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There is no more shocking news than the stat that most elderly COVID-19 patients on ventilators at New York hospitals don't survive. It's this type of stat that makes you want to protect the older people in your family and not allow them to leave.
A study that was published on Tuesday in the Lancet is consistent for the most part with Chinese and European findings. It confirmed that those with the greatest risk of a severe outcome from the novel coronavirus are the elderly population, especially if they also have chronic underlying diseases, such as hypertension, diabetes, heart disease, and obesity.
Max O'Donnell, the senior author of the study as well as a pulmonologist at Columbia University Irving Medical Center, reported he was stunned with the findings. "We had no idea how horrific this would be," he said. "Definitely not just the flu."
The study focused on 257 critically ill adults, slightly less than one-quarter of the coronavirus patients who were admitted to two hospitals in northern Manhattan between March 2 and April 1. The median age of those critically ill patients was 62. Two-thirds of the patients were male.
Of the critically ill who were studied, 39 percent died by April 28, and 37 percent were still hospitalized at Milstein and Allen hospitals. No critically ill patients under 30 years old died at either hospital, according to O'Donnell. Only a few of them had to be put on ventilators. However, more than 80 percent of people over 80 who had to be put on a ventilator didn't survive.
He believes this should be shared with elderly patients and their families when trying to decide whether to put them on the ventilators to treat severe illness associated with COVID-19. "It's a difficult conversation, obviously," O'Donnell noted.
The discharge and mortality rates of the most critically ill have varied amongst hospital systems. Mortality rates have been reported to be from 50 percent to 97 percent in studies. But this may have to do with regional demographics and different treatment protocols.
Early data from Northwell Health, the largest health system in New York state, shows that of 1,281 critically ill patients, only 3.3 percent of them were later discharged, with 24.5 percent of them dying. The rest remained hospitalized at the end of the study.
"The mortality rate [for patients on ventilators] creeps up to 70 percent when you're over the age of 70," said Thomas McGinn, deputy physician in chief at Northwell Health. He believes the study is consistent with what he saw at his organization. "If your mom's 85 and not well, they should know what the potential is for surviving before they have a ventilator placed."
However, down at Emory Healthcare in Atlanta, 40 percent of the 217 critically ill patients were discharged, while 29.7 percent died, according to unreleased data. A critical care doctor at Emory, Craig M. Coopersmith, believes the numbers show that "unequivocally, being on the ventilator is not a death sentence."
The study seemed to also confirm the associations between risk of death and inflammation and coagulation. Doctors have been reporting that some COVID-19 patients are suffering from blood clots that can lead to strokes or respiratory arrest.
The obesity factor is seen as well. Among critically ill patients under 50 who were admitted to the hospitals, 71 percent were obese.
It's unclear if the level of obesity makes a difference. Those with severe obesity, meaning with a BMI over 40, did not appear to have an increased risk of death compared to other critically ill patients. But the authors of the report feel more investigations are needed to understand the possible correlation.
Other studies have shown obesity to be a risk factor for having severe COVID-19, especially among patients younger than 60. One student in the Clinical Infectious Diseases journal said patients with a BMI over 30 were almost twice as likely to be admitted with COVID-19. If their BMI was higher than 35, they were three times as likely to die as someone with a healthy BMI.
NYU Langone epidemiologist Jennifer L. Lighter, the lead author on the study, believes there are difficult vulnerabilities with the virus in different parts of the world. Risk factors in China were pollution and smoking, and in Italy, it was the elderly and that many live in multi-generational households.
"In the United States, it's obesity. That's our Achilles' heel when it comes to this virus," she said.
She points to a number of theories as to why obesity may play a part on the effects of COVID-19, such as obese people being more likely to have compromised lung function entering into it and also being more vulnerable to inflammation. The virus attaches to ACE receptors, and those are highly expressed in fat cells.
"So maybe the virus has more opportunities to attack," she ascertained.
There were also problems that were not related to the respiratory system, such as kidney injury. That was seen in nearly a third of patients and shows how different it is from the flu.
Race played a part too, as the hospitals in the study were often from Hispanic and African-American neighborhoods. 62 percent were Hispanic. That played a part with timing as well. White non-Hispanic people came to the hospital thee days after symptoms began on average, Hispanics after five days, and African-Americans after seven days.
"Part of this may speak to access to care," said O'Donnell. When someone delays going to the hospital, "you're more likely to come in critically ill."
Harlan Krumholz, a professor of medicine at Yale School of Medicine, wrapped it up and noted that the Lancet study "gives a perspective on the devastating nature of COVID-19 and "should give pause to anyone who wants to dismiss SARS-CoV-2 as less than a major threat to health."
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