The nearly 1 million people worldwide who have lost their lives to COVID-19 have left us a gift: Through desperate efforts to save their lives, scientists now better understand how to treat and prevent the disease and millions of others might survive.
Ming Wang, 71, and his wife were on a cruise from Australia, taking a break after decades of running the family’s Chinese restaurant in Papillion, Nebraska, when he was infected. In the 74 days he was hospitalized before his death in June, doctors frantically tried various experimental approaches, including enrolling in a study on an antiviral drug that eventually showed promise.
“It was just a touch and go. Everything they wanted to try we said yes, do it, “Wang̵
Patients are already benefiting from it. While more deaths are expected this fall due to the recent rise in coronavirus infections in the U.S. and elsewhere, there are also signs that death rates are decreasing and that people who contract the virus are now doing better than those in the first few months. of the pandemic.
“Some of the reasons we’re doing better is because of progress,” Dr. Francis Collins, director of the US National Institutes of Health, told The Associated Press. Several medications have proved useful, and doctors know more about how to care for the sickest patients in hospitals, he said.
We are in the “stormy adolescence” phase of learning which treatments work – beyond childhood but not “all grown up,” Collins said.
THE AWFUL TOLL
The nearly 1 million deaths attributed to coronavirus in nine months are far more than the 690,000 from AIDS or the 400,000 from malaria in all of 2019. They are just under 1.5 million from tuberculosis.
Wealth and power have not protected rich countries from the terrible power of the virus. The United States “was the most affected country in the world” with over 6 million coronavirus infections and more than 200,000 deaths, reflecting “the failure we have had in containing this outbreak”, Dr Anthony Fauci, the principal The nation’s infectious disease specialist told Harvard Medical School audience earlier this month.
More than 40% of US adults are at risk of serious illness due to hypertension and other conditions. It’s not just the elderly in nursing homes who are dying, Fauci pointed out.
Dr. Jesse Goodman, former chief scientist of the U.S. Food and Drug Administration now at Georgetown University, agrees.
“Nobody should make a mistake about this” and think they are not at risk just because they may not personally know someone who has died or has not witnessed firsthand what the virus can do, he said.
Although cases are increasing, death rates appear to be decreasing, said Dr. Cyrus Shahpar, a former scientist with the U.S. Centers for Disease Control and Prevention now at the nonprofit Resolve to Save Lives.
The true lethality of the virus – the death rate of the infection – is not yet known, because scientists don’t know how many people have had it without showing symptoms. What is often reported is case death rates – the portion of people who tested positive and then died. Comparing them from country to country is problematic due to differences in tests and vulnerable populations. Tracking these within a country over time also carries this risk, but can suggest some trends.
“The cumulative death rate of cases in the United States as of April was about 5%. We are now around 3%, “Shahpar said.
In England, researchers reported that case death rates have dropped significantly since the peak in April. The rate in August was around 1.5% versus more than 6% six weeks earlier.
One reason is changing demographics: More cases these days involve young people who are less likely to die from their infection than older people.
Increased testing is also playing a role: As more people with mild or no symptoms are detected, the number of known infections increases and reduces the proportion that prove fatal, Shahpar said.
It’s clear that treatments are also affecting survival, many doctors said. People who have died from COVID-19, particularly those who have taken part in studies, have helped reveal which drugs do or don’t help.
Dexamethasone and similar steroids are known to improve survival when used in hospitalized patients who need extra oxygen, but they could be harmful to less ill patients.
An antiviral drug, remdesivir, can speed recovery for critically ill patients by reducing the average hospital stay by four days. Two anti-inflammatory drugs, one used in combination with remdesivir – the drug Wang helped test – have also been reported to help although the results of those studies have not yet been published.
The jury is still out of the convalescent plasma, which involves using the survivors’ antibody-rich blood to heal others. No large, high-quality study has tested it well enough to know if it works.
The value of rigorous scientific studies to test treatments has become clear, Goodman said. “We certainly see what happens” when treatments are widely adopted without them like hydroxychloroquine was, he said. “This has exposed many people to a potentially toxic drug” and has delayed the search for effective drugs.
Aside from medications, “the death rate of cases is actually improving over time as doctors become more adept at caring for these very sick patients,” said Dr. Gary Gibbons, director of the National Heart, Lung and Blood Institute of the United States. United States.
In hospitals, doctors now know more about ways to avoid using breathing machines, such as holding patients on their stomachs.
“We learned how to position patients, how to use oxygen, how to manage fluids,” and hospitals have increased their carrying capacity and supplies, said Dr. Judith Currier, a physician at the University of California, in Los Angeles in a recent webinar organized by the American Public Health Association and the US National Academy of Medicine.
The best way to avoid dying from coronavirus remains to avoid getting it, and experience has shown that simple measures advocated by public health officials work.
“Prevention is the most important step right now because we are waiting for a vaccine and we are improving treatment,” Goodman said.
Wearing a face mask, washing your hands, keeping a distance of at least 6 feet, and disinfecting surfaces “are clearly having a positive effect” on reducing spread, Fauci said.
If more people stick to common sense measures like closing the bars, “we should improve our ability to handle it” and prevent more deaths, Shahpar said. “It should take longer to get to the next million if that ever happens.”
Marilynn Marchione can be followed on Twitter at http://twitter.com/MMarchioneAP
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.