Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.
"We find that the death rate has gone down substantially," says Leora Horwitz, a doctor who studies population health at New York University's Grossman School of Medicine and an author on one of the studies, which looked at thousands of patients from March to August.
The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.
That's a big improvement, but 7.6% is still a high risk compared with other diseases, and Horwitz and other researchers caution that COVID-19 remains dangerous.
The death rate "is still higher than many infectious diseases, including the flu," Horwitz says. And those who recover can suffer complications for months or even longer. "It still has the potential to be very harmful in terms of long-term consequences for many people."
Studying changes in death rate is tricky because although the overall U.S. death rate for COVID-19 seems to be dropping, the drop coincides with a change in whom the disease is sickening.
"The people who are getting hospitalized now tend to be much younger, tend to have fewer other diseases and tend to be less frail than people who were hospitalized in the early days of the epidemic," Horwitz says.
So have death rates dropped because of improvements in treatments? Or is it because of the change in who's getting sick?
To find out, Horwitz and her colleagues looked at more than 5,000 hospitalizations in the NYU Langone Health system between March and August. They adjusted for factors including age and other diseases, such as diabetes, to rule out the possibility that the numbers had dropped only because younger, healthier people were getting diagnosed. They found that death rates dropped for all groups, even older patients by 18 percentage points on average.
The research, an earlier version of which was shared online as a preprint in August, will appear next week in the Journal of Hospital Medicine.
"I would classify this as a silver lining to what has been quite a hard time for many people," says Bilal Mateen, a data science fellow at the Alan Turing Institute in the United Kingdom. He has conducted his own research of 21,000 hospitalized cases in England, which also found a similarly sharp drop in the death rate. The work, which will soon appear in the journal Critical Care Medicine and was released earlier in preprint, shows an unadjusted drop in death rates among hospitalized patients of around 20 percentage points since the worst days of the pandemic.
Mateen says drops are clear across ages, underlying conditions and racial groups. Although the paper does not provide adjusted mortality statistics, his rough estimates are comparable to those Horwitz and her team found in New York.
"Clearly, there's been something [that's] gone on that's improved the risk of individuals who go into these settings with COVID-19," he says.
Horwitz and others believe many things have led to the drop in the death rate. "All of the above is often the right answer in medicine, and I think that's the case here, too," she says.
Doctors around the country say that they're doing a lot of things differently in the fight against COVID-19 and that treatment is improving. "In March and April, you got put on a breathing machine, and we asked your family if they wanted to enroll you into some different trials we were participating in, and we hoped for the best," says Khalilah Gates, a critical care pulmonologist at Northwestern Memorial Hospital in Chicago. "Six plus months into this, we kind of have a rhythm, and so it has become an everyday standard patient for us at this point in time."
Doctors have gotten better at quickly recognizing when COVID-19 patients are at risk of experiencing blood clots or debilitating "cytokine storms," where the body's immune system turns on itself, says Amesh Adalja, an infectious disease, critical care and emergency medicine physician who works at the Johns Hopkins Center for Health Security.
He says that doctors have developed standardized treatments that have been promulgated by groups such as the Infectious Diseases Society of America.
"We know that when people are getting standardized treatment, it makes it much easier to deal with the complications that occur because you already have protocols in place," Adalja says. "And that's definitely what's happened in many hospitals around the country."
But Horwitz and Mateen say that factors outside of doctors' control are also playing a role in driving down mortality. Horwitz believes that mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients.
And Mateen says that his data strongly suggest that keeping hospitals below their maximum capacity also helps to increase survival rates. When cases surge and hospitals fill up, "staff are stretched, mistakes are made, it's no one's fault — it's that the system isn't built to operate near 100%," he says.
For these reasons, Horwitz and Mateen believe that masking and social distancing will continue to play a big role in keeping the mortality rate down, especially as the U.S. and U.K. move into the fall and winter months.
Gates adds that the takeaway definitely should not be to cast the mask aside. There is still no cure for this disease, and even patients who recover can have long-term side effects. "A lot of my patients are still complaining of shortness of breath," she says. "Some of them have persistent changes on their CT scans and impacts on their lung functions."
