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Has the likelihood of surviving COVID-19 increased over time?

by Grailing Anthonisen - August 19, 2020   3027 Views   6 min
Has the likelihood of surviving COVID-19 increased over time?

Claim

As healthcare professionals learn more about COVID-19, people’s chances of survival increase, partly because they have learned about something called “happy hypoxia” and possible treatments

Verdict

Unsubstantiated (insufficient data)

This claim was sent to us by a user of the COVID19facts.ca portal through our contact form and has been circulating on Facebook pages. It suggests that as healthcare professionals learn more about COVID-19, people’s chances of survival increase. The evidence to support this claim is largely unsubstantiated. While there is preliminary data and studies to support that the survival rate has increased and treatment options have expanded, there is still more research necessary to confirm it.

The claim relies partly on the idea that healthcare professionals have learned about something called “happy hypoxia” as well as possible treatments and therefore are better able to care for COVID-19 patients. It references a number of new strands of research and preliminary studies, including treatments like remdesivir and favipiravir.

Has the survival rate of COVID-19 increased?

According to a study published by the American College of Cardiology, the mortality rate of COVID-19 patients in intensive care units has decreased since March. This study identified 24 observational studies and included 10,150 patients from centers across Asia, Europe, and North America. However, it also noted that the mortality rate of COVID-19 has so far been broadly consistent around the world. Similarly, according to the Centre for Evidence-Based Medicine, British hospitals found that the COVID-19 deaths in United Kingdom dropped between April and June.

 John Hopkins Medicine shares that some evidence suggests patients are recovering more, which is partly from increased knowledge of the disease. Another part is that the average age of patients contracting COVID-19 is dropping. Generally, these younger patients are more resilient and more able to recover.

 The World Health Organization (WHO) says it is difficult to establish figures during a pandemic for a number of reasons. This can be explained because a proportion of patients are asymptomatic or only have mild symptoms and do not present for testing, neglected or under-served groups may be undetected, testing capacity may be limited and restricted and cases could be misdiagnosed. Countries could also be more or less likely to detect and report deaths.

Does increased medical knowledge about “happy hypoxia”, or “silent hypoxemia”, help its treatment?

Hypoxia is when there is lower than normal levels of oxygen in the blood and the body is deprived of oxygen. According to the American Lung Association, “happy hypoxia”, or “silent hypoxemia”, is when blood oxygen levels drop, but the usual signs of it, like breathlessness or discomfort, are not present. Usually, it is a later symptom of COVID-19. They explain that it is still uncertain what causes this and that more studies are necessary.

There are multiple studies, like one published in Respiratory Research, exploring happy hypoxia and it is still uncertain how many patients experience it. There is new information and more studies, which allow healthcare professionals to be more informed while treating and monitoring patients.

Have treatment options improved?

While there is currently no vaccine or cure for COVID-19, there are a number of drug therapies and techniques that are recommended or under investigation to reduce the severity of COVID-19. One technique is for adults to sleep or lie on their stomach, in a prone position. There is a growing number of studies published in journals like Lancet and JAMA Internal Medicine that suggest this and WHO has released clinical management recommendations that include this technique, but has reservations because evidence is lacking and should be done under clinical trial protocol to assess efficacy and safety.

The claim specifically mentions remdesivir and favipiravir are not approved for treatment or prophylaxis, outside of the context of clinical trials. There are a number of clinical drug trials happening around the world, looking at existing drugs for “off label” use, including these two. “Off label” means that treating COVID-19 is not one of their standard or approved uses. Remdesivir was initially developed to treat Ebola, while favipiravir was initially developed to treat influenza.

WHO launched Solidarity clinical trial in partnership with 21 countries to find an effective treatment for patients hospitalized with COVID-19. One of these drugs is remdesivir. WHO recommends against widespread use of this treatment until there is evidence to prove that the drugs are safe and effective. Remdesivir has been approved in one country for treatment of COVID-19 patients, and for several others for emergency use. According to preliminary results of a randomized, controlled trial involving 1063 patients published by the New England Journal of Medicine, remdesivir increased recovery time for patients. John Hopkins Medicine notes that while there has been a small trial that suggests favipiravir can help treat, more studies are needed.

