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COVID-19 Mortality Rate Declines Significantly in Sweden

AHA Publisher — Wed, 04 Nov 2020 08:00:43 +0000

Dr. Ananya Mandal, MD via News-Medical Net – A new observational study by Swedish researchers shows a significant decline in death rates among hospitalized patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Their study titled, “Decline in mortality among hospitalized covid-19 patients in Sweden: a nationwide observational study,” was released online as a preprint on the medRxiv* server. Background The novel coronavirus SARS CoV-2 that causes coronavirus disease (COVID-19), has infected over 44 million individuals worldwide and claimed the lives of over 1.17 million. Most COVID cases are hospitalized for complications caused by the infection. The virus’s immense capacity to infect populations and spread rapidly has put enormous pressure on the healthcare system in general and on hospitals in particular, wrote the researchers. Those admitted to hospitals with COVID have a mortality of over 20 percent. Thirty-four percent of patients require intensive care. The proportion of patients requiring ICU admission is between 17 and 32 percent wrote the team. These numbers are derived from studies conducted between February and April 2020. With time, the understanding of the infection and its management has improved, and thus survival has also improved with time. This new study was undertaken among Swedish patients to see if there has been a change in mortality rates among hospitalized COVID-19 patients across the nation. The researchers attempted to see 60-day mortality (defined as death from any cause within 60 days of index hospital admission), mortality rate of the COVID-19 patients for both non-ICU treated, and ICU treated patients during the first 4 months of the pandemic. The data came from the Swedish National Board of Health and Welfare (NBHW). Flow chart of study inclusion: Patients hospitalized for covid-19 in Sweden 1 March – 30 June, 2020 Study design This was a nationwide observational cohort study of patients hospitalized in Sweden between 1st March and 30th June 2020. The patients had all tested positive for SARS-CoV-2 RNA between 14 days before to 5 days after admission. The code on their discharge was COVID-19. All hospitals in Sweden were included in the study. A total of 15,761 hospitalized patients with COVID-19 were included in the study. The data came from the Swedish National Board of Health and Welfare. 60-day all-cause mortality for the patients was recorded and analyzed. The patient population was classified according to the month of their admission. Relative risks of deaths in the patients by month of admission were calculated. Factors such as pre-existing comorbidities, age, gender and care dependency, and severe illness were considered. To assess the severity of illness, Simplified Acute Physiology, version 3 (SAPS3), and oxygenation index (PaO2/FiO2) were used among ICU admitted patients. Treatments and procedures they underwent in the ICU were also recorded. Timeline of patients admitted to, and in care, in hospitals for covid-19 in Sweden during the study period. Shown are number of patients admitted per day into hospital (by index admission date), and into ICU specifically (by ICU admission date) on left Y-axis; number of patients in care per day in hospital, and in ICU specifically on right Y-axis What was found? Overall results of the study can be summarized as: A total of 15,761 patients were admitted. The patients’ median age was 64 years (between 51 and 78 years), and of these, 57.5 percent were men. The highest number of admissions was during April 2020 The proportion of patients admitted to ICU was 14.4 percent overall. Age distribution of admitted patients changed over time, with the number of patients less than 40 years old and over 90 years of age rising between March and June. The overall all-cause 60-day mortality was 17.8 percent (between 17.2 and 18.4 percent) among Swedish patients hospitalized with COVID-19. The rates of deaths were 24.7 in March 2020 that fell to 13.3 percent in June 2020 Adjusted relative risk (RR) of death was 0.56 (95 percent CI, 0.51 to 0.63) for June, with rates inMarch used as a baseline. Compared to ICU admitted patients, relative risks of death for non-ICU patients were 0.60 (95 percent CI, 0.53 to 0.67) and 0.61 (95 percent CI, 0.48 to 0.79), respectively. Admission rates to the ICU fell from 19.5 percent (95 percent CI, 17.9 percent to 21.0 percent) in March to 11.0 percent (95 percent CI, 9.9 percent to 12.2 percent) in June 2020. In June, the proportion of ICU admitted patients receiving mechanical ventilation fell from 86.5 percent in March to 58.6 percent. In June, the proportion of ICU admitted patients receiving dialysis fell from 22.8 percent in March to 13.8 percent. SAPS3 and PaO2/FiO2 on ICU admission remained similar throughout the study period among the patients roportion of patients treated in ICU and receiving invasive mechanical ventilation during the hospital stay, according to month of hospital admission. Shown are proportions with 95% confidence intervals Conclusions and implications This study reveals that there has been a decline in the mortality rates among hospitalized Swedish COVID-19 patients with time over the pandemic. This decline is independent of the pre-existing comorbidities among the patients. Authors call for further research to understand the reasons behind this decline. Authors write, “The changing covid-19 mortality should be taken into account when management and results of studies from the first pandemic wave are evaluated.” *Important Notice medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information. Journal reference: Decline in mortality among hospitalised covid-19 patients in Sweden: a nationwide observational study Kristoffer Stralin, Erik Wahlstrom, Sten Walther, Mona Heurgren, Anna M Bennet-Bark, Thomas Linden, Johanna Holm, Hakan Hanberger medRxiv 2020.10.27.20220061; doi: https://doi.org/10.1101/2020.10.27.20220061, https://www.medrxiv.org/content/10.1101/2020.10.27.20220061v1 To read the original article click here.

