New treatments and other developments in hospital care for COVID-19 patients substantially reduced the rate of death from the viral infection during 2020, according to a new study published in the journal JAMA Network Open.
While it’s not surprising that hospital care for COVID-19 became more effective as healthcare providers gained knowledge about what works and what doesn’t, the study confirms that new treatments — rather than just demographic factors, like younger and healthier people getting the infection — led to a drop in the risk of death from COVID-19 last year. Some of the developments in hospital-based COVID-19 treatment have been especially important for people with diabetes, such as closer monitoring of blood glucose than would typically take place. But the main treatments that researchers believe are responsible for the drop in deaths from COVID-19 include giving people corticosteroids and the antiviral drug remdesivir — two of many potential treatments that were used in a trial-and-error manner to assess their effectiveness in the early months of the pandemic, before becoming a standard part of hospital treatment.
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For the latest study, the researchers were interested in figuring out how the death rate in people with COVID-19 changed throughout 2020, as well as what conclusions could be drawn about the causes of any changes in this death rate. They looked at records from 209 hospitals in the United States — both urban and rural, and of many different sizes — between March 1 and November 21, 2020. To be included in the study, patients had to be hospitalized for at least one day, test positive for COVID-19, and have a record of either discharge from the hospital or death. A total of 42,604 people met these criteria, representing 8.5% of all patients at these hospitals during this time period.
Change in COVID-19 death rates tied to improved treatments
The researchers found that overall, hospital admissions for COVID-19 were highest in people age 65 or older (46.8% of the total), followed by those ages 50 to 64 (27.2%) and 18 to 49 (24.9%). But the proportion of hospital admissions for those ages 18 to 49 increased from 20.7% in April to 30.3% in June and 29.6% in July — two months during which this age group made up a higher percentage of patients than the age group of 50 to 64. Not surprisingly, the rate of death in COVID-19 patients was greater with advancing age — ranging from 0.2% in those under age 18 to 20.9% in those over age 75. Male patients with COVID-19 were more likely to die than female patients, with an overall death rate of 12.5% for males and 9.6% for females.
The death rate for COVID-19 patients changed throughout the study period, increasing from 10.6% in March to 19.7% in April before dropping to 9.3% by November. The oldest age groups saw the greatest drop in the death rate. For those ages 50 to 64, the death rate dropped from a high of 12.8% to 5.4%. For those ages 65 to 75, the death rate dropped from 22.8% to 10.3%. And for those over age 75, the death rate dropped from 36.2% to 17.4%.
Based on these trends, the researchers concluded that falling death rates for COVID-19 patients couldn’t be explained by an influx of younger and healthier patients, since the death rate dropped the most in those at highest risk for death. This means that improvements in hospital treatments were the most likely explanation for the drop in the risk of death. “Reasons for decreases in mortality since the start of the pandemic may include increased clinical experience in caring for and ventilating patients and use of prone positioning, systemic corticosteroids, and remdesivir,” they wrote. These results, they noted, “supported the findings of smaller, more geographically focused studies and found decreases in in-hospital mortality across all age groups throughout the pandemic period.”
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