COVID-19 Mortality Dropped as Drug Therapies Emerged

New COVID-19 drug therapies along with better clinical management of patients with SARS-CoV-2 infection may have contributed to reductions in in-hospital COVID-19 mortality rates, according to a recent JAMA Network Open study.. 

At the beginning of the COVID-19 pandemic, in-hospital mortality among patients infected with SARS-CoV-2 was notably high, ranging from 12 percent to 28 percent in early cases. 

But in the JAMA Network Open study, researchers found that in-hospital mortality decreased in all age groups by at least 50 percent from the beginning of March to the end of November 2020.

Specifically, in-hospital mortality rates were 10.6 percent in March, then increased to 19.7 percent in April, and decreased to 9.3 percent in November.

The multicenter cohort analysis included 503,4009 patients from 209 acute care facilities in BD Insights Research Database. The facilities were located in urban and rural areas throughout the US. 

SARS-CoV-2 infection was defined as positive by PCR or antigen test within seven days before admission or during hospitalization.

Patients with SARS-CoV-2 positive tests were more likely to experience in-hospital mortality compared to those with SARS-CoV-2 negative tests, at 11 percent and 2.5 percent, respectively. 

And in-hospital mortality rates increased in older adults for patients with both SARS-CoV-2–negative tests and SARS-CoV-2–positive tests. In patients 18 years of age and younger with a negative SARS-CoV-2 test, mortality was just 0.4 percent. 

But for patients who were 75 years of age or older, mortality increased to 4.5 percent. 

And in patients 18 years of age and younger with a positive test, mortality was 0.2 percent, while in patients older than 75 years of age with a positive test, mortality reached 20.9 percent. 

Reductions in mortality rates can not be attributed to age distribution of hospitalized patients with SARS-CoV-2–positive tests, researchers stated. Rather, new COVID-19 therapies and improvements in the clinical management of patients with SARS-CoV-2 infection could have contributed. 

“The decreases in mortality rates can be linked to increased clinical experience in caring for and ventilating patients and use of prone positioning, systemic corticosteroids, and COVID-19 treatment, remdesivir,” researchers said in the study. 

In September, a JAMA Network Open study found that in critically ill patients with COVID-19, administration of systemic corticosteroids compared with standard care was associated with lower 28-day all-cause mortality. 

The study gathered data from seven randomized clinical trials that evaluated the efficacy of corticosteroids in 1,703 COVID-19 patients from February 26, 2020, to June 9, 2020. 

A total of 678 patients were randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone, while 1,025 patients received standard care. 

The association with mortality was 0.64 for dexamethasone compared with standard care, 0.69 for hydrocortisone compared with standard care, and 0.91 for methylprednisolone compared with standard care.

This corresponds to an absolute mortality risk of 32 percent with corticosteroids compared with mortality risk of 40 percent with standard care.

At the start of the pandemic, data on the efficacy of corticosteroids was limited. But as of July 2020, 55 studies of corticosteroids had been registered on ClinicalTrials.gov.

At the beginning of June 2020, Gilead announced positive Phase 3 trial results for remdesivir. In the trial, researchers found that patients in the five-day remdesivir treatment group were 65 percent more likely to see clinical improvement at Day 11, versus individuals receiving standard of care.

There was also a 62 percent reduction in the risk of mortality compared with standard care.
FDA approved remdesivir as the first COVID-19 treatment in October. The drug is currently available in hospitals and other healthcare settings across the US. It elicits the best results in acute care and inpatient hospital care, Gilead stated.