COVID Death Rate Declining

A variety of factors have led to better survival chances for those hospitalized with the disease.

Under the headline “Studies Point To Big Drop In COVID-19 Death Rates,” NPR‘s All Things Considered slowly teases two medical studies of those hospitalized with the novel coronavirus.

Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.

“We find that the death rate has gone down substantially,” says Leora Horwitz, a doctor who studies population health at New York University’s Grossman School of Medicine and an author on one of the studies, which looked at thousands of patients from March to August.

The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.

That’s a big improvement, but 7.6% is still a high risk compared with other diseases, and Horwitz and other researchers caution that COVID-19 remains dangerous.

The death rate “is still higher than many infectious diseases, including the flu,” Horwitz says. And those who recover can suffer complications for months or even longer. “It still has the potential to be very harmful in terms of long-term consequences for many people.”

So, a rather massive drop in fatality rate is good news. But . . . why is it happening? What’s the intervening variable? There’s been no revolutionary advance in treatment reported in the news. Are people going in earlier? Are fewer going in at a time, thus not being triaged?

Studying changes in death rate is tricky because although the overall U.S. death rate for COVID-19 seems to be dropping, the drop coincides with a change in whom the disease is sickening.

“The people who are getting hospitalized now tend to be much younger, tend to have fewer other diseases and tend to be less frail than people who were hospitalized in the early days of the epidemic,” Horwitz says.

So . . . fewer people are dying because we’ve already killed off the oldest, sickest people in the first wave? Well, not so fast.

So have death rates dropped because of improvements in treatments? Or is it because of the change in who’s getting sick?

To find out, Horwitz and her colleagues looked at more than 5,000 hospitalizations in the NYU Langone Health system between March and August. They adjusted for factors including age and other diseases, such as diabetes, to rule out the possibility that the numbers had dropped only because younger, healthier people were getting diagnosed. They found that death rates dropped for all groups, even older patients by 18 percentage points on average.

So, great. But what has changed? If it’s a function of the medical establishment being better at treating those who are sick, presumably there’s some specific treatment, technique, or such that can be isolated?

Mateen says drops are clear across ages, underlying conditions and racial groups. Although the paper does not provide adjusted mortality statistics, his rough estimates are comparable to those Horwitz and her team found in New York.

“Clearly, there’s been something [that’s] gone on that’s improved the risk of individuals who go into these settings with COVID-19,” he says.

Horwitz and others believemany things have led to the drop in the death rate. “All of the above is often the right answer in medicine, and I think that’s the case here, too,” she says.

Okay. So, what alls are above?

Doctors around the country say that they’re doing a lot of things differently in the fight against COVID-19 and that treatment is improving. “In March and April, you got put on a breathing machine, and we asked your family if they wanted to enroll you into some different trials we were participating in, and we hoped for the best,” says Khalilah Gates, a critical care pulmonologist at Northwestern Memorial Hospital in Chicago. “Six plus months into this, we kind of have a rhythm, and so it has become an everyday standard patient for us at this point in time.”

So . . . there is now some kind of “rhythm.”

Were we killing patients in the early cycles by making them guinea pigs in the various clinical trials and we’ve stopped that?

Is there some intervention that we were doing on Day 3 that we’re now doing on Day 1?

Or, again, could it be a capacity issue? These studies were done in New York. Were they simply overwhelmed in the first wave and not able to give each patient as much attention as they’re now getting?

Doctors have gotten better at quickly recognizing when COVID-19 patients are at risk of experiencing blood clots or debilitating “cytokine storms,” where the body’s immune system turns on itself, says Amesh Adalja, an infectious disease, critical care and emergency medicine physician who works at the Johns Hopkins Center for Health Security.

He says that doctors have developed standardized treatments that have been promulgated by groups such as the Infectious Diseases Society of America.

“We know that when people are getting standardized treatment, it makes it much easier to deal with the complications that occur because you already have protocols in place,” Adalja says. “And that’s definitely what’s happened in many hospitals around the country.”

