Effectiveness of early COVID-19 treatments

[Grinkle]

TL;DR Summary

What is the most effective stage to administer treatment?

Do we have data to give any perspective on these questions regarding COVID-19 victims -

If a patient is deemed to need a respirator, what is the expected morbidity for them at that time if they are put on a respirator? I assume that without a respirator, the morbidity is close to 100%.

Is there a level of earlier care that can prevent a patient from deteriorating to the point where they require a respirator?

If so, is that level of care more effective if administered by a physician than a less trained person?

I wonder, for instance, if 1000 new tanks of oxygen might be easier to create and deploy and administer than 1 new respirator and might be as effective or more effective therapy in terms of improved outcomes for more people.

 

[Ygggdrasil]

Disclaimer: I am not a medical doctor.

Here are statistics from two studies in China that look at critically ill cases of COVID-19:

32 patients required invasive mechanical ventilation, of whom 31 (97%) died.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext

In particular, the second article notes:

Non-invasive ventilation is not recommended for patients with viral infections complicated by pneumonia because, although non-invasive ventilation temporarily improves oxygenation and reduces the work of breathing in these patients, this method does not necessarily change the natural disease course.6

and cites this study on the 2009 H1N1 influenza pandemic: https://ccforum.biomedcentral.com/articles/10.1186/cc8883

 

[Grinkle]

Thank you, @Ygggdrasil .

I suspect this data is somehow skewed, although I have no theory on what may be skewing it. If Italian doctors are seeing 90% mortality for people they put on ventilators I don't see how the anecdotal narrative could end up being how difficult it is to decide who gets a ventilator.

The second article is a good lesson on the danger of lay-people like myself applying a personal brand of common sense to come up with therapies. It does clearly say that non-invasive ventilation is not known to be helpful for COVID-19.

Is isolation the primary benefit of hospitalization (I wonder)?

 

[berkeman]

I assume that without a respirator, the morbidity is close to 100%.

I think you mean "mortality" https://www.verywellhealth.com/what-is-morbidity-2223380

Is isolation the primary benefit of hospitalization (I wonder)?

I don't think so. If you are hospitalized, you already are infected, so isolation is not going to cut down on that infection. More likely the main benefits are good hydration via IV and early intervention when any bacterial infections occur. And invasive respiratory therapy if your respiratory system starts to fail. Without that intervention, other systems in the body fail pretty quickly from the lack of oxygenation.

 

[Ygggdrasil]

Thank you, @Ygggdrasil .

I suspect this data is somehow skewed, although I have no theory on what may be skewing it. If Italian doctors are seeing 90% mortality for people they put on ventilators I don't see how the anecdotal narrative could end up being how difficult it is to decide who gets a ventilator.

The second article is a good lesson on the danger of lay-people like myself applying a personal brand of common sense to come up with therapies. It does clearly say that non-invasive ventilation is not known to be helpful for COVID-19.

Is isolation the primary benefit of hospitalization (I wonder)?

The high mortality of COVID-19 patients on ventilators seems like an outlier. Here's a study of 178 H1N1 cases from 2009, which shows a 46% mortality of patients on mechanical ventilation, and a wider meta-analysis of treatments for ARDS (acute respiratory distress syndrome) finds a 34.6% mortality of patients with severe ARDS treated with mechanical ventilation or ECMO, so ventilators are clearly helping in these situations.

If I were to speculate (again, disclaimer that I am not a medical doctor nor do I have any particular expertise in medical science aside from skimming through a few of these papers), I would guess that there could be two reasons for the very high mortality of COVID-19 patients on ventilators: 1) Ventilators treat the symptoms but not the cause of the problems. If the virus is still active in the body, ventilators ultimately won't solve that problem. This would suggest that ventilators could become more effective if effective anti-viral treatments are found that can address the underlying viral infection. 2) It has been reported that the virus could infect other organs of the body, so while ventilation could solve issues with lung function, the virus may cause death due to damage to other organs such as the heart, liver or kidneys.

 

[Laroxe]

In most countries only people who are already very sick are hospitalised, so their mortality rate will be higher than the average. Then its only the most ill patients among those hospitalised are put on ventilators, so they will already be considered at the highest risk of death. When people are hospitalised because of the severity of their symptoms their physical state is constantly monitored to identify any change, there are a variety of treatment options to help symptom management which may be offered and some potentially life threatening complications can be treated if identified early. These include the cytokine storm, bacterial super infections and multi organ failure.
Many people in hospital are also offered one of the treatments that are undergoing evaluation.
The overall mortality rate of people hospitalised and ventilated has changed considerably as people became more experienced in managing the condition. The first link looks at the early cases, the second more recent figures.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/fulltext
https://www.ecdc.europa.eu/en/2019-ncov-background-disease