‘Cortisone lowers mortality in seriously ill covid patients’


“Our hospitalized Covid-19 patients are slightly younger this time.” Hospitals about the differences between the first corona wave and the growing influx in recent weeks. ‘We now systematically administer cortisone on intensive care units.’

The strong increase in the number of corona infections in recent weeks is explicitly manifested in hospital statistics: an average of 113 patients are admitted every day, the Sciensano health institute reports Monday. 1,329 people are in Belgian hospitals with Covid-19.

This is immediately the highest level since May 22, although still considerably less from almost 7,000 at the height of the epidemic. 243 patients are treated in intensive care. That is also the highest level since the end of May. By way of comparison: at the time of the corona peak in April, almost 6,000 patients were in hospital, 1,300 of whom were in intensive care.

Apart from the numbers, other questions arise. Can patients be treated better today than during the first wave? Are critically ill Covid-19 patients now less at risk of dying?

We certainly expect this to have an effect over time. During the first wave, we administered cortisone sporadically, but we have been doing so systematically for some time now.

Dominique benoit

Head of intensive care at UZ Gent

‘It is still too early to judge whether the mortality among the covid patients on intensive care is lower than during the first wave’, says Dominique Benoit, head of intensive care at UZ Gent, where they have now compared a fifth of the number of patients with the peak in spring. During the first wave, about 20 percent, or 1 in 5 of the covid patients on intensive care, died. So far, the covid patients on our ward are still seeing the same ventilation duration, an average of two weeks, and length of stay as during the first wave. ‘

Systematic use of cortisone

Although there is an important difference. “Clinical studies indicate that cortisone reduces mortality in critically ill patients from 40 to 30 percent,” says Benoit. ‘We certainly expect this to have an effect in the long term. During the first wave, we administered cortisone sporadically, but we have been doing this systematically for quite some time now. ‘

Guy Hans, medical director of UZ Antwerpen, also refers to the availability of better and more targeted medication. While we had nothing at the start of the first wave, we now have a ton of treatment protocols. For example, we can even administer corticosteroids and an antiviral agent such as remdesivir early, even to covid patients who are not on intensive care units. ‘

Benoit sees another difference from the first wave. ‘Then at UZ Gent we only saw patients on intensive care who were ill due to Covid-19 and thus showed the typical symptoms, such as pneumonia. Today we also see people in intensive care who are infected with the virus, but do not get sick from it. After surgery, they are on intensive care without artificial respiration, for example with a stomach bleeding or intestinal perforation. Such cases indicate that the virus is highly circulating in the population. Since they tested positive for Covid-19 we have to isolate them. That weighs on the capacity of the hospital. ‘

At UZ Antwerpen, Hans notes that fewer patients need to be intubated in intensive care than during the first wave. ‘Perhaps this has to do with the fact that our global Covid-19 population, including the patients who are not on intensive care units, is slightly younger this time and is less burdened with other risk factors. Thorough research should prove that. It is very beneficial in any case, because those patients have to stay in intensive care for less time and have a better chance of survival.

‘Another big difference with the first wave is that thanks to our telecovid program, we can monitor more and more patients at home, who are referred by a doctor, for example. They keep a digital diary and we advise them, for example on the correct lying position. If we notice that they suddenly deteriorate quickly, we can immediately take them to the hospital. ‘

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