Britain now has more intensive care beds, so why are more people dying?


Coronavirus deaths in Britain continue to increase. The sun is shining, the NHS has dramatically increased its capacity for intensive care – but hundreds of deaths are still reported every day.

The latest official figures show 4,934 deaths from Covid-19 in Britain at 5 p.m. Saturday, 621 more than Friday. The total number of deaths reported in the past week has increased sharply, reflecting the early exponential spread of the virus across the country.

It is a reminder that the terrible toll of the disease – although it is not as visible on our television screens as in Italy, Spain and now in America – is still very present among us and makes many victims , young and old.

Warnings that we would follow the same path as Italy unfortunately occurred, with reported deaths in the UK tracking Italy 14 to 15 days later. Fortunately, Italy is now reporting fewer deaths every day, suggesting that isolation has stifled the rate of new infections and, at least for the moment, has brought the epidemic under control.

The details on the reduction of social interactions after the lockout, provided last week by Google from anonymous mobile phone data, are broadly similar for the two countries. This suggests that the number of deaths should also start to slow in about a week to 10 days.

But why, given that we have expanded our intensive care capacity and our hospitals are not yet overwhelmed, are we seeing so many deaths in the UK? Surely, with all these new fans, we should be doing better.

Looking at crude death rates (confirmed deaths versus confirmed cases), the picture looks bleak. The gross case fatality rate in the UK is around 10%, compared to 12% in Italy and only 1.5% in Germany.

But these data are extremely misleading. Deaths are likely to be underestimated for each country because, although updated daily, the deaths themselves can be several days or even weeks old, which means that there is a significant delay in notification.

Confirmed cases are even less reliable and really only reflect a country’s testing capacity rather than the incidence of the virus. The reason why the death rate in Germany seems so much lower is probably explained by the fact that it performs many more tests – Germany has carried out more than 11,000 tests per million inhabitants against 2,580 in Great Britain. -Brittany.

Most experts, including the chief medical officer, Professor Chris Whitty, still expect the final death rate to be less than 1%. The Imperial College model used to predict the course of the epidemic in Britain assumes a mortality rate of 0.9%.

But for Britain’s intensive care physicians, this will be little comfort for the moment. Critical care services are already exceeding normal capacity and medical teams are working long hours 24 hours a day to save the lives of thousands of patients.

Professor Graham Cooke, a research professor at NIHR at Imperial College London, said it was wrong to think that ventilation alone could provide a “cure” for Covid-19. “Ventilation saves time, it is supportive care – it saves the body time to recover,” he said.

“For some of those who are very fragile and who will not survive despite intensive care, it may be considered better not to subject people to it. “

Even for those in good health, intensive care beds are not necessarily a lifeline. Professor Paul Hunter, professor of medicine at the University of East Anglia, highlighted early data from the Intensive Care National Audit & Research Center which suggests that intensive care for Covid-19 patients is less effective than for other types of viral pneumonia.

“Unfortunately, about half of the cases (50.1%) are under intensive care [with Covid-19] are still dying. This is much higher than for other viral pneumonias (22.4%). Why this is the case and how much higher this figure would be without intensive care beds is unclear. “

This is not to say that intensive care beds are unimportant – half can die, but half survives. Professor Keith Neal, emeritus professor of epidemiology of infectious diseases at the University of Nottingham, said: “Patients die because of the severity of their illness. The number of intensive care beds will only become large if there are no more if this situation is never reached. “

Dr. Tom Wingfield, clinical lecturer at the Liverpool School of Tropical Medicine, added: “It is possible that the reconfiguration of NHS services and the expansion [critical care] beds may have already resulted in fewer deaths … It is not yet possible to quantify this, but we should be able to understand it in more detail in the coming weeks. “

Over time, the outcome for critical Covid-19 patients is likely to improve. Covid-19 is a new disease and, although intensive care beds give people time to recover, they do not treat the virus or the dangerous immune response – inflammation of the lungs – that it causes.

Professor Cooke is one of many senior doctors to organize rapid clinical trials across the UK to test new therapies. “It is the immune response rather than the virus itself that is the problem in many cases. If we can figure out how to control this, we will see much better results. This work is under urgent investigation in Britain and around the world. “

Follow Paul Nuki on Twitter @paulnuki

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