Aha! So, yes, they have indeed developed a routine of care that has been standardized. Essentially, the early patients were in fact guinea pigs and we learned from them what worked and what didn’t. (That’s not a criticism! That’s the harsh reality of a novel disease and getting better as we go is the best we can hope for.)

But Horwitz and Mateen say that factors outside of doctors’ control are also playing a role in driving down mortality. Horwitz believes that mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients.

That certainly stands to reason.

And Mateen says that his data strongly suggest that keeping hospitals below their maximum capacity also helps to increase survival rates. When cases surge and hospitals fill up, “staff are stretched, mistakes are made, it’s no one’s fault — it’s that the system isn’t built to operate near 100%,” he says.

Aha!

FILED UNDER: COVID-19, Health
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. KM says:

    While a dropping fatality rate *IS* good news, we still have no idea about long term side effects and damage. Hearing that COVID “is less fatal than we thought” will only encourage the reckless among us to be infected and spread the consequences of COVID to more innocents. I fear it will embolden the maskholes to continue ruining our economy with their plague-ridden ways; idiots don’t understand science, statistics, risk assessment or that being dead wasn’t the only consequence of this disease.

    Sure, your chances of dying have gone down if all known factors are good. However, have your chances of being on a ventilator gone down? Chance of permanent lung or heart damage, stroke or chronic fatigue? Finally, that unique to the US BS – has your chance of a ruinous medical bill from a COVID infection gone down…. or has it gone UP with a new, costly treatment and longer time spent under medical care??

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  2. Long term side effects are still an issue that we absolutely DO NOT understand.
    Mortality rate drop, or not, I don’t want this virus…and anyone advocating for “herd immunity” is tragically un-informed.

    9
  3. Slugger says:

    Management of a complex disorder has a learning curve. This shouldn’t be a surprise. There has been a rule in medicine to avoid hospitals in early July because that is when newly graduated internes start. Rookies make missteps. All doctors were rookies when Covid started.

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  4. MarkedMan says:

    Were we killing patients in the early cycles by making them guinea pigs in the various clinical trials and we’ve stopped that?

    Almost certainly. The patients actually in the clinical trials were probably the best off, but there were probably many, many more who received no screening and treatment that approximated what was going on in the trials because “what have we got to lose.” That’s what’s going to happen in triage experimentation. And I’m not blaming the doctors – it was frickin’ triage and people were dying horribly within a few days, and there were no “best practices” yet. And no, doctors and hospitals will never say that’s what happened, at least not for the record.

    If there is one thing I learned in my medical device design career is that when it comes to the search for effectiveness, the “individual doctor knows best for their patients” is a load of crap. You are much, much better off going to a doctor who is willing to say, “I don’t have a lot of experience with this. Let me see what the best practices are as recommended by the pertinent specialty group.”

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  5. Kathy says:

    @Slugger:

    Quite so.

    Let’s remember science has the most trouble finding specific mechanisms, especially in biology. Once these are found and understood, progress in treatment and prevention happens at a greater rate.

    So far, we’ve learned mostly about qualitative aspects of SARS-CoV-2, about pandemics, and about how to manage them.

    For instance, we learned you can’t let your guard down or cases surge. We learned early, complete, and decisive intervention can make a huge difference, be it through lockdowns, testing and tracing and isolation, or through preventive measures like masks and distancing.

    3
  6. James Joyner says:

    @Daryl and his brother Darryl: Absolutely. That’s noted in the excerpts in the OP but re-emphasized in later parts of the article that I didn’t quote.

    2
  7. sam says:

    I watched an interview with Christopher Cross the other day. He’d come down with the virus and subsequent to that, he came down with Guillain-Barre. That’s the first I’ve heard of that sequalae of Covid.

    1
  8. Kathy says:

    Another thing is that where there is a learning curve, knowledge inevitably changes. Therefore some measures recommended early may not apply as more information is gained, and new measures may arise as well.

    Masks are a good example. Yes, there was a reticence to recommend masks to protect the supply for healthcare workers, but really no one knew about asymptomatic transmission early on. In all cases of contagious respiratory diseases, it makes sense for the infected individual to wear a mask in order to keep from spreading the pathogen. At first it was thought this meant symptomatic cases. Now we know better. Keep in mind you also protect healthcare workers by keeping the case loads down.