And many people will continue to die, even if the rate has dropped. A recent estimate by the Institute for Health Metrics and Evaluation suggests the total death count could reach well over 300,000 Americans by February.
"I do think this is good news," Horwitz says of her research findings, "but it does not make the coronavirus a benign illness."
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There's a thing called the mom penalty. It's the price women pay when they step back from their jobs to have kids. The penalty is severe for well-educated, highly paid women. Stepping down the career ladder puts their earning power and futures as female leaders at risk. Now the pandemic is piling on, as NPR's Andrea Hsu explains.
ANDREA HSU, BYLINE: Joyce Chen was that working mom who somehow was making it all work. She's an associate professor of development economics at the Ohio State University. She was eyeing a promotion to full professor next year, a rare achievement for women in economics. And then came the pandemic.
JOYCE CHEN: It's almost impossible to do research (laughter) in these kinds of circumstances. You know, there's always something going on, and somebody needs something or something's not working.
HSU: Her husband's been tied up with a huge pandemic-related project, so she has been the parent keeping things together for their three kids, which means her own research is now on hold.
CHEN: You know, the first month or two, I thought maybe I'd be able to get back to it. But that never really happened.
HSU: She's missed out on grant opportunities, and she hasn't submitted any papers for publication this year. She's turned down collaborations.
CHEN: And of course, it's not just women that are having to do that now. But, you know, that's something that's going to ripple out through your entire career, really.
HSU: Chen has had four productive years but now wonders if that promotion might be derailed. Harvard economist Claudia Goldin has seen this division of labor play out for decades in affluent, highly educated families just like Chen's. And she's seeing it play out now in the pandemic.
CLAUDIA GOLDIN: Women just step into that void.
HSU: Creating not just the mom penalty but the dad premium. In normal times, it's driven by the biological clock. Women step back to have and raise kids just as their careers are taking off, giving men the opportunity not just to carry on with work but to amp up their careers. For women, the setbacks can be significant and long-lasting, especially so for those in higher-paid fields. Take MBAs. Goldin found that starting salaries for men and women are pretty close, but by mid-career, women make just 64 cents for every dollar earned by men.
GOLDIN: The differences when they come out pale in comparison to the differences that evolve over time.
HSU: And Goldin ties that directly to motherhood. Jessica Mintz of Los Angeles never imagined she'd be a stay-at-home mom. She's had an exciting career in corporate marketing over 14 years, even worked when her kids were babies.
JESSICA MINTZ: Before, I would say we were a very, like, two-career balanced family. And now we're very traditional. My husband's the only one working. I'm home with the kids.
HSU: Mintz had a nanny up until last year. Now she spends her days homeschooling her 4-year-old and helping her second-grader with distance learning.
MINTZ: I don't know when this is going to end. I don't know when we'll be able to go back to something that resembled normal. But I do worry that when I get to that point, I'll have had this gap.
HSU: A career gap brought on by the pandemic. Mintz worries that this lost time could make her less competitive, but here's the reality. Even with an MBA, she wasn't earning as much as her husband. He's in sales. If they were going to live on one salary, it had to be his.
MINTZ: In terms of our family, there was no way that it could have been him who stepped into this position.
HSU: Now, of course, there are exceptions to all of this - dads who've stayed home with kids and moms like Amy Chantasirivisal. She is a software engineer who spent 13 years building websites in Silicon Valley, where it was growth at all cost.
AMY CHANTASIRIVISAL: If it wasn't seven days a week - and in some cases, it was - it was at the very least on your mind seven days a week even if you weren't actively working.
HSU: So six months after having a baby, Chantasirivisal realized she had no path forward in the relentless startup culture. She went looking for change and landed at a small tech company founded by a husband and wife who are themselves parents who get it. Early on in the pandemic, they told their employees, things are not business as usual. Take the time you need, which Chantasirivisal took as...
CHANTASIRIVISAL: Permission to be unproductive.
HSU: That bit of empathy, she says, goes a long way. Business at the company remains good, proving that even in a pandemic, there are possibilities - just nowhere near enough and out of reach for far too many women.
Andrea Hsu, NPR News. Transcript provided by NPR, Copyright NPR.