Accepted for/Published in: Interactive Journal of Medical Research
Date Submitted: Aug 7, 2022
Date Accepted: May 20, 2024
CENSUS DEPENDENT MORTALITY OF COVID-19 VENTILATED PATIENTS: A LESSON FROM THE ISRAELI NATIONAL SYSTEM
ABSTRACT
Background:
The coronavirus SARS-CoV-2, the agent of COVID-19, was first identified on November 17, 2019, and was declared a pandemic by the World Health Organization on March 11, 2020. The virus is extremely contagious and the emergence of multiple mutated strains increased its contagiousness. The disease severity in a small percentage of patients requires complex intensive care facilities. Medical systems throughout the world have been tremendously challenged by COVID-19, leading to major disruptions of routine hospital services, sowing chaos and exhausting reserve medical supplies. Excess mortality beyond expected rates was observed in many countries, including Israel. Possibly, many curable patients might have
Objective:
Extreme expansion of hospital admissions without adequate medical resources may increase mortality. We aimed to determine whether daily census of ventilated patients affects national COVID-19 death rates.
Methods:
Cohort study using COVID-19 National, public-domain, population-based study of hospitalized patients. Israeli database reported from March 11, 2020 until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe by CDC classification and mechanically ventilated or not. Outcome measures were daily death rates and death rates expressed as percent of ventilated patients.
Results:
There were 3 frequency surges for severe and ventilated patients. Daily mortality rates varied in parallel to the 3 surges. Daily mortality rates expressed as a percent of deaths per ventilated patients followed a similar pattern of 3 peaks and correlated significantly with daily census of ventilated patients, even after correcting for age and gender. On days when there were 150 ventilated patients or more, daily mortality rate per ventilated patients exceeded 15%, more than 3 times that of when there were less than 50 ventilated patients (5%) (P<0.001).
Conclusions:
Daily mortality rates per ventilated patients increase with increasing numbers of ventilated patients, suggesting "saturation" of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses as indicators of system saturation, although further validation of these results might be needed to use this marker to drive public policy
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