How Far Have We Come In Treating COVID-19?

Extricating the fight against the disease from the fight against the pandemic.

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22

Six months and counting into our coronavirus era, we’ve gotten much better at quantifying the fight against the disease. How well a country or state or county is faring is broken down into charts and scatterplots: Cases per capita and tests run per capita, hospital capacity and PPE availability, test positivity rate and test turnaround rate and case fatality rate.

Given that blizzard of data, it’s strange that one question remains so difficult to examine: How much better are we actually getting at fighting the disease?

We’ve certainly gotten better at fighting the disease’s spread. Everyone knows the drill by now: Masks, social distancing, washing your hands. What’s less obvious is how far we’ve progressed in the task of healing the very sick. Doctors and hospitals have tried to defeat the virus with a cornucopia of drugs and treatments. But in part because that effort has been so improvisational and eclectic, tracking its effectiveness over time remains a serious challenge.

The central fact of the current stage of the pandemic is this: Although new cases soared throughout July and August far above what we saw in April and May, daily COVID deaths have not climbed back to their late-April heights. That rate may continue to rise even with new cases descending again—deaths are, after all, a lagging indicator—but the discrepancy is too sharp to ignore.

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  1. Jack Janzen

    People are confident that there will be a vaccine. What if we don't? Or what if none of the vaccines are any good? We will have to figure out how to live with it. Locking down until a vaccine is available is not a very good option.

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    DougAz

    I am concerned we are overly optimistic about COVID-19 and Children. Their health. Their parents health. Teachers health. New Mass General study:

    https://medicalxpress.com/news/2020-08-children-silent-spreaders-sars-cov-.html

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  4. linda

    My wild hunch is that there is a genetic component involved with those who get a life threatening case and those who don't. There have been instances where several members of one blood family die of it but their spouses have light cases. A healthy 20 something dies but a 80 something lives. Granted older people have more risk in general. Was just reading about a young healthy 28 yr old who spent over a hundred days in the hospital due to covid. While there the virus attacked his brain resulting in 2 strokes and he had a heart attack. Many others are kind of sick for a few days while others don't even know they are sick.

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    DougAz

    Not a joke, I'm a secular Progressive Liberal now (Age 66). But with Covid, my science education, and business experience I am conservative here. Meaning - cautious, conserve over-optimism.

    Covid-19 for America could have benefited by vastly more conservative, cautious, realistic civic-duty inspiring efforts.

    Covid-19 is still killing TWO times as many Americans every day, than died in Vietnam.

    I've said for a long time, this is a new species of Virus. It clearly effects multiple-systems. It clearly has totally NEW ways of interacting with humans. Even today, more and more reports of Children with Covid.

    And in America we are not even in 20th place as far a national-performance with all if not better starting information.

    Optimism with this is good in little doses. Let's now make it fools gold.

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      George.Skinner

      You-re right - this is a time to be conservative. As a product safety engineer, I deal with risk analysis all the time. All of these conflicting studies imply uncertainty, and the conservative assumption is to assume a higher level of risk because of it. People have been favoring studies based on their pre-existing biases. Even worse, they interpret a lack of data as a lack of effect. I can accept arguments from people that they are willing to assume a higher risk, but my suspicion is that they're not so much accepting the risk as denying it.

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        DougAz

        Thanks George. You're in a great field. I've relied on your discipline in Class III Medical Devices. Hazard and Harm and Risk are often challenging to simply. As you say, our human biases come easily into play.

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  6. Bob Simrak

    I was wondering this morning about the treatment status. And here it is. Thanks.

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  7. Bob Blanchard

    Thanks for another great article.

    I would be very interested in hearing more about the relationship between age and comorbidities with outcomes. I’m really surprised that with the number of deaths we’ve had in US and other countries that there hasn’t been much specific reporting on how they track with outcomes. It seems to me there should be a lot of data to follow.

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      Andrew Egger

      Hi Bob--thanks for reading, and it's a good question. One difficulty here is that COVID-19 manifests so differently in different patients, not just in the severity of symptoms, but in the whole symptom profile. The apparent reason for this is that, in addition to attacking the lungs, the virus also seems to cause the blood to clot much more readily, creating large numbers of extremely small clots that can end up lodging all sorts of places in the body and causing all sorts of seemingly unrelated issues.