    I think, too, we need to take a comprehensive, standardized approach to pandemic prevention and mitigation implemented globally, rather like the approach to air safety. There are many reasons why air travel is so safe, but a big one is the set of rules which mandate covering all known contingencies beforehand.

    I’ll go into more detail later.

    3
  9. JKB says:

    Only a few researchers/doctors have admitted it, but we really don’t know why viruses “stop”. Not the SARS 2.0, not other epidemics and not the Great Pandemic of 1917.

    Excepting NIOSH approved N95+ masks worn in high viral load environments, masks do very little to protect the wearer. If there are a lot of people shedding virus, masks will lower the extent of projected virus expelled by the wearer. They don’t stop aerosols coming or going, unless as stated above, they are properly fitted, properly worn N95+ masks which will lower the viral load receive per unit time.

    There is evidence vitamin D deficiency is a factor in having a bad COVID-19 case. We are at peak natural vitamin D right now as even those imprisoned in their homes by government edict can get a good dose of sunshine. And people have just had enough of the internments some government have imposed on the populations they consider at threat.

    Ultimately, we aren’t going to know why the death rate has declined definitively. What the experts don’t tell you is that in the end, for all the medical-assistance, you live or die due to the immune system. Our immune systems are getting the recipe to fight the virus and not “panicking” in a cytokine storm as much.

    1
  10. charon says:

    Over at Balloon Juice there is extensive discussion of Vitamin D deep into the comments:

    https://www.balloon-juice.com/2020/10/21/covid-19-coronavirus-updates-tuesday-wednesday-oct-20-21/#comment-7914234

    16.
    Bill Arnold

    OCTOBER 21, 2020 AT 11:00 AM

  11. Kathy says:

    I’ve heard much anecdotal evidence concerning vitamin D and resistance to colds and flu. I also gather that one cannot depend on sunlight for it, as the ability of the skin to churn it out declines over time.

    Ideally one should get one’s levels measured and take supplements if necessary.

    Me, I drink about 2-3 cups of milk every day on weekdays, maybe 1 cup on weekends. I also get some yogurt every day, and some cheese as well.

    While all milk contains vitamin D, milk sold for drinking comes with added vitamins and minerals. Milk sold as raw material for dairy products ins’t enriched this way. You’ll get some vitamin D from cheese and yogurt, but not as much as from milk.

    1
  12. Teve says:

    @Kathy: when I found out that low vitamin D levels are associated with a significant increase in respiratory infections, I started taking a daily multivitamin.

    1
  13. Scott says:

    Last year during my annual exam, the labs came back with decreased Vitamin D, so I’m taking supplements. BTW, technically, Vitamin D is a hormone the body produces to regulate absorption of calcium and helps with the immune system. So I can see it may help with COVID infections.

    2
  14. Dutchgirl says:

    Anyone else predicting the plots, characters, and stylization of the medical dramas/movies that will be made about this? The Very Special Episode of… that will write the national memory of this experience? Will it focus on the heroic efforts of involved people, or the failures (esp the political failures)?

    1
  15. Nightcrawler says:

    This gives me zero comfort. I’m far more afraid of being disabled by COVID-19 than I am of dying of it.

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  16. Teve says:

    @Nightcrawler: ditto

    2
  17. Nightcrawler says:

    I’ve been taking Vitamin D for several years at the instruction of my oncologist. My cancer was highly estrogen-receptive. I had a hysterectomy, and I’m taking an aromatase inhibitor to strip the remaining estrogen from my body. This puts me at high risk of osteopenia. The Vitamin D helps counteract that.

    3
  18. MarkedMan says:

    As for the contention that aside from N95 rated product “masks do very little to protect the wearer” there is no evidence for that. There is some good evidence that surgical style (pleated) masks have benefit. There is no evidence either way that I am aware of regarding cloth masks. But anyone making a blanket statement such as the above is either cherry picking or making it up.

