Covid patients are more likely to survive intensive care because of recent medical advances, according to a London doctor who led international trials of a new treatment.
Professor Anthony Gordon, of Imperial College London, said a combination of “clinical evidence and experience” since the first wave appeared to be reducing the mortality rate of ICU patients.
“At the beginning of the year at times it felt almost hopeless, knowing that we had no specific treatments,” he said. “Yet less than six months later we have found clear, reliable evidence of how we can tackle this devastating disease.” But he said he remained “worried” that the NHS could still get over-run this winter and urged the public to maintain social distancing to prevent hospitals from having to suspend non-Covid surgery again.
Professor Gordon led the UK arm of the REMAP-CAP trial that last month established that the steroid hydrocortisone improved the survival of the sickest Covid patients.
The findings echoed those of the Oxford University-led Recovery trial, which found that another steroid, dexamethasone, was similarly effective in patients receiving oxygen or requiring ventilation.
Professor Gordon, who works at St Mary’s hospital in Paddington, said it meant that two “cheap, commonly available drugs” could be used interchangeably in the event of shortages — and that future research could investigate the benefits of other anti-inflammatory drugs.
Latest data from the Intensive Care National Audit and Research Centre shows that mortality rates in patients admitted to ICU have fallen from 40 per cent between March and August to 15 per cent since the start of September.
Professor Gordon said: “Outcomes may be improving for seriously ill patients. We have seen the trends over time that mortality rates seem to be coming down. It’s a combination of two things.
“One is the trials that we have been doing, such as REMAP-CAP and the results around steroids. There is also a general learning of a disease that none of us had seen before. Having looked after many patients, we have tailored our treatments.”
He said age remained the “biggest factor” in the risk of dying from Covid, and obesity, high blood pressure and type 2 diabetes were “very strong risk factors in becoming critically ill”.
The average age of patients being admitted to ICU has increased slightly, from 58.8 to 59.7. However, many Covid patients are not admitted to intensive care, and deaths are most common in people aged 85 and older — with the average age of a Covid fatality being 82.4 in England and Wales. Doctors knew that steroids dampened the immune system, reducing the body’s “inbuilt” ability to fight the virus. The trials highlighted that steroids were still of net benefit to the sickest patients as they targeted lung inflammation.
Professor Gordon said: “Numbers are far fewer than we saw in the first wave. If they continue to rise, when the health service gets stretched and the ICUs are completely full, it’s very hard to provide the best clinical care for patients.”