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      Idontdocute

      One of the problems we are having with the system here is that it is set up to have the data come into the health department by fax and get processed from there. It didn’t help that the national data is now going through HHS, which does not have many pandemic specialists and maybe not a well functioning data system and not to the CDC. There is that some states count all Covid + tests where about half don’t count any of the rapid tests in their totals. Some states mixed together positive tests with positive antibody tests for a time. Then there are the found dead that may be Covid victims that just look like heart attacks, strokes, or PEs because we don’t test them. We don’t have the time right now.
      We get all of that stuff straight, we might be able to get something useful.

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  8. Michael Kliegman

    Unfortunately, you're dismissive about hydroxychloroquine because you haven't done the leg work on it. The "conspiracy theories" are from those who dismiss it, not those who endorse its use. Doctors are using it. It is unhelpful in treating severely ill, but lots of evidence it is very helpful when given soon after symptoms or even positive test results. See articles by Yale's Harvey Risch and August 14 article by Norman Doidge in Tablet magazine.

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      Idontdocute

      You might like this one. It’s from June, but it shows the work. Start at about 1/4 in when you see the blackboard.

      https://www.youtube.com/watch?v=o5w7FiDJe1g

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      George.Skinner

      People keep moving the goalposts in pursuit of scoring political points. Trump's initial spin was that this was either a complete cure, or an effective prophylactic that would stop the pandemic (he obviously thought the latter, given that he stated he was taking it for that reason.) It's not a complete cure. It doesn't seem to be effective as a prophylactic treatment. It has no benefit in serious cases. There are a couple of studies that support its effectiveness at an early stage, but there are a number of confounding effects (as noted in the generally positive article in Tablet.) It would be entirely like Trump to claim complete vindication based on any positive outcome despite rather constrained utility vs. the initial claims. Even as a treatment, this doesn't avoid the need for all the other measures to mitigate the spread of COVID like physical and social distancing and wearing masks - all things Trump has actively resisted for months.

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      Nick H

      The problem is that hydroxychloroquine is touted as a cure for COVID-19 in general as opposed to what it really is - a treatment for a specific symptom of COVID-19 which is only present in a limited number of patients. The former is what the conspiracy theories claim, but using it to treat people who don't have the problematic immune system response to COVID-19 is not only ineffective, it might be actually harmful.

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    5. Tim Johnson

      As a treatment for Covid - Trump was touting it as a way to prevent or cure it. Huge difference.

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      Andrew Egger

      I ran past hydroxychloroquine a bit quickly here because there was so much ground to cover, and we're (I believe) publishing an interview tomorrow that goes into a little more detail. But when I say conspiracy theories, I'm not talking about clinical debates over whether it has a benefit. I'm talking about the hardcore tin-hat stuff that's been going insanely viral on social media for months, like the Plandemic video and Stella Immanuel's claims.

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        Ben Lang

        Andrew, great rundown of things... Have you read this re: Hydroxychloroquine? https://www.tabletmag.com/sections/science/articles/hydroxychloroquine-morality-tale
        This, I think, gets to the heart of the matter in explaining what's actually going on with the drug... Treatment, research, the political division around which information is reliable, etc... Definitely worth a read for all my fellow Dispatchers.

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    Victor Clairmont

    Thank you so much for this update!

    I think even with all the failures and the slow learning, whenever another serious pandemic happens in the future, we should (if we are not polarized like now) be more prepared for another one of these terrible plagues. South Korea, Japan, Taiwan have had to deal with these in the past (such as with SARS) and were prepared and their population knew how to already work in a pandemic.

    America and Europe now, will need to be better prepared for the future and have zero excuse. Very thankful this virus didn’t kill millions, though the death toll is still very harsh. That means making sure PPE is up to date, the CDC has a decent enough funding and surplus ready at all times. If we need to cut budgets, cut anything but the CDC.

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  10. Tim Johnson

    Good article, thank you.

    My concern is that good news on the mortality front leads to less vigilance in combating the spread.

    Survivors seem to have pretty severe and long-lasting effects from the disease, and that's just a few months out. How about a few years out?

    We just don't know, and until we know, we shouldn't take too much solace in the fact that fewer people are dying from it.

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      Andrew Egger

      You make a good point--although months into a deadly pandemic with no end in sight I'd suggest it's healthy to let ourselves take some solace where we can get it!

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