Even if the disease is rather mild for a large number of those infected with the coronavirus, the situation is very different for the severe cases. Sick because of a severe course of Covid – 19 had to be ventilated in a clinic, only a short one 50 – percent chance to survive.
This is the result of an analysis by the Scientific Institute of the AOK (WIdO), the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and the Technical University of Berlin, which is now published in the medical journal “The Lancet Respiratory Medicine”
For the investigation, the authors used AOK's accounting data of around 10. 000 Patients with confirmed Covid – 19 – Diagnosis evaluated between the 26. February and 19. April 2020 in 920 German hospitals were treated. “Mortality in patients with ventilation was 52 percent where without ventilation with 16 percent significantly lower, “says the study.
This statement puts Reinhard Busse, Professor for Management in Health Care at the TU Berlin and one of the co-authors of the study, into perspective: “In absolute numbers there are more Covid in the hospital – 19 Patients died who were not ventilated. ”
Overall, 1727 inpatiently treated Covid – 19 – Patients artificially ventilated, of whom around 900 died. Slightly more than three quarters of these patients received invasive ventilation, i.e. via a tube in the trachea. The remaining 8294 patients were cared for without ventilation. Of them died around 1320.
At the beginning of the pandemic, many were shocked by how high the mortality rate to Covid – 19 was sick patient, says Busse. Now there are finally numbers that shed more light on this. “It turns out that the sometimes visible complacency of the intensive care physicians that they have treated more successfully in this country was not entirely justified.”
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Because the mortality rate of the hospitalized Covid – 19 – Patients in Germany are quite comparable to other European countries. “Also in Great Britain it is about half.”
But there is a decisive difference: “In Germany a larger proportion of people infected with the coronavirus kept away from the hospital. “Only about every fifth Covid – 19 – patient came to a clinic, in France it was 70 percent.
In the meantime, however, the ratio in most countries is adjusting at a lower level – simply because more is being tested outside of hospitals and therefore more patients with easier disease course are treated on an outpatient basis. “In France, for example, the rate dropped to every sixth infected person who needs to be admitted to a clinic.”
The background to the high percentage of deceased ventilation patients is apparently associated illnesses, in which the ventilated Covid – 19 – Patients suffered. Added to this is their mostly old age. For example, 24 percent of patients without ventilation cardiac arrhythmias, in the ventilated patients that was 43 percent.
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“A diabetes disease was 26 percent of patients without ventilation and with 39 percent of patients with ventilation before ”, says the study. The share of deceased over – 80 – Year-olds who were ventilated, is 72 percent who is the non-breathable of this age group with 34 percent not even half as high.
Respiratory patients average 25 days in hospital
In addition, ventilated patients must stay in the hospital for a long time. The average length of hospital stay for Covid – 19 – patient fraud 14 days. In the non-ventilated patients she was with 12 days significantly shorter than for the ventilation patients with 25 days. “The duration of artificial ventilation was on average 14 days. “Just under one in four even had to be ventilated for longer than three weeks.
There would also be other reasons for the high mortality rate of ventilated patients. In recent weeks, experts have repeatedly discussed whether ventilation itself poses risks, i.e. when the right time to start ventilation and which ventilation technique is the most promising. But the analysis cannot answer such a question, says Reinhard Busse. “We don't have a control group.”
The results of the analysis suggest that gender also plays a role in the need for ventilation: the proportion of men who are ventilated is 22 Percent and was thus almost twice as high as that of women at twelve percent.
“Mortality, however, was at a comparable level”, says the study “Aus This clear difference cannot be explained in the billing data, there is a need for further research here, “Christian Karagiannidis, spokesman for the DIVI section” Lung – Respiratory Failure “and head of the ECMO Center of the Lung Clinic Cologne-Merheim is quoted in the study.
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Another striking number is the rate of patients transferred, i.e. those who were admitted to a clinic and during therapy transported to another, better equipped clinic w
“This quota is 27 percent, that is compared to stroke or heart attack, where the transfer rate is around 15 percent is an extremely high number, ”says the Berlin health scientist Busse. “That means that more than a quarter of the Covid – 19 – patient had first ended up in the wrong hospital. “
“Covid – 19 – Clinic on the Berlin exhibition grounds is superfluous “
This should – even in preparation for a possible second wave of illness – improve significantly. The Berlin system, in which the clinics with intensive care units were divided into three groups – a main clinic for patients requiring ventilation with Covid – 19), other clinics that are looking for more Covid – 19 – Patients cared for, and a third group that remains available for other intensive care patients – could serve as a model for this nationwide, Busse says.
And not only because this means that most of the patients are correct in the same way for Covid – 19 Appropriate equipped clinics come, but also because other hospitals are free of Covid – 19 remain and thus transmission of the virus is prevented in the clinics. “And that is at least as important as the Covid – 19 – bring patients to the right hospital. “
In another decision, however, Berlin is not a model: “The so-called Covid – 19 – Setting up the clinic on the exhibition grounds was wrong “, says Busse.
“With her inadequate equipment, she would have needed exactly what has already happened too often: A massive relocation of seriously ill Covid – 19 – Patients in other houses that are better equipped with staff and technology. “And that is why this clinic is superfluous, even if there should be a second corona wave.