COVID-19 Scan for Nov 24, 2020

COVID-19 death in ventilated patients
COVID-19 stressors

Poor outcomes noted for mechanically ventilated COVID-19 patients

A PLOS One study yesterday showed a 43% overall mortality rate for mechanically ventilated COVID-19 patients, with an even higher risk of death for patients of advanced age.

This study included 164 US COVID-19 patients who required invasive mechanical ventilation (IMV) within the Inova Health System in Virginia—five hospitals and a large tertiary care center—from Mar 5 to Apr 26, and followed patient outcomes to reassessment on Aug 19.

Health system hospitals were experiencing a high volume of COVID-19 patients at that time, but not a surge that outstripped their ability to provide critical care. Patient data collected via electronic medical records included demographics, comorbidities, laboratory values, respiratory treatments, and outcomes.

Of a total 1,023 COVID-19–positive admitted patients, 164 required IMV (16.0%). Overall, 42.7% of IMV patients had died by the Aug 19 reassessment. The researchers observed an 84.3% in-hospital mortality rate for patients older than age 70, but 67.4% of patients below age 70 survived to hospital discharge.

Deceased patients were older (median age 66 years vs 55, P < 0.0001) and had significantly higher laboratory values for two common blood tests—initial D-dimer and peak ferritin levels—compared with survivors. Younger age, non-white race, and treatment at a tertiary care center were all associated with lower mortality.

"Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system," the authors wrote.
Nov 23 PLOS One study


Pandemic stress caused by longer-term concerns, survey finds

A survey of 1,337 adult Americans found that their level of serious psychological distress went down from 14.2% in April to 13.0% in July, with worry about COVID-19 infection and finances topping the list, according to a research letter published yesterday in JAMA. Comparatively, in 2018, only 3.9% of adults reported serious psychological distress.

Stress was measured by the 24-point Kessler 6 scale, and the results showed the highest prevalence among adults who were aged 18 to 29 years in April (25.4% in April, 26.5% in July), those who earned less than $35,000 per year (20.2%, 21.2%), and Hispanics (17.9%, 19.2%). Of those who were classified as seriously distressed in July, 72% were already feeling that way back in April.

The most common stressors were concerns about getting COVID-19 (65.9%) or having the pandemic affect employment (65.1%) or finances (60.6%). Notably, 35% cited healthcare access as a stressor. Of those who were attending school or who had school-aged children, 69% said they were concerned about education, as well.

The researchers conclude, "High prevalence at both time points suggests that the pandemic's longer-term disruptions are important drivers of distress."
Nov 23 JAMA research letter

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