Practice Makes Perfect

The editors of the Wall Street Journal remark on the reduction in mortality rate due to COVID-19:

Doctors have observed that the coronavirus case-fatality rate seems to have decreased considerably since the early days of the pandemic. But a pre-publication study from Italian universities and local public-health authorities comparing the case-fatality rates in two provinces (Ferrara and Pescara) during March and April is the first to show this might be true.

After adjusting for age and comorbidities, the study found the overall death rate declined by some 40% from March to April with huge reductions in those over age 80 (from 36.3% to 16.1%), and subjects with hypertension (23% to 12.1%), diabetes (30.3% to 8.4%), cardiovascular disease (31.5% to 12.1%), COPD (29.7% to 11.4%) and renal disease (32.3% to 11.5%).

The study’s findings need to be confirmed by more studies of fatality rates over time in other places. But the researchers note that the decline in death rates is unlikely to be due to less crowded hospitals since infection rates were low in the two provinces and never exceeded the intensive care unit capacity. Hospital utilization could confound results in other hot spots.


We now know, for instance, that deaths among severely ill patients often result from an overreactive immune response known as “cytokine storms” as well as systemic blood clots. The Food and Drug Administration this week approved a new blood test by Roche that measures levels of the inflammatory-causing protein interleukin-6 and can help predict patients at risk for cytokine storms. Using drugs to break up blood clots and calm down the immune system earlier can prevent severe cases from turning deadly.

Doctors have also observed that some patients with fatally low oxygen levels aren’t gasping for air or losing consciousness and their symptoms resemble altitude sickness—dizziness, nausea and headaches—more than pneumonia or acute respiratory distress. As a result they are using less intensive ventilation such as nasal cannulas and sleep-apnea machines.

Mechanical ventilators can cause long-term brain and respiratory damage as well as secondary infections. A study in the Journal of the American Medical Association has found that a shockingly high 80% of those between ages 18 and 65 who were placed on ventilators in New York City died while just 2.4% were discharged alive during the study period. More targeted therapeutics can reduce the need for ventilators.

As experience in dealing with COVID-19 is gained, facility in treating the disease is likely to improve. The implication of this is that sharing of information and better communication among physicians treating the disease may be as or more important than a scientific breakthrough in treatment or a vaccine in coping with COVID-19. Those are “Hail Marys”. Gradual improvement based on experience is the way the best medicine works.

3 comments… add one
  • steve Link

    I told you this weeks ago. Some guy from the WSJ reads something we in the medical profession published a while ago and now it is fact. Sigh. Again, as I told you, we started talking with the docs in Italy months ago. We** continued this with the NYC docs. We added steroids, anticoagulants and used proning plus a lot of Hi flo and BiPap. (When the say cannulas what they are really talking about is Hi Flo. We use better fitting cannulas than what we normally use where we run conventional flows of 1-6 liters per minute. With Hi Flo we run 40-60 liters. It is surprisingly well tolerated. Some people just wont wear the BiPap masks so it is a life saver.)

    The numbers for deaths of pts on ventilators is an outlier. Most studies are showing mortality rates of 60%-70%. Like everything the WSJ does, they are reporting a selective set of data. If you want the talk again about how people misunderstand ventilators glad to oblige.

    ** We, to be clear, doesnt mean just my institution. All of the other institutions we were communicating with were doing the same things.


  • Greyshambler Link

    I complained earlier we seem to have learned nothing in 100 years but on reflection it’s not a surprise that the strength of our age, rapid communication came to our aid. Medical advances should follow.

  • TarsTarkas Link

    ‘I told you this weeks ago. Some guy from the WSJ reads something we in the medical profession published a while ago and now it is fact.’

    No point in sneering at their reporting, their target is not you or I but the general populace, who for the most part remain unaware of these things until it’s on the tube or cable or in the paper. We knew it here as it was happening because of your daily on-the-ground reporting of the frantic struggle to save lives and adapting on the fly.

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