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Death rates have fallen by 18% for hospitalized COVID–19 patients as treatments improve

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Professor of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco
Monica Gandhi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Two large recent studies show that people hospitalized for COVID-19 in March were more than three times as likely to die as people hospitalized for COVID–19 in August.
The first study used data from three hospitals in New York City. The chance of death for someone hospitalized for the coronavirus in those hospitals dropped from an adjusted 25.6% in March to 7.6% in August. The second study, which looked at survival rates in England, found a similar improvement.
In March, out of 1,724 people hospitalized for COVID-19 in the three New York hospitals, 430 died. In August, 134 were hospitalized and five died. This change in the raw numbers could be driven by who was arriving at the hospital – if only older people were getting sick, the death rate would be higher, for example – but the researchers controlled for this in their calculations.
To better understand what was causing this decrease in hospitalization death rate, the researchers accounted for a number of possible confounding factors, including the age of patients at hospitalization, race and ethnicity, the amount of oxygen support individuals needed when they got to the hospital and such risk factors as being overweight, smoking, high blood pressure, diabetes, lung disease and so on.
No matter what their specific situation, a person hospitalized in March for COVID-19 was more than three times as likely to die as one hospitalized in August.

The study in England looked at hospitalized coronavirus patients who were sick enough to go to a high-dependency unit (HDU) – one where they were monitored closely for oxygen needs – or the intensive care unit (ICU). As in the New York study, the researchers also accounted for confounding factors, but they calculated survival rates instead of mortality rates.
Looking at 21,082 hospitalizations in England from March 29 to June 21, 2020, the authors found a continuous improvement in survival rates of 12.7% per week in the HDU and 8.9% per week in the ICU. Overall, between March and June the survival rate improved from 71.6% to 92.7% in the HDU and from 58% to 80.4% in the ICU. These increases in survival after hospitalization for the coronavirus in England mirrored the changes in New York City.
The main reason researchers think coronavirus patients are doing better is simply that there are now effective treatments for the virus that didn’t exist in March.
I am a practicing infectious disease doctor at the University of California, San Francisco, and I have witnessed these improvements firsthand. Early on, my colleagues and I had no idea how to treat this brand-new virus that burst onto the scene in late 2019. But over the spring, large studies tested different treatments for COVID-19 and we now use an antiviral called remdesivir and a steroid called dexamethasone to treat our hospitalized coronavirus patients.
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Along with these new treatments, physicians gained experience and learned simple techniques that improved outcomes over time, such as positioning a patient with low oxygen in a prone position to help distribute oxygen more evenly throughout the lungs. And as time has gone on, hospitals have become better prepared to handle the increased need for oxygen and other specialized care for patients with the coronavirus.
Though improvements in care and effective drugs like remdesivir and dexamethasone have helped greatly, the virus is still very dangerous. People with severe cases can suffer prolonged symptoms of fatigue and other debilitating effects. Therefore, other treatments should be and are still explored.
Treatments have undoubtedly gotten better. But the authors of the New York City study specifically mention that public health measures not only led to the plummeting hospitalization rates – 1,724 in March vs. 134 in August – but might have helped lower death rates too.
My own research proposes that social distancing and face coverings may reduce how much virus people are exposed to, overall leading to less severe cases of COVID–19. It is important to continue to follow public health measures to help us get through the pandemic. This will slow the spread of the virus and help keep people healthier until a safe and effective vaccine is widely available.
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How to stay safe with a fast-spreading new coronavirus variant on the loose

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Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University
Associate Professor of Mechanical Engineering, Clarkson University
Suresh Dhaniyala receives funding from National Science Foundation and NY State Energy Research and Development Authority.
Byron Erath receives funding from the National Institutes of Health, the National Science Foundation, and the Empire State Development's Division of Science, Technology and Innovation (NYSTAR)

Clarkson University provides funding as a member of The Conversation US.
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A fast-spreading variant of the coronavirus that causes COVID-19 has been found in at least 20 states, and people are wondering: How do I protect myself now?
We saw what the new variant, known as B.1.1.7, can do as it spread quickly through southeastern England in December, causing case numbers to spike and triggering stricter lockdown measures.
The new variant has been estimated to be 50% more easily transmitted than common variants, though it appears to affect people’s health in the same way. The increased transmissibility is believed to arise from a change in the virus’s spike protein that can allow the virus to more easily enter cells. These and other studies on the new variant were released before peer review to share their findings quickly.
Additionally, there is some evidence that patients infected with the new B.1.1.7 variant may have a higher viral load. That means they may expel more virus-containing particles when they breathe, talk or sneeze.
As professors who study fluid dynamics and aerosols, we investigate how airborne particles carrying viruses spread. There is still a lot that scientists and doctors don’t know about the coronavirus and its mutations, but there are some clear strategies people can use to protect themselves.