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COVID Report Raises Questions About Fatality Rate, and Studies Show Sugar Puts You at Risk

AHA Publisher — Wed, 02 Sep 2020 07:00:05 +0000

News Staff via CBN News – New numbers from the CDC reveal 94 percent of Americans who have died from COVID-19 already had underlying health problems. This reinforces what doctors have been telling us all along, that the weakest among us are the ones who are most susceptible to the virus. CBN News Medical Reporter Lorie Johnson explains, “The data does not suggest that these people with underlying conditions would have died anyway from that condition if they had not been infected with coronavirus. It should not be interpreted to mean that the only ‘real’ coronavirus deaths are the ones where the patient had no underlying conditions.” Since God created us with immune systems to fight disease, Johnson points out we should work on improving our health to make us less vulnerable to serious complications from viruses like COVID. “We need to stay as healthy as possible, because that way our body is better able to fight off the virus if it enters our body,” she explained on CBN Newswatch. “Believe it or not, doctors recommend eating less sugar because new research shows too much sugar can blunt our body’s ability to fight off the virus.” Johnson spoke with Dr. Michael Goran, a sugar researcher at USC who said since COVID could be with us for a while, now is a good time to give up sugar. “Clearly a high sugar diet in the long term is going to contribute to longer-term increases in your blood glucose levels,” he began. “And what these studies are showing is that when you have a higher blood glucose level in general it contributes to this kind of broad, across-the-body, low-grade state of inflammation that comes along with that high blood glucose.” “And so what these studies are showing is that when you have that low-grade inflammation across the body, when you actually get an infection, like from COVID-19, the response becomes a little abnormal and the body responds to the low-grade inflammation throughout the body instead of just attacking the COVID. So it’s not a good thing to have broad-scale inflammation in the body when your immune system needs to fight COVID-19.” “The combination is not very good and you have a greater amount of complications to the infection because the thinking is that the immune system is attacking other parts of the body instead of the COVID 19,” he explained. Dr. Goran just wrote a book called Sugarproof that comes out on September 1, and it’s all about how sugar harms children. The book offers practical advice about how to get them off the sweet stuff and even includes recipes. Childhood obesity is a known problem in America, but even skinny kids often eat too much sugar which can adversely affect their development. It can cause attention problems, anxiety and inflammatory conditions such as asthma and acne. And beware that even if you’re buying organic cereal and goat milk yogurt don’t think they are low in sugar. Meanwhile, the head of the Food and Drug Administration says he’s open to fast-tracking a COVID-19 vaccine before clinic trials are completed. Dr. Stephen Hahn told the Financial Times that, under the right circumstances, an emergency authorization could be approved while stage three trials are still underway. Dr. Hahn said the drug company would have to request emergency authorization before the FDA makes the decision. He stressed that pressure from the White House would not influence the decision. To read the original article click here. For more articles by CBN News click here.

