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Death rates among severe COVID-19 patients drop by a half — Public Health England data

Death rates from people with severe COVID-19 in hospital have dropped to around a half of the rate at the peak of the pandemic, new research has revealed. An analysis of over 21,000 hospital admissions found a significant drop in death rates for both high dependency unit admissions and intensive care admissions between March and the end of June.

The team was led by the University of Exeter and involved the University of Warwick, and was supported by The Alan Turing Institute. They found death rates were highest in late March, at 26% among people admitted to high dependency units, and 41% among people admitted to intensive care. For June admissions, death rates had dropped to 7% among high dependency unit admissions, and to 21% among intensive care admissions.

Dr John Dennis, of the University of Exeter Medical School, who led the research, said: "Importantly, we controlled for factors including age, sex, ethnicity and other health conditions such as diabetes. This suggests the improvement in death rates in more recent months is not simply due to younger, or previously healthier, people being admitted to critical care. A number of factors are likely to be at play here, including improved understanding of how to manage COVID-19 amongst doctors, and the introduction of effective treatments."

The team accessed national data from adults admitted to critical care via the COVID-19 Hospitalisation in England Surveillance System (CHESS), collected by Public Health England. They look at how the proportion of people with COVID-19 dying within 30 days of admission changed over March until the end of June.

Dr Bilal Mateen, of the University of Warwick, said: "The reduction in the number of people dying from COVID-19 in hospitals is clearly a step in the right direction, but it's important that we do not become complacent as a result. It's possible that the higher death rates at the peak of the pandemic are in part because hospitals were so overcrowded at that point. Even at the lowest point, nearly a quarter of admissions to intensive care were still dying- that's a huge number of people, and we have to do all we can to control the spread of the virus and keep hospital admissions as low as possible."

Abstract
Objectives: To measure temporal trends in survival over time in people with severe coronavirus disease 2019 requiring critical care (high dependency unit or ICU) management, and to assess whether temporal variation in mortality was explained by changes in patient demographics and comorbidity burden over time.
Design: Retrospective observational cohort; based on data reported to the COVID-19 Hospitalisation in England Surveillance System. The primary outcome was in-hospital 30-day all-cause mortality. Unadjusted survival was estimated by calendar week of admission, and Cox proportional hazards models were used to estimate adjusted survival, controlling for age, sex, ethnicity, major comorbidities, and geographical region.
Setting: One hundred eight English critical care units.
Patients: All adult (18 yr +) coronavirus disease 2019 specific critical care admissions between March 1, 2020, and June 27, 2020.
Interventions: Not applicable.
Measurements and Main Results: Twenty-one thousand eighty-two critical care patients (high dependency unit n = 15,367; ICU n = 5,715) were included. Unadjusted survival at 30 days was lowest for people admitted in late March in both high dependency unit (71.6% survival) and ICU (58.0% survival). By the end of June, survival had improved to 92.7% in high dependency unit and 80.4% in ICU. Improvements in survival remained after adjustment for patient characteristics (age, sex, ethnicity, and major comorbidities) and geographical region.
Conclusions: There has been a substantial improvement in survival amongst people admitted to critical care with coronavirus disease 2019 in England, with markedly higher survival rates in people admitted in May and June compared with those admitted in March and April. Our analysis suggests this improvement is not due to temporal changes in the age, sex, ethnicity, or major comorbidity burden of admitted patients.

Authors
John M Dennis, Andrew P McGovern, Sebastian J Vollmer, Bilal A Mateen

 

[link url="https://www.exeter.ac.uk/news/research/title_823411_en.html"]University of Exeter material[/link]

 

[link url="https://journals.lww.com/ccmjournal/Abstract/9000/Improving_Survival_of_Critical_Care_Patients_With.95449.aspx"]Critical Care Medicine abstract[/link]

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