    4
  19. Jim Brown 32 says:

    @Teve: Im satisfied by the studies available that Vitamin D supplementation is an effective damage-control strategy in the event you get Covid. Not guaranteed of course but a good percentage play to mitigate risk to the lower respiratory system.

    I have been taking 6000IU of vitamin D3 since March– have had several colds, strep throat, and a sinus infection since then. Anecdotally–milder symptoms and lower duration–mostly in the form of swollen tonsils and adenoids. No sore throats(even with the strep)–runny noses, etc. Im sold–and will continue the regimen Post Pandemic. Im also interested to see if the extra Vit D will have an affect on my Seasonal moods which kick in after Daylight Savings Time ends. I have been using “sun” lamps to get rid of the blues but I’ve give the Vit D a chance.

    I recommend any of our Black commenters and lurkers also consider vitamin D supplementation. My research shows it’s probably better understood as a hormone and our melanated skin and location in North American means we make a lot less Vitamin D naturally than non-melanated people living in this region. There is a whole body of research that alludes to Vitamin D deficit as a contributing factor in the poor overall health outcomes of Black people in general.

    5
  20. Teve says:

    @Jim Brown 32: you’re definitely right that darker skin inhibits production of vitamin D from sunlight. 6000 IUs is a lot though. You don’t want to absorb too much calcium.

    3
  21. Teve says:

    Test

    1
  22. Teve says:

    Just as a fun fact, biologists think Vitamin D played a big role in different human populations’ skin pigmentation.

    https://www.sciencedirect.com/science/article/pii/B9780128099650000033

  23. Lounsbury says:

    @JKB: Stop with the bloody bleeding dishonest and stupid Dezinformatsia you waste of human flesh

    Excepting NIOSH approved N95+ masks worn in high viral load environments, masks do very little to protect the wearer

    The public health science is now abundantly clear that masks have collectively and individually significant mitigation impact you dishonest twit.
    Nature: https://www.nature.com/articles/d41586-020-02801-8

    Useless dishonest bloody git.

    15
  24. Kathy says:

    Update on the KN95 masks I got the other week: the fit is lousy.

    No matter how I adjust the clip and straps, I clearly feel air coming in from where the clip is on the bridge of my nose. It feels like more air that comes in the sides of the regular, disposable, triple-layer masks I get from work daily.

    Now, it works rather well if I press down on the clip while wearing it, but that’s no solution. Maybe, though, I could add something under the clip or on top of it. We’ll see.

  25. Gustopher says:

    @Kathy: Have you considered using something else to form a seal? I expect it would be very uncomfortable and unpleasant, but taffy would probably work as a proof of concept.

    Only 50-50 trolling with this. There should be something that can be used to form a better seal than just the shape of the mask matching the shape of the face.

  26. Gustopher says:

    The death rate is down, and luckily the undeath rate has not increased. No covid zombies so far as I know.

    This one was 100% gentle trolling.

  27. Just nutha ignint cracker says:

    @Teve: The question of how much to take may also depend on how your system metabolizes it. I’ve been taking 50,000 IU of D2 weekly along with 1ooo of D3 daily for several years now and my D level in my blood had it’s first adequate levels score so far. I’m still at the very bottom of the available range of appropriate levels in my blood.

    2
  28. Just nutha ignint cracker says:

    @Kathy: Can the straps/elastics/loops that anchor the mask be tightened so that it fits tighter to your face? One solves the problem of CPAP mask leak by tightening the head strap and the reason that head straps need to be replaced is because they eventually stretch to a point where they no longer hold the mask tight against the face.

    (I’ve heard that some people refuse CPAP therapy because they don’t like waking up and seeing the face mask/strap compression marks on their faces in the morning mirror. I never notice, but that’s because I sometimes forget to put on my glasses first bathroom trip in the morning. 😉 )

    2
  29. EddieInCA says:

    @Kathy:

    Update on the KN95 masks I got the other week: the fit is lousy.

    Kathy –

    I only learned this week the difference between N95 and KN95 masks. On set, we all have to use either KN95 or N95 masks without vents. I showed up with a vented N95 and was asked to replace it with the KN95 offered by the studio.

