The survival chances for corona patients who end up on the IC are about the same during the second wave as during the first wave. And that is good news, says Dave Dongelmans, intensivist and chairman of Nice, the foundation that keeps track of data on ICU patients. Five questions about the probabilities of the ic.
What is the chance that corona patients will die on the ic?
During the second wave, from mid-September to the end of January, it was 23 percent. From February to May last year it was worse: 27 percent. But that figure does not say everything. “After we transfer from the ic, another part dies,” says Dongelmans. During the entire hospital stay, about 30 percent of the patients who were ever admitted to the ICU died during the second wave. That is about the same as during the first wave.
How is that possible? We are now better able to treat patients?
That’s right, but the patients who now end up on the ICU are on average sicker. They had more problems with other conditions before they became infected with the corona virus, and their condition due to corona is also more severe on average than during the first wave. The chance of survival has remained the same, while patients are worse off when they enter the ic. That is good news, according to Dongelmans.
Why are IC patients now on average worse off than during the first wave?
Dongelmans sees two possible explanations. “For patients who may be just too bad for the ward, and too good for the ic, we now look a little longer to see if it still works in the ward.” Nursing units in the hospital are also better able to treat this group of patients due to the increased knowledge. These patients, which are relatively healthy by IC concepts, are less likely to end up in IC, as a result of which the health of IC patients – on average – decreases.
In addition, ICs may be more inclined to take in sicker patients, because doctors find it useful to treat them due to the increased knowledge. For example, it is better known which underlying conditions really worsen the chances of survival, and for which the effect is not so bad. According to Dongelmans, age in particular has a major influence on the chance of survival.
Were the chances of survival much better before?
Yes, according to Nice, only 18 percent of the patients on the ICU died in the period May-June, and 25 percent in July and August. After that, it rose to 32 percent in October and November (comparable to the peak in March-April), and recently the numbers seem to be falling again. In short: during the peaks the chances for IC patients were worse than during quieter periods.
It is not known why this is so. The ICs may also take in fewer sick patients during the quiet periods, because there is more space, says Dongelmans. That would increase the average survival rate on the IC. Another explanation is that the heavy burden during the peaks, where nurses sometimes had to take care of several patients, has led to worse chances for patients. “It really is speculation,” says Dongelmans. Nice is investigating further. The foundation is also looking at whether transferring patients might have an impact on their chances of survival. Age may also play a role: during the quiet summer the average age on the ic fell.
What does the advance of the British variant mean?
This could worsen the chances of survival, a British study showed this week. According to an overview study, the mutation is not only more contagious, but the chance of death is also one and a half times higher after infection.
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