What are the reasons for the decline of global new crown mortality? From Nature

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The following is the What are the reasons for the decline of global new crown mortality? From Nature recommended by recordtrend.com. And this article belongs to the classification: novel coronavirus.

Worldwide, covid-19 has infected more than 50 million people and caused 1.2 million deaths. One of the bad news is that the new coronavirus strains sweeping the world have shown in many ways that they are more transmissible than when they first appeared. The good news is that many medical institutions around the world have observed that the mortality of covid-19 is declining, and patients with new coronavirus entering intensive care unit (ICU) now have a higher chance of survival.

Intensive care specialist Bharath Kumar tirupakuzhi vijayaraghavan works at Apollo main hospital in India. In April, up to 35% of the patients in their new crown ward died, and about 70% of the cases on ventilator died. Now, the mortality rate of patients using ventilator has been reduced to 45% ~ 50%.

Derek Angus, an intensive care physician at the University of Pittsburgh, sees the same trend in his hospital. Data from more than 20000 cases collected by the National Health Service (NHS) between March and June also show an increased chance of survival for critically ill patients.

However, at the same time, these experts pointed out that the “magic drug” did not appear, and there was no significant breakthrough in the medical program. What makes covid-19 seem to be less lethal? Recently, “nature” magazine published a long report on this in detail.

Hard won treatment experience

Experts point out that people’s understanding of covid-19 is changing, which is very important for improving treatment. At the beginning of the outbreak, new coronavirus was regarded as a terrible new thing. In order to save patients, some unproven intervention measures were taken. “When it comes to whether covid-19 is a completely different and completely new disease, the initial discussion was very messy, which made things extremely complicated, causing distraction, and anyone could be off track.” According to Dr. vijayaraghavan.

One example of this detour is Dr. Charlotte summers, an intensive care specialist at Cambridge University. She used “furore” to describe the previous use of hydroxychloroquine in the treatment of new crowns. When some preliminary studies suggested that the drug for malaria seemed to help treat the new crown, despite the lack of strong evidence, it was strongly advocated by some people.

However, hydroxychloroquine did not improve the mortality of covid-19 inpatients, according to the results of a large-scale study exploring various new crown therapies and the British recovery clinical trial published in June.

After a mid-term analysis confirmed the lack of efficacy of hydroxychloroquine, the trial stopped patients in the hydroxychloroquine group on June 5. At the same time, this and other studies have also found that hydroxychloroquine may cause heart damage in some patients with new crowns, especially when used in combination with the antibiotic azithromycin.

According to Dr. summers, hundreds of clinical trials of hydroxychloroquine that have been launched have wasted resources and energy that could have been spent elsewhere. “For hospitalized patients, hydroxychloroquine has been abandoned, so we have one less thing to worry about.” She said.

Time proven drugs and protocols

In the early stage of the epidemic, “cytokine storm” was also a problem that deepened people’s concern. This phenomenon refers to that some patients will produce a large number of cytokines, causing excessive inflammatory reaction. Therefore, some doctors try to use targeted therapy to suppress the immune response, such as inhibiting the activity of cytokine IL-6.

However, some subsequent studies have shown that IL-6 levels in some severe covid-19 patients do increase, but not higher than those in other acute respiratory distress syndrome. Therefore, Dr. Angus is not optimistic about the role of cytokine inhibitors: “for decades, researchers have been looking for targeted methods to suppress the immune response of critically ill patients, but we have been failing for 20 or 30 years by blocking the cytokine cascade to improve outcomes.”

The results of clinical trials seem to confirm his claim. In a phase 2 / 3 clinical trial conducted in hospitalized patients in the United States, the IL-6 blocking antibody sarilumab failed to bring significant improvement in critically ill patients.

“In just half a year, I think we’ve replicated the results of the past 20 years in acute respiratory distress syndrome.” Dr. Marcus Schultz, an intensive care specialist at the University of Amsterdam medical center in the Netherlands, concluded.

Steroids that completely inhibit the immune system have shown benefits in reducing mortality in large trials compared to more targeted drugs. Dexamethasone is a commonly used corticosteroid, which has been used to improve acute respiratory distress syndrome for decades. However, at the beginning of the outbreak, there was no conclusion on whether to use corticosteroids in critically ill patients with covid-19.

