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As COVID-19 cases grow, patients die at a slower rate

When the number of people sent to the hospital with COVID-19 began to creep up in Los Angeles County early this summer, officials warned that a large increase in deaths was inevitable. A record number of cases could lead to a record number of deaths, they predicted.

But almost two months later, it has not been realized. The coronavirus continues to kill hundreds of people each week in LA County, but the death toll has remained lower than expected.

The trend is partly due to younger people becoming ill, as well as better control over the spread of the disease in high-risk environments, such as nursing homes.. But doctors say there is another factor that increases the survival rate: better treatments.

It was so gloomy in the beginning, ”said Dr. Armand Dorian, an ER physician and medical director of Verdugo Hills Hospital at USC. “Now we actually have treatment regimens that help. … From the beginning, say February to now, we have learned a lot. “

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

9 died between March and May of the disease. Among those diagnosed between June 1 and August 3, that figure dropped to 1.2%, according to a Times analysis of condition data. Extended tests, changed patient demographics and better patient care all played a role in that case, experts say.

The statistics are what epidemiologists call the death in number of cases: the number of deaths divided by the number of cases. This measures how deadly the disease is once humans have contracted it – the chance of survival. While the pandemic remains gloomy, the reduced death rate is a glimpse of progress, experts say.

The mortality rate is available together with another statistic: the mortality rate – deaths divided by the total population – which reflects the spread of the disease within the population.

In an interview with Axios released last week, President Trump discounted the country’s mortality rate, which is worse than most other countries, while praising his mortality rate, which is better than most countries.

But improved fall mortality cannot compensate for the widespread spread of the deadly virus, experts say. California’s mortality rate increases when the state’s death toll from COVID-19 exceeded 10,000 on Thursday. If many people get sick, many people will die, even with improvements in the level of survival.

Dr Tim Brewer, an infectious disease specialist and epidemiologist at UCLA, said that even the medical improvements could be negated if the number of patients continues to grow. An overwhelming healthcare system could hamper doctors’ ability to provide life-saving care, he said.

“We have acquired a huge amount of information over the last seven months that has been helpful. We just need everyone to realize that the virus has not disappeared, Brewer said.

When COVID-19 patients first began appearing in hospitals in the spring, doctors did not know which drugs or treatments would be effective. Little understood how the virus was transmitted or the best way to protect staff. USC’s Dorian described health care workers who handled the unique crisis as “deer in headlights.”

But that has changed rapidly as doctors around the world study and treat the coronavirus. Research results in one country can within a few days become clinical guidelines in another.

“The collaboration between physicians around the world on how best to treat COVID-19 has been quite unusual,” says Dr. Bilal Naseer, a critical care physician in Sacramento with CommonSpirit Health, a large nonprofit hospital system. “I think the level of trust among doctors and healthcare groups is very high now – how to identify patients with COVID-19 early and how to prevent serious illness is really much better understood.”

Early in the outbreak, health care workers panicked and administered several drugs to patients to try to save them, unsure who could help. But that strategy made it difficult to tell what worked and did not work, so that doctors could not get the knowledge they could use to help the next patient.

“Doctors around the world and in LA basically threw everything we could at these patients,” Brewer said. “We needed to lower our panic levels a bit and do research and studies and studies.”

One of these studies, conducted by British researchers, led to a surprising result. For other deadly coronaviruses, such as SARS and MERS, steroid drugs had been shown to worsen symptoms.

But British researchers found that dexamethasone, a common low-cost steroid, reduced the mortality rate of patients on ventilators by a third and by a fifth for those who require oxygen, according to the study published in June.

Doctors had already started administering remdesivir, an antiviral drug developed by Gilead Sciences, which has been shown to shorten the time it takes for patients to recover from the infection. Both drugs are now regularly prescribed by doctors who treat COVID-19 patients, they say.

“We are far from having real cures like vaccinations and more specific drugs,” Dorian said. “But we have something. It feels good to say, “Why don’t we give strap divis?”

San Diego State University epidemiologist Eyal Oren pointed out that many people who become ill may not die, but will still endure long-term health consequences. He warned that looking at small improvements in survival rates could eliminate the reality that thousands continue to die from COVID-19, especially people of color.

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

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

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

Yet the average deaths never exceeded what they had reached in the spring. The county’s death rate from COVID-19 has dropped from 4% in May to 2% now, according to the county’s data.

“For me, it probably means we do better care,” said Dr. Jeffrey Gunzenhauser with the LA County Department of Public Health.

Gunzenhauser said that the decline is probably also due to changes in who becomes ill. Infections have decreased in nursing homes, whose residents are particularly vulnerable to the virus, while cases have increased among young people, who are healthier and more likely to survive, he said.

Dexamethasone has helped reduce deaths among COVID-19 patients.

Dexamethasone is an inexpensive, widely available steroid that has reduced deaths among seriously ill, hospitalized COVID-19 patients.

(Impartial Press)

When patients end up in hospital, doctors have new protocols to improve their survival odds. Early in the pandemic, doctors rushed to put patients on ventilators as they struggled to breathe.

But now it has become clear that it may not be necessary to intubate these patients, which may open them up to other complications that actually reduce their chances of survival.

Now doctors are laying patients on their stomachs to allow more oxygen into the lungs and give them oxygen through the tubes that are inserted into the nose. Patients are put on ventilators as a last resort, the doctors say.

“We were on a hair release to put people on valves at the beginning of the epidemic,” said Bradley Pollock, president of the UC Davis Department of Public Health Sciences. “If anyone looked like they were reduced, we will immediately put them on a valve – it was a mistake, in retrospect.”

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

The knowledge gained in recent months has improved care simply by making staff more secure, says Dorian. Patients benefit when healthcare professionals are not stressed and can take time with them and listen to their needs, he said.

“It simply came to our notice then. It’s not just medicine, he said.

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