February, we have learned a lot. “

Trends are not limited to LA County. In California, 3.6% of people diagnosed with COVID-1

9 between March and May died from the disease. Among those diagnosed between June 1 and August 3, that figure dropped to 1.2 percent, according to Times analysis of state data. Experts say extensive testing, demographic change, and better patient care all played a role in that decline.

The statistic is called the death rate by epidemiologists: the number of deaths divided by the number of cases. This measures how deadly the disease is once infected – the chance of survival. While the pandemic remains bleak, the drop in case mortality is a light of progress, experts say.

Mortality rates coexist with another statistic: the mortality rate – the number of deaths divided by the total population – reflects the spread of the epidemic among populations.

In an interview with Axios published last week, President Trump reduced the nation’s death rate, which is lower than that of most other countries, while praising its better mortality. compared with most countries.

However, the improved mortality cannot offset the massive spread of the deadly virus, experts say. California’s death rate is rising as the state’s COVID-19 death tolls surpassed 10,000 on Thursday. If more people continued to fall ill, more people would die, even as survival rates improved.

Dr. Tim Brewer, infectious disease specialist and epidemiologist at UCLA, says that even medical improvements could be denied if patient numbers continue to rise. An overburdened healthcare system can hamper doctors’ ability to provide healthcare services, he said.

“We have gathered a great deal of useful information over the past seven months. We just need people to realize that the virus hasn’t gone away yet, ”says Brewer.

When a COVID-19 patient first started arriving at the hospital in the spring, doctors didn’t know what drugs or treatments would work. Little is known about how viruses are transmitted or how best to protect employees. USC’s Dorian describes health-care workers coping with an unprecedented crisis as the “deer in the headlights”.

But that quickly changed as doctors around the world studied and treated coronavirus. Research results in one country may become clinical guidance in another in a matter of days.

Dr. Bilal Naseer, a key care physician in Sacramento with CommonSpirit Health, a major non-profit hospital system, said: “Collaboration among doctors around the world on the best treatment for COVID- 19 is quite phenomenal. “I think the trustworthiness of doctors and the medical team is very high today – how to identify patients with COVID-19 early and how to prevent serious illness is really much better understood. “

At the beginning of the outbreak, the panicked health workers injected patients with various drugs in an attempt to save them, unsure of which drugs could help. But that strategy makes distinguishing what was and is not working, so doctors cannot have the knowledge they can use to help the next patient.

“Doctors around the world and in LA basically threw whatever we could at these patients,” says Brewer. “We need to reduce the level of panic a little bit and do research, experiment and research.”

One of the studies done by British scientists led to a surprising discovery. For other deadly coronaviruses, such as SARS and MERS, steroid medications have been shown to aggravate symptoms.

But researchers in the UK have found that dexamethasone, a popular and low-cost steroid, has reduced death rates for ventilated patients by one-third and one-fifth for those who need oxygen, according to research published in June.

Doctors have already begun using remdesivir, an antiviral drug developed by Gilead Sciences that has been shown to shorten the time it takes patients to recover from an infection. Both drugs are currently prescribed regularly by doctors treating COVID-19.

“We’re miles away from having real cures like vaccinations and more specific meds,” said Dorian. “But we have something. It feels great to say, “Why don’t we give remdesivir?”

San Diego State University epidemiologist Eyal Oren has shown that many people who get the disease may not die, but still suffer from long-term health consequences. He warns that looking at small improvements in survival could shed light on the fact that thousands continue to die from COVID-19, especially people of color.

“Why do we have so many cases and so many deaths?” he say. “What’s the big picture?”

But for some, the improved survival rates are a small part of the hope.

Before the latest wave of patients in LA County, the number of people hospitalized for COVID-19 in the county at one time was just over 1,950 at the end of April. That record was broken in July, when more than 2,200 people were hospitalized for infections.

However, the average death toll never exceeded what they achieved in the spring. According to county data, the county’s COVID-19 mortality rate fell from 4% in May to 2%.

“For me that could mean we’re taking better care,” said Dr. Jeffrey Gunzenhauser of the LA County Department of Public Health.

Gunzenhauser said that the decline was probably due to changes in the sick person as well. He said: “ Infections have been reduced in nursing homes, where their residents are especially susceptible to the virus, while cases are on the rise in young, otherwise healthy, and more survivability, he said.

Dexamethasone has helped reduce mortality in patients with COVID-19.

Dexamethasone is an inexpensive, widely available steroid that reduces death in critically ill, hospitalized COVID-19 patients.

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When patients last enter hospital, doctors have new regimens to improve their survival rates. In the early part of the pandemic, doctors rushed patients to the ventilator when they were having difficulty breathing.

But it has now become clear that there may not be a need for intubation of these patients, which may open up for them other complications that actually reduce their chances of survival.

Now, doctors put their patients on their tummy to put more oxygen into their lungs and deliver oxygen to them through tubes inserted into their noses. Doctors said patients were put on a ventilator as a last resort.

“We kicked people into the vents when the epidemic started,” said Bradley Pollock, head of public health science at UC Davis. “If someone looked like they were in denial, we would immediately put them in the vent – it was a mistake, looking back.”

Doctors also know that COVID-19 tends to thicken patient blood and form blood clots, which can cause strokes and heart attacks. In some US hospitals, blood clots have been reported to be the cause of 40% of COVID deaths. Now, doctors know how to use anticoagulants to prevent these deaths.

The knowledge gained over the past few months has improved care simplicity by making employees more confident, Dorian said. Patients benefit when the paramedics are not stressed and can spend time with them and listen to their needs, he said.

“That’s what makes people turn their backs. It’s really more than just medicine, ”he said.




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