The SARS-CoV-2 variants are believed to spread primarily through the air rather than on surfaces.
When someone with the coronavirus in their respiratory tract coughs, talks, sings or even just breathes, infectious respiratory droplets can be expelled into the air. These droplets are tiny, predominantly in the range of 1-100 micrometers. For comparison, a human hair is about 70 micrometers in diameter.
The larger droplets fall to the ground quickly, rarely traveling farther than 6 feet from the source. The bigger problem for disease transmission is the tiniest droplets – those less than 10 micrometers in diameter – which can remain suspended in the air as aerosols for hours at a time.
With people possibly having more virus in their bodies and the virus being more infectious, everyone should take extra care and precautions. Wearing face masks and social distancing are essential.
Spaces and activities that were previously deemed “safe,” such as some indoor work environments, may present an elevated infection risk as the variant spreads.
The concentration of aerosol particles is usually highest right next to the individual emitting the particles and decreases with distance from the source. However, in indoor environments, aerosol concentration levels can quickly build up, similar to how cigarette smoke accumulates within enclosed spaces. This is particularly problematic in spaces that have poor ventilation.
With the new variant, aerosol concentration levels that might not have previously posed a risk could now lead to infection.

1) Pay attention to the type of face mask you use, and how it fits.
Most off-the-shelf face coverings are not 100% effective at preventing droplet emission. With the new variant spreading more easily and likely infectious at lower concentrations, it’s important to select coverings with materials that are most effective at stopping droplet spread.
When available, N95 and surgical masks consistently perform the best. Otherwise, face coverings that use multiple layers of material are preferable. Ideally, the material should be a tight weave. High thread count cotton sheets are an example. Proper fit is also crucial, as gaps around the nose and mouth can decrease the effectiveness by 50%.
2) Follow social distancing guidelines.
While the current social distancing guidelines are not perfect – 6 feet isn’t always enough – they do offer a useful starting point. Because aerosol concentrations levels and infectivity are highest in the space immediately surrounding anyone with the virus, increasing physical distancing can help reduce risk. Remember that people are infectious before they start showing symptoms, and they many never show symptoms, so don’t count on seeing signs of illness.
3) Think carefully about the environment when entering an enclosed area, both the ventilation and how people interact.
Limiting the size of gatherings helps reduce the potential for exposure. Controlling indoor environments in other ways can also be a highly effective strategy for reducing risk. This includes increasing ventilation rates to bring in fresh air and filtering existing air to dilute aerosol concentrations.
On a personal level, it is helpful to pay attention to the types of interactions that are taking place. For example, many individuals shouting can create a higher risk than one individual speaking. In all cases, it’s important to minimize the amount of time spent indoors with others.
The CDC has warned that B.1.1.7 could become the dominant SARS-CoV-2 variant in the U.S. by March. Other fast-spreading variants have also been found in Brazil and South Africa. Increased vigilance and complying with health guidelines should continue to be of highest priority.
[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]
This story was updated Jan. 18 with latest CDC count and map showing B.1.1.7 cases now found in 20 states.
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How to stay safe with a new fast-spreading coronavirus variant on the loose

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Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University
Associate Professor of Mechanical Engineering, Clarkson University
Suresh Dhaniyala receives funding from National Science Foundation and NY State Energy Research and Development Authority.
Byron Erath receives funding from the National Institutes of Health, the National Science Foundation, and the Empire State Development's Division of Science, Technology and Innovation (NYSTAR)