    What I learned is that the biggest difference, despite all the science, is fit. N95 masks seal to the face. KN95 masks do not. KN95 masks will always have more of an air gap.

    But for the technical among you….

    But how are N95 masks different from KN95 masks? The main difference lies in how the masks are certified. “In general,” says Sean Kelly, founder of New Jersey-based PPE of America, “N95 is the U.S. standard, and the KN95 is the China standard.” Because of this, only N95 masks are approved for health-care use in the United States, even though KN95 masks have many of the same protective properties.

    N95 masks must pass a rigorous inspection and certification process from the National Institute for Occupational Safety and Health (NIOSH), which is part of the CDC. Companies making KN95 masks, meanwhile, can seek approval from the FDA, through an emergency authorization for a foreign certification which meets the 95 percent filtration requirement. The FDA says the manufacturer of KN95 masks must also provide documentation that the masks and materials used are authentic.

    According to Kelly, whose company was among those tapped by Connecticut lawmakers to provide personal protective equipment to frontline workers in the state, certification of KN95 masks include a requirement on “fit testing,” which tests the air inside and outside of the mask, as well as how the mask fits around your face. The N95 masks do not have these requirements to meet their standard. Still, he says, “N95 mask requirements are a bit more stringent regarding the pressure drop in the mask during breathing in, which makes the N95 more breathable than most KN95 masks. The N95 masks have similar requirements for exhaling. These requirements,” Kelly says, “make the N95 mask a bit more advanced with the overall breathability for users.”

    Keep in mind, the certifications mentioned above only refer to the country in which the standards and regulations were created, not where the masks are made. Most N95 masks are still made in China. Similarly, the CDC has authorized the use of KN95 masks as a suitable alternative to N95 masks for its response to Covid-19.

    2
  30. Teve says:

    @Just nutha ignint cracker: Jesus Christ. I wonder if your system has trouble absorbing it.

    1
  31. DrDaveT says:

    @Kathy:

    No matter how I adjust the clip and straps, I clearly feel air coming in from where the clip is on the bridge of my nose. It feels like more air that comes in the sides of the regular, disposable, triple-layer masks I get from work daily.

    Now, it works rather well if I press down on the clip while wearing it, but that’s no solution. Maybe, though, I could add something under the clip or on top of it. We’ll see.

    For $10 I purchased a 4-pack of hollow rubber nosepieces that fit inside the top of the mask and form a seal between my face and the mask. The insert is hollow, vented to the sides, so that when I exhale the air that used to leak around the top of the mask and fog my glasses now vents to the sides, inside the mask.

    2
  32. DrDaveT says:

    One treatment improvement that wasn’t mentioned in the article (or the comments above) but that I heard about months ago from a NY physician on the news, is pronation — getting patients with significant fluid buildup off their backs (where they drown in their own fluids) and onto their stomachs, head slightly down, so that the fluid drains out by gravity. It makes many other routine parts of care more awkward, which is why nobody does it automatically, but apparently it makes a big difference for the worst cases.

    3
  33. Grewgills says:

    @JKB:

    and not the Great Pandemic of 1917

    Really? Are you so in love with your orange overlord that you have to parrot his every error?
    I did read beyond this, but shouldn’t have. The rest was just as accurate. Honestly, once I saw JKB at the top I should have stopped, realizing it would be either dishonest or just plain wrong.

    7
  34. Kathy says:

    @Just nutha ignint cracker:

    Nope. it’s got plain elastic straps, very fixed.

    @EddieInCA:

    I’m learning about fit. Some months back a coworker gave me a KN95 that fit rather well. But he got it from someone else, and few come with any identifiable branding (odd). So I’m stuck trying different ones or looking for a fix.

    @DrDaveT:

    I’ve some ideas on what to try. I’m thinking gluing a thin piece of sponge. We’ll see.

  35. Kathy says:

    Ok, I said first I adjust the straps, then that they can’t be adjusted. Sorry for the confusion.

    I can tug on the straps and rearrange them over the ears, and it kind of sticks for a bit, but it doesn’t fix the leak.

