Study Looks at COVID-19 Differences in Treatment and Survival

This past Wednesday, the United States recorded 1,100 coronavirus-related deaths within 24 hours for the second consecutive day, according to a Reuters analysis. Reading numbers like this can be disconcerting, but getting this type of information is important because it keeps us informed about the virus and its effect on the U.S. However, there is more to the story than these numbers and this results in increasing worries about COVID-19.

To ease some of this anxiety, researchers with the Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19 (STOP-COVID), led by Brigham and Women's Hospital in Boston, tried to fill in some of the blanks. Though most of the facts put out by the researchers are already known, national level data is still missing information since scientists and governments are grappling with the "new normal."

So, how did they manage to accomplish this herculean task of finding a nationally representative population during the pandemic? The researchers tracked the treatment, progress and recovery of 2,215 patients with confirmed COVID-19 between March 4 to April 4, 2020. All were critically ill and treated in intensive care units (ICUs) at 65 hospitals in different parts of the country. Furthermore, a study published on July 15 in JAMA Internal Medicine examined what other health conditions aside from COVID-19 patients may have had that could contribute to the number of deaths, as well as rates of organ failure. The researchers found that not everyone had access to the same treatment and the patient outcomes among the hospitals were dependent on local hospital resources. "This is the largest nationwide study of patients with COVID-19 admitted to ICUs across geographically diverse sites in the U.S.," lead author Shruti Gupta, MD, MPH, a physician in the Brigham's Renal Division, said in a news release.

This Is What The Study Said

Mortality - 35 percent of patients died within 28 days of being admitted to the ICU, while 37 percent left the hospital alive and 27 percent continued treatment. However, by June 4 when the researchers finished conducting a follow-up, 39 percent of the 2,215 patients admitted to the ICU had died of COVID-19. More than half recovered at the time of follow-up: 54 percent were discharged and 6 percent stayed behind.

Age - Older age in general was a risk factor for death, particularly for those between 40 to 80 years of age. Nevertheless, the study noted that 15 percent of COVID-19 patients died across all age groups, even among people younger than 40. Since two-thirds of the patients were men, being male was also associated with a higher risk of death.

Symptoms - Patients most often experienced cough, shortness of breath and fever before they were admitted to the ICU. Prior to this, about 78 percent of the patients had at least one pre-existing condition including hypertension, diabetes and chronic lung disease.

Causes of death - Several patients died due to more than one cause: 92.7 percent died of respiratory failure, 39.7 percent of septic shock and 37.6 of kidney failure.

Organ failure - Respiratory distress - difficulty breathing - was the most common organ failure among this critically ill group, followed by kidney injury. After 14 days in the ICU, 1,859 patients of the 2,215 in the study had to have life saving measures, such as ventilators to help them breathe. Most patients had developed acute respiratory distress syndrome soon after admission. About 42.8 percent of the patients developed an acute kidney injury. Only 10 percent of the patients experienced blood clots.

No racial disparities - While almost one out of three patients included in the study were Black, race did not affect mortality rates in comparison to whites at the hospital level.

Treatment Differs Depending on Hospital Resources

When looking at medications given to treat the COVID-19 infection, the researchers found that 80 percent of patients received hydroxychloroquine. The drug was the topic of controversy when President Donald Trump endorsed it, although there was lack of evidence regarding its effectiveness.

Other commonly prescribed drugs included azithromycin and anticoagulants (blood thinners). Patients with low levels of oxygen in their blood, called hypoxemia, were treated with medications that paralyze their muscles so the ventilators could do their work, prone positioning (lying on their stomach) and inhaled medications. It's important to note that the treatments patients received depended on the hospital they were in and how much the institute was able to provide.

The study also found many differences regarding the types of medications patients received. For example, some hospitals had more remdesivir to offer than others. Also, a few hospitals were better equipped to provide supportive therapies, the researchers noted. Interventions such as prone positioning were available to only 4 percent of patients at one hospital. In contrast, another hospital could give 80 percent of its patients prone positioning treatment to improve the oxygen levels for those patients who were in severe acute respiratory distress.

Despite attempts to even out the scale, death rates were vastly different from hospital to hospital. The range of death rates varied greatly between 6 percent to 80 percent, depending on the level of modernity and sophistication of the treating hospital. Where hospitals had fewer than 50 ICU beds, patients had a three times higher risk of death compared with the patients who were in hospitals equipped with more than 100 ICU beds.