Clarkson University provides funding as a member of The Conversation US.
View all partners
A fast-spreading variant of the coronavirus that causes COVID-19 has been found in at least 10 states, and people are wondering: How do I protect myself now?
We saw what the new variant, known as B.1.1.7, can do as it spread quickly through southeastern England in December, causing case numbers to spike and triggering stricter lockdown measures.
The new variant has been estimated to be 50% more easily transmitted than common variants, though it appears to affect people’s health in the same way. The increased transmissibility is believed to arise from a change in the virus’s spike protein that can allow the virus to more easily enter cells. These and other studies on the new variant were released before peer review to share their findings quickly.
Additionally, there is some evidence that patients infected with the new B.1.1.7 variant may have a higher viral load. That means they may expel more virus-containing particles when they breathe, talk or sneeze.
As professors who study fluid dynamics and aerosols, we investigate how airborne particles carrying viruses spread. There is still a lot that scientists and doctors don’t know about the coronavirus and its mutations, but there are some clear strategies people can use to protect themselves.
The SARS-CoV-2 variants are believed to spread primarily through the air rather than on surfaces.
When someone with the coronavirus in their respiratory tract coughs, talks, sings or even just breathes, infectious respiratory droplets can be expelled into the air. These droplets are tiny, predominantly in the range of 1-100 micrometers. For comparison, a human hair is about 70 micrometers in diameter.
The larger droplets fall to the ground quickly, rarely traveling farther than 6 feet from the source. The bigger problem for disease transmission is the tiniest droplets – those less than 10 micrometers in diameter – which can remain suspended in the air as aerosols for hours at a time.
With people possibly having more virus in their bodies and the virus being more infectious, everyone should take extra care and precautions. Wearing face masks and social distancing are essential.
Spaces and activities that were previously deemed “safe,” such as some indoor work environments, may present an elevated infection risk as the variant spreads.
The concentration of aerosol particles is usually highest right next to the individual emitting the particles and decreases with distance from the source. However, in indoor environments, aerosol concentration levels can quickly build up, similar to how cigarette smoke accumulates within enclosed spaces. This is particularly problematic in spaces that have poor ventilation.
With the new variant, aerosol concentration levels that might not have previously posed a risk could now lead to infection.

1) Pay attention to the type of face mask you use, and how it fits.
Most off-the-shelf face coverings are not 100% effective at preventing droplet emission. With the new variant spreading more easily and likely infectious at lower concentrations, it’s important to select coverings with materials that are most effective at stopping droplet spread.
When available, N95 and surgical masks consistently perform the best. Otherwise, face coverings that use multiple layers of material are preferable. Ideally, the material should be a tight weave. High thread count cotton sheets are an example. Proper fit is also crucial, as gaps around the nose and mouth can decrease the effectiveness by 50%.
2) Follow social distancing guidelines.
While the current social distancing guidelines are not perfect – 6 feet isn’t always enough – they do offer a useful starting point. Because aerosol concentrations levels and infectivity are highest in the space immediately surrounding anyone with the virus, increasing physical distancing can help reduce risk. Remember that people are infectious before they start showing symptoms, and they many never show symptoms, so don’t count on seeing signs of illness.
3) Think carefully about the environment when entering an enclosed area, both the ventilation and how people interact.
Limiting the size of gatherings helps reduce the potential for exposure. Controlling indoor environments in other ways can also be a highly effective strategy for reducing risk. This includes increasing ventilation rates to bring in fresh air and filtering existing air to dilute aerosol concentrations.
On a personal level, it is helpful to pay attention to the types of interactions that are taking place. For example, many individuals shouting can create a higher risk than one individual speaking. In all cases, it’s important to minimize the amount of time spent indoors with others.
The CDC has warned that B.1.1.7 could become the dominant SARS-CoV-2 variant in the U.S. by March. Other fast-spreading variants have also been found in Brazil and South Africa. Increased vigilance and complying with health guidelines should continue to be of highest priority.
[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]
Write an article and join a growing community of more than 119,500 academics and researchers from 3,844 institutions.
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The great polio vaccine mess and the lessons it holds about federal coordination for today’s COVID-19 vaccination effort

