An observational study by German researchers examined the cases of 10,021 patients from 920 hospitals in Germany between Feb 26 and April 19, 2020 . The study was published in The Lancet, Respiratory Medicine, July 28th, 2020. The study by Karagiannidis et al. is titled: “Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study.” These are all hospitalized patients, so it is a subsection of the Covid-19 population. Those with the mildest cases were sent home.
The outcomes of these cases are instructive as to what your risk and mine might be, if we should happen to contract Covid-19. However, individual cases vary. Some Covid-19 cases are unusual or even unique, and so risks vary from person to person.
The need for mechanical ventilation (MV) is particularly interesting, as the mortality rate is much higher for any patients who needed this type of treatment. About half the patients needing MV were over 72 years. Twice as many men as women needed MV. This suggests that Covid-19 is much more likely to be severe in men, than in women as the need for MV indicates a severe case. So the likelihood that someone will have a severe case increases with age, and is greater for men than women. In the non-ventilated group, there were about as many men as women.
“The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199) .” Out of all 10 thousand patients, 17% needed MV. So 88% of women do not need MV; while 78% of men do not need MV. By age, 75.5% of those needing MV were 60 or over.
Ventilated patients were much worse off than non-ventilated patients. “Dialysis was required in 599 (6%) of all patients and in 469 (27%) of 1727 ventilated patients. ” Dialysis means that the kidneys have shut down and a mechanical is needed to clear the blood of, well, what turns out to be urine. More than one quarter of ventilated patients needed dialysis, which means their kidneys were severely affected by Covid-19. The mortality rate (i.e. death rate) for Covid-19 patients needing ventilation was 73% . By comparison, in all ventilated patients who were 80 or over, the mortality rate was 72%.
The virus can attack the kidneys because it can infect any cells that have an ACE2 receptor on the surface of the cell. ACE2 receptors are found in cells in the lungs, kidneys, heart, intestine, the lining of the blood vessels, platelets, and neurons in the brain and throughout the nervous system.
The mortality rate for the entire group of 10,000 hospitalized Covid-19 patients was 22%. While the overall death rate was 22% in-hospital, those not needing ventilation had a 16% mortality rate, those needing invasive mechanical ventilation had a 53% mortality rate .
This is not a good mortality rate today. This study covered the period from Feb 26 to Apr 19th, 2020. Since then, the mortality rate overall has fallen, and this must be due to a lower mortality rate in hospitals as only the most severe cases of Covid-19 result in death, and that would be hospitalized cases. See my post: The Latest Look at Weekly Death Rates.
Dr. Mobeen Syed interviewed Dr. Paul Marik about the MATH+ Protocol, a set of recommendations for care of Covid-19 patients in this video on YouTube. Dr. Marik: “We have an effective therapy that can save lives.” Dr. Marik stated that the mortality rate for his hospital using the MATH+ protocol is 6.1%, whereas the typical rate in other hospitals is about 24%.
Since the time of the German study, some hospitals have been able to reduce their mortality rate with improvements in treatment regiments. But other hospitals have not improved much at all. The problem is that there is no standardized treatment regimen, recommended by health authorities. So you are lucky if you end up in a hospital with a lower mortality rate, and unlucky if you end up in a hospital with a higher mortality rate. This problem must be overcome by studies proving which treatment regimens work best.
Ronald L. Conte Jr.
Note: the author of this article is not a doctor, nurse, or healthcare provider.
1. Karagiannidis, C. et al., “Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study.” The Lancet, Respiratory Medicine; July 28, 2020.