  36. JohnMcC says:

    @sam: OMG! Guillain Barre was the side-effect of the ‘swine flu’ vaccine back in the President Ford days which led to that hurry-up vaccine becoming a disaster. (At the very least, a PR disaster.)

  37. Just nutha ignint cracker says:

    @Teve: That’s been the conclusion. We don’t know why though.

    1
  38. dazedandconfused says:

    My advice, FWIW (nothing IANAD) is take your D and wear your masks but more important GET YOUR CARDIO UP. Seems to me you get this stuff, you will need as much wind and you can get. Stationary bike, run, put on a weighted back pack and walk up some hills. 1/2 hour every day will do it (for most).

    I think it likely that we are all going to get it, just a matter of time.

    2
  39. JohnMcC says:

    @DrDaveT: Back when dinosaurs roamed and long-term survival on vents was becoming a ‘thing’ in trauma care, we used to routinely put the head of bed towards the floor (Trendelenberg) and roll the pt waaaaaay over and do percussion and suction. Then shift to the other side. Very high-personnel activity. Took 3 or 4 nurses and RTs at times when there were Swan-Ganz and Craniotomy lines involved. Good times.

    Two nieces are anesthesiologists, they were explaining the virtues of ‘proning’. Yep, I said. I’m hip.

    2
  40. Teve says:

    @Grewgills: deliberately copying The Leader’s error to prove fealty…what a psycho idiot.

  41. MarkedMan says:

    @Gustopher: I’ve been dealing with dozens of different N95 masks and KN95 masks over the past half year. I’m 6’1”, 210 pounds and have a longish face. There are masks that fit tightly and masks that don’t. But I suspect it has less to do with physique and more to do with design and manufacturers giving an eff.

  42. MarkedMan says:

    @EddieInCA: I believe you have that exactly backwards. N95 masks are certified to the US NIOSH standard. KN95 masks are certified to the Chinese equivalent. Although they are roughly equivalent in theory, in practice real-for-real N95 masks made by an American company or a few others are the way I would go for penetration, fit and seal. (If I could get them.) The testing I do confirms this. We make equipment that tests penetration and the KN95 masks typically test out as 96 or 97% efficiency, whereas a particular US manufacturer tests at 99.5%. And, per my trials, the band that holds it in place around the nose is more pliable and retains its shape better. If it conforms, then lifts off, it downgrades to a 10 cents surgeons mask.

    As for valve masks, they theoretically protect you from others but do nothing to protect them from you, so kind of an eff U in a communal environment. Add to that what my salesmen hear: most of the valve masks are fakes and the “valves” is just a hole with plastic over it.

  43. Jen says:

    Please, all, be very careful with taking excessive levels of Vitamin D supplementation. Vitamin D is fat-soluble, so it can build up. It’s not like Vitamin C that is water-soluble and you just pee out excess.

    As noted above, it’s a hormone. It’s one of the very few vitamin supplements that has a significant amount of science behind it. Low levels of Vit. D have been detected in people with autoimmune diseases (including Type 1 diabetes), but it hasn’t been established yet if people with low levels are more prone to develop autoimmune disorders or if it’s the reverse–people with autoimmune diseases can’t make enough Vit. D.

    Food sources, such as milk, are generally not enough to maintain adequate levels, but of course this can vary from one person to the next–especially in areas where there’s a lot of daily sunshine.

    Also, it should go without saying that the 1918 pandemic happened in 1918, not 1917, and that masks work.

    3
  44. Hal_10000 says:

    I wrote about this some time ago. Medicine is as much art as science — you need experience to have those instincts to know what do with a patient. I once spoke to a pediatrician who said she was terrified of a kid catching measles because she’d never seen it and didn’t have those instincts to know when to be worried. Doctors and nurses now have more experience and better instincts of what to do.

    Note: this also means that the lockdowns and restrictions, by delaying infections, saved lives. Imagine how many more will save if we can push the big wave past a vaccine.

    2
  45. Vanny says:

    @Kathy: For someone who had small face, it doesn’t fit very well. The KN95 that I bought fit very well on me. You may need to adjust the strings shorter,

    1