Now, there is a better understanding of how to use dexamethasone clinically. The results of the recovery clinical trial were published in the New England Journal of Medicine (NEJM) in July. Dexamethasone can reduce the mortality rate within 28 days after treatment in covid-19 patients receiving mechanical ventilation or oxygen inhalation.

Subsequently, the World Health Organization (who) rapid evidence assessment team for covid-19 therapy further supported this result. A large meta-analysis showed that the risk of all-cause death in patients with severe covid-19 receiving corticosteroid treatment decreased by 34% compared with the control group after 28 days of randomization.

Based on this evidence, the WHO Expert Group recommends systemic (oral or intravenous) corticosteroid therapy in severe and critically ill patients with covid-19. In addition, there are no other drugs that have been shown to have a significant effect on improving the mortality rate of covid-19, including the first covid-19 treatment approved by FDA.

The best solution is still unknown

There are still hundreds of therapies being tested, but due to the scale of the trials, it is not possible to produce sufficiently reliable results soon. Among them, the most in-depth studies have been carried out on neutralizing antibodies against new crowns, including purified antibodies and plasma therapy (using antibody rich plasma obtained from patients who have recovered from the disease).

However, a randomized controlled trial of more than 450 moderate covid-19 patients in 39 hospitals across India showed that the use of convalescent plasma did not affect the risk of progression to severe illness or death. The UK recovery trial is collecting the convalescent plasma with the highest antibody level for testing. It is expected that a larger scale and more strict selection of convalescent plasma will bring further answers.

Tests to purify the antibodies are also in progress. For example, Regent’s cocktail therapy, regn-cov2, has shown in the preliminary clinical trial results that it can help mild covid-19 patients relieve symptoms faster, but whether it will reduce the mortality of severe patients, there is no evidence yet.

For different treatment options, some multicenter clinical trials are testing different combinations of therapies to increase or decrease certain therapies. For example, Dr. Angus said: “perhaps, in the case of steroids, the addition of radcivir would have a better effect.”

Reducing medical pressure is essential

Many experts believe that compared with medical progress, the support of standard medical measures is a more important factor to reduce the mortality rate of new crown. As a result of the new outbreak, many hospitals have rapidly increased the number of intensive care beds and transferred staff from other departments. Over time, these staff are more experienced in intensive care, and hospitals are more experienced in patients with higher risk factors for shunting diseases.

Singapore has one of the lowest covid-19 mortality rates, with an ICU mortality rate of less than 15%. Jason Phua, an intensive care physician at the country’s Alexandra Hospital, believes that the key to success is to reduce the spread of the virus and keep the medical institutions from being overwhelmed. “I don’t think it’s because we’re using the right drugs, and the reality is that other places are overburdened.” He said.

Back to the root, reducing transmission is the best way to reduce the mortality rate of new crown, which has become the consensus of many experts. An expert pointed out that reducing the mortality rate by 10% – 20% is a great victory for the intensive care unit, but the number of deaths is still large, especially among the elderly – for those over 80 years old, the mortality rate is close to 30%. “From a macro point of view, we have to say that it is best to ensure that people in their 70s and 80s are not infected.”

No one knows how long the downward trend in mortality will last. After nearly a year, people in many places have been tired of complying with the epidemic prevention measures. However, with the arrival of a new wave of epidemic in many countries in the northern hemisphere after autumn and winter, strengthening protection is particularly critical at this moment.

Since Yao mingkant read more: “nature”: research shows that children aged 5-9 years have the lowest risk of death from infection with the new crown. “Nature”: scientific progress worthy of expectation in 2020 Biomedicine accounts for half of the seats nature: the survey shows that 36% of the respondents have been anxious and depressed because of their doctoral degree. Nature: the world’s top five “scientific keywords” in the first decade of the 21st century West China hospital ranks No.1 in China Nature: research shows poor mental health of young researchers nature: study found that excessive drinking is more likely to lead to cancer 10 nature: less and less cited papers by female scientists YouGov: surveys show that fewer and fewer Americans say they are willing to be vaccinated with new crowns. Who: the number of confirmed cases of new crowns in the world has reached a record high. In 2020, American universities will lose hundreds of millions of dollars due to the epidemic

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