Improved treatment could decrease Covid deaths in ICU by 30%

International studies and personal lessons learned in the first wave of the coronavirus in the Netherlands mean that people who now end up hospitalized with a Covid-19 infection get improved treatment to those who were hospitalized in March and April. Doctors now have three medicines that can help their patients, and have adjusted treatments in other ways too. Doctors' associations hope that this will reduce the number of Covid-19 patients who need intensive care by around 30 percent, and reduce the number of deaths in ICU by around 30 percent, NOS reports.

"In the beginning, everyone was searching," Annelies Verbon, chairman of the Dutch association for internist infectiologists, said to the broadcaster. "We read a lot about what happened in China, but it is different when you have real patients in front of you. It could happen that you read something in the trade journals in the evening that you had to apply immediately in the morning." During the first wave of infections, Dutch doctors focused mainly on supporting patients. "We gave them oxygen, fluids and drugs against complications. We investigated the effect of drugs such as hydroxychloroquine, but had nothing concrete in hand."

The first ICU patients received strong ventilation and many patients were placed on their stomachs, Diederik Gommers of the association for intensive care NVIC said to NOS. At the start, Covid-19 was considered to be mainly a type of pneumonia, and the idea was that the blood could absorb more oxygen if you pushed the fluid out of the lungs with high pressure. Six months later, it's clear that Covid-19 has much more going on. Doctors have distinguished different phases and manifestations of the disease, and they can focus treatment much more on that, Gommers said.

At the beginning of the infection, there is a lot of the virus in the body. "People who have a mild infection at home don't need virus inhibitors," Verbon said. "But hospital patients who belong to a high-risk group or who require extra oxygen can now receive the virus inhibitor Remdesivir. As a result, some patients will probably not need artificial respiration and some can go home a few days earlier." Some patients' immune systems overreact. They can benefit from the anti-inflammatory Dexamethasone, added Leon van den Toorn, chairman of the Dutch Association of Physicians for Pulmonary Diseases and Tuberculosis. Covid-19 patients who are hospitalized are also given blood thinners, because it turned out that coronavirus patients are at extra high risk for blood clots.

The method of treatment has also been adjusted. Not all Covid-19 patients in ICU are ventilated with high pressure anymore. "Corona patients with classic pneumonia respond well to this, but people who suffer from blood clotting problems do not benefit from it," Gommers said. "It is more personalized medicine."

During the first Covid-19 wave, about 1.5 percent of people who got the virus had to be hospitalized, and about 25 percent of them needed intensive care. Van Toorn expects that the improved treatment will result in around 30 to 40 percent fewer ICU admissions, and that deaths in the ICU will be reduced by about a third. Verbon hopes for 30 percent fewer ICU admissions, and about 25 percent less deaths. But both stressed that it is difficult to predict how the results of international studies will translate to the Dutch situation.