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Study Suggests Natural UV Radiation Protects Against Coronavirus

AHA Publisher — Fri, 10 Jul 2020 07:00:55 +0000

Dr. Liji Thomas, MD via News-Medical Net – A new study by scientists at the University of Edinburgh and published on the preprint server medRxiv* in July 2020 suggests an interesting link between ultraviolet A radiation and deaths due to COVID-19. While this is an observational study, which means that direct inferences cannot be drawn from this finding, it does, however, suggest better strategies for reducing the death rate due to COVID-19. The COVID-19 pandemic is still spreading throughout many countries, and scientists are exploring its risk factors as part of the effort to contain the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among the variables being considered are seasonal variations, temperature and humidity conditions, and ultraviolet irradiation. These are known to play a role in several infectious diseases already, such as influenza. Ultraviolet, Sunlight and COVID-19 Since the current pandemic has not yet completed one cycle of seasons, all these factors cannot be thoroughly evaluated. However, the level of ultraviolet (UV) irradiation in the atmosphere can be studied in relation to COVID-19 death rates. Previous research by the same team showed that sunlight can reduce blood pressure via nitric acid production, independent of vitamin D levels. Population-wide studies show that increased UV levels are related to lower blood pressure and decreased heart attack rates. This could also cause diabetes and metabolic syndrome incidence rates to fall. The Study: UV and COVID-19 in 3 Countries Since COVID-19 disease appears to have greater severity among people with these conditions, the current study explores the association between ambient UV and COVID-19 deaths in three countries, namely, the USA, England, and Italy. It looks at over 11,000 counties and areas in these countries in three independent data sets, using only those counties where the UV level was below the threshold known to induce significant vitamin D3 biosynthesis in the skin. This threshold corresponds to a monthly mean vitamin D effective UV (UVvitd) of under 165 KJ/m2. This period is termed the UV vitamin D winter and covered the months from January to April 30, 2020. The daily UV irradiance was derived from satellite data, after accounting for atmospheric absorption by water vapor and ozone. The researchers found that the daily mean UVA levels hovered between 450 to 1,000 KJ/m2 across these countries. After adjusting for demographic, socioeconomic, susceptibility, and long-term environmental variables, the researchers arrived at a multivariate analysis outcome. These include the percentage of older people, ethnic composition, low income and poverty indicators, air pollution indicators such as PM2.5, which reflects fine particulate matter in the air, and the susceptibility to infection. The latter was calculated from various factors such as the population density coupled with the percentage of positive tests and exposure in various ways, as by public transport. UVA Reduces COVID-19 Mortality The model shows that UVA levels are inversely related to COVID-19 mortality. The mortality risk ratio (MRR) is 0.73, which reflects a 27% reduction in risk with an increase of 100KJ/m2 in UVA irradiation in the USA. In England and Italy, it is 0.51 and 0.81 respectively, which means a reduction in deaths by 49% and 19% respectively. Overall, therefore, the MRR was 0.68. This effect is independent of both cold temperatures and of whether the UVA ambient levels crossed the threshold for vitamin D synthesis. An interesting finding is that the higher UVA levels produced more significant reductions in mortality risk in countries with a lower average UVA level, namely, England, compared to the USA or Italy, which have higher average ambient UVA. Mechanisms of Action The researchers suggest that UVA may act via several mechanisms. For one, the irradiation may inactivate the virus in airborne droplets and fomites, reducing the rates of spread and the size of the inoculating dose in those coming into contact with infectious material. This would lead to less severe infection. Secondly, UVA induces the release of nitric oxide from the skin, which then enters the bloodstream, causing blood vessels to dilate and reducing the blood pressure. This, in turn, promotes cardiovascular and metabolic health. This produces a reduction in the risk of death from COVID-19 since heart disease, vascular conditions, and metabolic syndrome are high-risk factors. Thirdly, UVA may reduce the replication of the virus. In SARS-CoV, it acts by s-nitrosating the spike protein, which means it cannot bind with its receptor, the angiotensin-converting enzyme (ACE) 2. Both SARS-CoV and SARS-CoV-2 have homologous spike proteins, and hence this action could be present in the latter as well. Fourthly, endothelial damage, and impaired endothelial nitric oxide synthase activity could be the underlying reason for extensive organ damage in severe COVID-19. UVA could reduce this as well, by promoting the photochemical reaction that produces more nitric oxide. Future Research and Conclusion The study concludes, “Our analysis, replicated in 3 independent national datasets, suggests ambient UVA exposure is associated with lower COVID-19 specific mortality.” The next step would be to confirm that this is a causal association. If so, this could be an easy way to reduce the mortality from the pandemic by advising optimal sun exposure. Moreover, the independent mechanisms could be replicated therapeutically, especially those involving circulating nitric oxide. *Important Notice medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information. To read the original article click here.

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