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The number of patients receiving treatment in hospital due to covid-19 is increasing. The same is true for the number of seriously ill patients requiring intensive care (vat).
– The number of admitted patients is increasing. We have also received VAT cases extremely fast, here it goes very fast, said Signar Mäkitalo, infection control doctor in the Sörmland region, recently.
The picture looks almost the same in the 21 health regions of the country. The spread of the infection is increasing dramatically and therefore also the number of patients ending up in hospital.
But unlike last spring, mortality among those who end up in hospital has dropped dramatically since the start of the pandemic. Furthermore, there is great hope that the decline will continue, even into the coming winter.
– It is a big difference. Among those of us working with this, he feels much more hopeful than he did last spring. The feeling is that now things are going much better for patients. Both in IVA and in the wards, says Ola Blennow, an infection physician at Karolinska University Hospital in Huddinge.
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Don’t always sleep
It is more than a feeling. A Swedish registry study presented at the end of October shows that mortality among all those seen in hospital for COVID-19 decreased from 24.7 to 13.3 percent between March and June, calculated up to 60 days after diagnosis inclusive. During the same period, the death rate among those seen in intensive care decreased from 36 percent to 20 percent. A dramatic reduction, in other words.
According to Ola Blennow and her colleague, infection doctor Hilmir Ásgeirsson, the explanation is better patient care, both in terms of medications and other treatments.
– In the past, patients used to be quickly anesthetized and intubated when they came to IVA. Partly because he was afraid of spreading the infection, partly because that’s how he usually does it. But we have gradually learned that many of these patients can often survive for a long time on oxygen alone.
You can get rid of a tough deal
Patients, he says, get oxygen with the help of a high-flow halter in the nose. They are still very sick and need so much oxygen that they cannot be anywhere other than vat, but they do not need to be put to sleep and breathe with the help of a throat tube, which is connected to a respirator.
In this way, some patients are able to avoid a treatment that may be so stressful on the body that the treatment itself may pose a risk.
– Instead, they can lie down and text their wife, says Ola Blennow.
This has resulted in only a quarter of the covid patients hospitalized in the intensive care unit in Huddinge being intubated at this time.
– Another important thing is the abdominal position, which we put certain patients face down. This improves oxygen exchange, says Hilmir Ásgeirsson.
Patients receive Remdesivir
Medication has also improved. In the spring, it became clear that many COVID-19 patients are at risk of developing blood clots, especially in the lungs.
– That’s why we give all patients a clot dissolving treatment for preventive purposes, says Ola Blennow.
Additionally, patients also receive the antiviral drug Remdesivir.
– We have started to use belt straps more and more. It’s not for everyone, but for the right patients and at the right time, early in the process, it can have an effect, says Hilmir Ásgeirsson.
Time and factor
Later in the course, anti-inflammatory cortisone can also be used.
– When the first phase of the virus ends, inflammation becomes more and more important, and then cortisone is a good medicine for the most seriously ill, says Ola Blennow.
Furthermore, it appears that patients arrive earlier now than last spring in a different phase of the disease, meaning that it also increases the chances of survival.
Another important lesson is the importance of time, to which the vast majority of patients turn sooner or later.
– In most, the lungs recover, but it takes time and we must give the body the time it needs, says Ola Blennow.
