At 18:47 29/03/2020, Kevin.Mcconway wrote:
>I don't have the relevant experience. But perhaps it's interesting
>to note that the report gives, as comparison, data from 2017-19 on
>patients with non-COVID-19 viral pneumonia, and there were lots of
>such patients (5,338) and they wouldn't have been subject to the
>sort of biases that I described for the COVID-19 patients. Of those
>patients, the morality rates were 9.9% for age 16-49, 23.4% for age
>50-69, and 31.6% for age 70+. OK, nothing specific on those aged
>80+, but you can tell from the IQR given in the report that quarter
>of all those non-COVID viral pneumonia patients were over 70. That
>sounds to me like quite a lot of patients over 70 in ICUs with viral
>pneumonia. A 31.6% mortality rate isn't wonderful, but it's a lot
>better than 70-80%.
Yes, when I read the report properly, I noticed that, and found it
very surprising, and certainly not in keeping with my personal
experience - not only the fact that 25% were over 71, but also the
(which I would call 'surprisingly low') mortality of 'only' 31.6% in
that group. The mortality figures are, of course, crucial dependent
upon the criteria used for deciding who to admit (and not admit) to
an ICU. For example ....
... one possible factor in relation to the comparison with the
Covid-19 data and the 2017-19 viral pneumonia data, which you have
already mentioned, that the ICU stays (for both survivors and
non-survivors) were considerable shorter for the Covid-19 patients -
which might suggest that (probably not unreasonably), they were (at
least in the case of the non-survivors) waiting until there was a
relative 'desparate' need for ventilation before instituting it than
would be the case in non-Covid times.
Of course, it's one of those situations in which (at least in
'normal' times) once actually 'wants' to see an appreciable number of
non-survivors amongst ICU admissions - since, if most people admitted
to ICU survive, it begs the questions as to (a) whether there were
some others who should have been admitted to ICU who weren't and (b)
whether all those admitted to ICU really needed to be.
Kind Regards,
.
John
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