Covid-19: How survival rates have improved

People admitted to intensive care are less likely to die now than they were at the start of the pandemic.

The entrance to one of five Covid-19 wards at Whiston Hospital
The entrance to one of five Covid-19 wards at Whiston Hospital

Dexamethasone has become the “backbone” of the hospital treatment of patients with Covid-19, a senior medic said.

The cheap steroid was found to reduce death rates by up to a third among some hospital patients.

The University of Oxford-led clinical trial was hailed as “the world’s first coronavirus treatment proven to reduce the risk of death”, after the team reported its trial results in June last year.

The treatment was immediately rolled out across NHS hospitals.

And this treatment, along with others, could be behind the significant reduction in death rates among those admitted to intensive care units since the start of the pandemic.

The Intensive Care National Audit and Research Centre examined information on Covid-19 patients from England, Wales and Northern Ireland admitted to intensive care up to August 31 and those admitted from September 1.

The data released in October shows that on average, 39% of critical care coronavirus patients died up until the end of August, with just less than 12% dying since.

Research continues and breakthroughs are still occurring which could change the way patients are treated, and improve survival rates further still.

Earlier this month, data from the REMAP-CAP clinical trial showed tocilizumab and sarilumab reduced the risk of death by 24% when administered to patients within 24 hours of entering intensive care.

Dr Indeewar Kapila, a critical care consultant in Manchester and chair of the British Medical Association’s North-West Consultants Committee, said that when the pandemic hit the UK in spring 2020, knowledge of the disease was “limited”.

But clinical trials began to show which treatments worked among hospital patients, such as dexamethasone, and those that did not.

Dr Kapila told the PA news agency: “I think the very start of the pandemic last year – towards the end of February/March when we started getting more and more cases – our knowledge of that disease was extremely limited at that time.

“Really we were dealing with an unknown disease, a virus, that was pretty much unknown to most people in the UK.

“From that perspective, not knowing what we were dealing with, and not knowing the consequences of the infection in the early stages, meant that we were sort of in the dark a bit.”

He said much care provided is “supportive” – which means medics support people as their body’s immune system battles the virus.

This could be done by supporting breathing through supplying oxygen or ventilation, or by supporting patients if the disease progressed and led to other organs failing such as the heart or kidneys.

“Our initial way of dealing with this was essentially very supportive,” he said.

“Supporting the patients during their time when the organs were not working properly or failing.”

Dr Kapila continued: “And then as the trials that were being conducted started producing some data, and some information about some of the treatments that we’re using today, such as the use of steroids – dexamethasone in particular, which essentially forms the backbone of our treatment of the condition – in addition to all the supportive measures that we provide: the ventilatory support; the circulatory support; the renal support etc.”

Medics are awaiting the news on trials for other immunomodulator drugs which are expected to show promising results.

“In terms of medical treatments or drug treatments, I’m afraid there isn’t much out there at the moment that can provide significant benefit apart from the dexamethasone,” he said.

“These two immunomodulator drugs have some promising qualities, but we’re still awaiting further data on them.

“The essence of our care remains supportive and we try to support the patient until their own immune system starts showing some response to the infection.”

He added: “As our knowledge has improved, it has allowed us to optimise the condition of patients.

“I think a number of patients do avoid coming down to intensive care because the treatments are now being started as soon as they come into hospital.”

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