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Associate Professor of International Business and Strategy at the D'Amore-McKim School of Business, Northeastern University
Bert Spector does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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I nervously fell into a long line of fellow first graders in the gymnasium of St. Louis’ Hamilton Elementary School in the spring of 1955. We were waiting for our first injection of the new polio vaccine.
The National Foundation for Infantile Paralysis – with money raised through its annual March of Dimes campaign – had sponsored field tests for a vaccine developed by Jonas Salk. The not-for-profit had acquired sufficient doses to inoculate all the nation’s first and second graders through simultaneous rollouts administered at their elementary schools. The goal was to give 30 million shots over three months.
Now, more than six decades later, attention focuses on the rollout of two COVID-19 vaccines, following their emergency use authorization by the U.S. Food and Drug Administration. States have begun to administer them in a rocky and frustratingly slow delivery process – while hundreds of thousands of new cases continue to be diagnosed daily in the U.S.
While not necessarily comforting, it is useful to recognize that the early days and weeks of mass distribution of a new medication, particularly one that is intended to address a fearful epidemic, are bound to be frustrating. Only after examining the complex polio vaccine distribution process as documented in papers collected in the Dwight D. Eisenhower Presidential Library did I come to understand how partial my childhood memories actually were.
After I received my polio shot, I remember my parents’ relief.
The polio virus causes flu-like symptoms in most people who catch it. But in a minority of those infected, the brain and spinal cord are affected; polio can cause paralysis and even death. With the distribution of Salk’s vaccine, the much-feared stalker of children and young adults had seemingly been tamed. Within days, however, the initial mass inoculation program went off the rails.
Immediately following the government’s licensing of the Salk vaccine, the National Foundation for Infantile Paralysis contracted with private drug companies for US$9 million worth of vaccine (around $87 million today) – about 90% of the stock. They planned to provide it free to the country’s first and second graders. But just two weeks after the first doses were administered, the Public Health Service reported that six inoculated children had come down with polio.
As the number of such incidents grew, it became clear that some of the shots were causing the disease they were meant to prevent. A single lab had inadvertently released adulterated doses.
After considerable fumbling and outright denial, Surgeon General Leonard Steele first pulled all tainted vaccine off the market. Then, less than a month after the initial inoculations, the U.S. shut down distribution entirely. It wasn’t until the introduction of a new polio vaccine in 1960, created by Albert Sabin, that public trust returned.
This story offers several lessons relevant to the COVID-19 vaccine distribution just now getting rolling.
First, federal coordination of an emergent lifesaving medical product is critical.
The federal government had declined to play an active oversight and coordination role for the polio vaccine, but still wanted the credit. The federal Department of Health, Education and Welfare (now Health and Human Services) offered no plan for distribution beyond the privately funded school-based program.
The department waited a full month after the vaccine was first administered before bringing together a permanent scientific clearance panel. That delay had less to do with formal procedures than with the ideological opposition of Health, Education and Welfare Secretary Oveta Culp Hobby.
Hobby was a political appointee who had taken office just months before the vaccine was approved. Her reluctance to involve the federal government in matters that she believed were best left in private hands – and her oft-stated fear of “socialized medicine” – meant that safety checks would be left to the private labs producing the vaccine. The results immediately caused dire problems and even avoidable deaths.
Second, the polio vaccine distribution process demonstrated how vital it is for the federal government to act in ways deserving of public trust.
In those hopeful first few weeks of the polio vaccine distribution, those of us lining up for shots had little to fear beyond the sting of an injection. That changed quickly.
Once some children had in fact been harmed by the shot, obfuscation by government officials, clumsy explanations and delayed responses engulfed the entire production and distribution process in confusion and suspicion. Trust in the government and the vaccine eroded accordingly. Gallup polls found that by June 1955, almost half of the parents who responded said they would not take any further vaccine shots – and the full regimen of polio inoculation required three doses. In 1958, some drug companies halted production, citing “public apathy.” It wasn’t surprising to see a startling upsurge in polio in 1959, doubling cases from the previous year.
Today, with COVID-19 already highly politicized – polls suggest that a minority of Americans will decline to take any vaccine – it is critical to administer an effective vaccine delivery program in a manner that builds trust rather than undermines it.
Scattered reports of allergic reactions to the COVID-19 vaccine have generated not the denials of the Eisenhower administration but rather honest and realistic responses from the Centers for Disease Control and Prevention. Particularly for vaccines that require multiple inoculations – both Pfizer and Moderna vaccines require two shots administered with a 21- or 28-day gap – mass inoculations will require not just an initial willingness to get the first dose but the maintenance of trust sufficient to get people back for the followup.
There are significant differences in the social-political contexts of the era in which the polio vaccine was distributed and today, including the nature and threat of the two diseases and the technologies of the vaccines. But time and again, the COVID-19 pandemic has revealed disconcerting parallels with mistakes made in the past. The good news is vaccination works – no case of polio has originated in the U.S. since 1979.
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