The United States has seen two spikes in the number of Covid-19 cases; Europe is starting to see its second wave, apparently bigger than the first (in terms of daily cases) in France and Spain, but smaller in Germany, Italy and the UK. India continues to experience a strong and steady increase in the number of daily cases; it has not yet peaked, with active cases approaching one million and daily cases approaching 100,000.
Globally, the infection appears to be slowing down – that could change if the second wave gains momentum in Europe, and the US sees a third wave (it probably will), with the number of cases growing by just 9.2% in August. , compared with 64% in July. The number of cases in India in August grew by 75%, compared with 183% in July.
It is clear from the two tables that accompany this column that countries around the world have progressively improved in saving lives. That shouldn’t be a surprise.
Both China and the World Health Organization (WHO) made mistakes when the virus first appeared in Wuhan. In March and early April, when the disease was spreading across Europe and the United States was experiencing its first wave, no one even knew that the disease could be transmitted by air. A group of scientists would write about this to the WHO in early July. Not all the symptoms now associated with the virus were known. And some experts believed that Sars-CoV-2 exclusively affected the respiratory system. 
Over the months, our understanding of the virus, how it affects the human body (and what systems in the human body), how it travels and infects people, and the therapies and medications that can help infected patients with severe symptoms to fight disease. all have evolved.
There are studies showing that the use of Remdesivir in early stage patients and steroids like Dexamethasone in late stage patients helps. Countries have also developed the capacity of intensive care units with oxygen and ventilators, both imperatives for patients with severe symptoms who may not be able to breathe on their own.
Plasma therapy has been shown to work in some cases, although more research is needed before its efficacy can be established beyond doubt. Medications used to treat autoimmune disorders have shown promise in some cases (and some scientists say that Covid-19 itself should be treated as an autoimmune disease – I wrote about this in an earlier installment of this column, Dispatch 140 on August 25. ).
In many parts of the world, the average age of infected people has decreased and many of the infections are mild; both increase the chances of recovery. In fact, even in India, as evidence increases, the majority of new cases are from patients who have mild symptoms or none at all.
Now, a team of Yale researchers has discovered, according to an article on the medRxiv prepress server, that there is something in common for most inpatients who subsequently need to be transferred to intensive care units for ventilation or respiratory support ( or who will eventually succumb to the disease). The study covered 3,300 patients and found, using a machine learning algorithm, that most of them, whose disease became severe, had a strong signature of a certain neutrophil, on the first day of hospitalization. Neutrophils are a type of white blood cell and are part of the body’s immune system. “Using a machine learning algorithm, we identified a prominent neutrophil activation signature, including resistin, lipocalin-2, HGF, IL-8, and G-CSF, as the strongest predictors of critical illness. Neutrophil activation was present on the first day of hospitalization in patients who only later would need to be transferred to the intensive care unit, ”the researchers write in the article, which has not yet been peer-reviewed.
They add that the signature was even a predictor of higher mortality.
Prior knowledge of which Covid-19 patients could see their condition deteriorate can help save more lives. Lives lost and lives saved should be the only metrics that really matter.
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