The question of the chances of survival of patients covid-19 in respiratory distress is critical
Indeed, the confinement of 51 million to French and French to good health has been decided to allow réanimations to take care of all of the patients who were going to develop a severe form of the disease
If it turns out that the mortality of patients covid-19 in acute respiratory distress, elderly or with comorbidity, was close to 100%, then the decision to confine more than half of the world’s population to save the patients in the icu has been the biggest “blunder” of all time
The mortality rate of patients with severe respiratory distress under assisted ventilation hospitalized in intensive care, their survival curves, Kaplan-Meier, data for the calculated, could not be found (Google, points weekly epidemiological of Public Health, France) and remain unknown to this day, at least to the general public.
For example, below the curve of survival of 55 patients in acute respiratory distress at the outbreak of MERS (coronavirus), which has affected the middle east. The median survival time was 15 days.
Only the advice of the scientific council dated 12 march 2020, refers to an estimated mortality rate of 61%. In spite of a bibliographic reference (Yang et al, 2020 “) – is very incomplete, we have been able to find the publication of the Lancet. This is an observational cohort study retrospective (basically, we take the patients ‘ medical records). It concerns only 52 patients hospitalized in a critical condition in the intensive care unit in Wuhan, China, where has emerged the virus. In the publication, mortality at 28 days is 61.5%.
The patients in this series were not very old since the average age of non-survivors was 64.5 years, and the survivors of 51.9 years. Only 19% of the patients were over 70 years of age and 4% over 80 years… 94% of deceased patients were on life support (assisted ventilation).
By making the “critical reading” of this publication, which is highly recommended in medicine, patients are young, we may even wonder if they have not been the subject of a ” Cherry picking “, literally ” Harvest of cherries “, a “selection bias” by which the inclusion of more young people would be preferred. The publication does not mention any criteria for non-inclusion in the study and the conditions common to icu admission are not specified.
Curiously, the scientific council makes no comment to this study in its opinion. The intensivists chinese, those from other countries who have not published their results, the scientific council, they wanted to hide the despair of the réanimations everywhere in the world, helpless to save these severely ill patients by the novel coronavirus ?
In medicine, we don’t publish always the negative studies
The survival rate (38.5 per cent, the inverse of mortality rate) relatively high reported by the chinese, was to be contrasted in a manner very surprising with the information received from Italy, where we learnt of a report broadcasted on the 28th of march to Cremona, located 80 km South of Milan, the staff of reanimation, was on the verge of exhaustion.
More than a month after welcoming its first patient, in spite of all its efforts, the service has not been able to save any patient. On 19 march, having doubled its number of beds, the hospital was completely saturated, and 59 people were waiting in the emergency department to be hospitalized…
From the mouth of professor Karine LACOMBE, head of the department of infectious and tropical diseases hôpital saint-Antoine, AP-HP, Paris, questioned by the mission of inquiry of the national assembly on 25 June : “We have seen people arrive at the hospital on their own two legs, without oxygen, having the oxygen to 4 liters at noon, to be intubated in the evening, and for some, dying the next day “
Another figure that we will have a lot of trouble to obtain : Among in-hospital deaths, how many have been caused by complications nosocomial sedation, intubation, and mechanical ventilation of patients in respiratory distress ?
Finally, it would also be very useful to know what has been the rate of survivors among the patients who were the subject of transfers “heroic” helicopter, military plane and by train ” sanitary “
On April 19, Edouard Philippe stated, ” They have helped save lives.”
We would like to know precisely how many ?
Beyond the survival of patients covid-19 in respiratory distress, what is their life expectancy in the output of resuscitation, how many are rehospitalized within 30 days, what are their consequences ?
Here’s an idea for a future column Covid…
Author(s): François Pesty for FranceSoir