On 27 July 2020,  Canada  became the first country to approve the use of remdesivir by prescription, through the drug Veklury. Health Canada stated that “The efficacy and safety of Veklury in the treatment of COVID-19 have not been fully characterized at this time because the available clinical trial data are not comprehensive. (…) However, given the high unmet medical need and emergency context of the COVID-19 pandemic, Health Canada considered the balance of benefit and harm for Veklury to be positive.” A number of countries, including the United States, have also approved the emergency use of remdesivir. Favipiravir, according to WHO, still needs more preclinical data before it can be added to the solidarity trial.

The evidence is still in its early stages of testing to ensure that they are effective and safe. Remdesivir is at phase III out of IV of clinical studies. According to the American Food and Drug Administration, only 25 to 30% of drugs pass phase III. Favipiravir is further behind than remdesivir in testing.

Why isn’t preliminary evidence enough to make conclusions?

While the claim was correct that healthcare professionals have gotten better at treating patients with COVID-19, there isn’t enough evidence yet to confirm that survival rates have increased. Much of its specific points regarding treatments and techniques to treat symptoms are still in the preliminary phases of research. In reading about studies and research, it’s important to keep in mind that preliminary evidence and studies are not conclusive and are usually conducted to see if more follow-up research would be valuable. Healthcare professionals still don’t fully understand how COVID-19 affects different people and there is still a great deal of information and studies that are necessary.

How did this post travel and get changed?

A user of the COVID19Facts.ca portal emailed us this claim. It has been posted on a variety of message forums and Facebook pages. The posts are identical, beginning with “A professor of pharmacy at U of Toronto friend sent this clearly worded update to his family”, without ever naming the professor. It ends with a call to action, encouraging other people to share the post to share positive news, similar to a chain email. It can be tempting to share good news, but it is important to critically examine it before sharing because there are a number of elements of this post that should raise red flags. The first being, it does not identify the source of this information.

The earliest case of this claim that we can find was posted to the Georgia section of Patch, a local news and information sharing platform, by Yu Kang. According to her bio, she is a licensed acupuncturist, a registered dietitian, and a certified herbalist in Atlanta, Georgia. She is not affiliated with the University of Toronto, but the post is largely the same. The original post includes more reminders to practice physical distancing, wear face masks, work from home when possible, hand wash and stay home during lockdown.

In its reposting, some of the recommended preventative measures are removed and a new source is added, likely to increase legitimacy. Repeating preliminary findings without emphasizing that they are, risks downplaying the continued seriousness of COVID-19 and the fact that, while a lot is being learned, there is still more research necessary. In its reposting, the claim could also easily have been altered at any point if someone were to copy and paste it to a new platform.

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The American College of Cardiology

https://www.acc.org/latest-in-cardiology/journal-scans/2020/07/21/13/29/outcomes-from-intensive-care-in-patients

The American Lung Association

https://www.lung.org/media/press-releases/silent-hypoxia-covid-19

The American Journal of Respiratory and Critical Care Medicine

https://www.atsjournals.org/doi/10.1164/rccm.202006-2157CP

Centre for Evidence-Based Medicine

https://www.cebm.net/covid-19/declining-death-rate-from-covid-19-in-hospitals-in-england/

Federal Drug Administration

https://www.fda.gov/media/137565/download

https://www.fda.gov/patients/drug-development-process/step-3-clinical-research

Health Canada

https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?lang=en&linkID=RDS00669

Journal of Respiratory Research

https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-020-01462-5

John Hopkins Medicine

https://www.hopkinsmedicine.org/coronavirus/

https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_#4

https://www.hopkinsguides.com/hopkins/ub?cmd=repview&type=479-1161&name=14_538747_PDF

The New England Journal of Medicine

https://www.nejm.org/doi/10.1056/NEJMoa2021436

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

The World Health Organization

https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19

https://www.who.int/publications/i/item/clinical-management-of-covid-19

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments

https://www.who.int/news-room/detail/16-06-2020-who-welcomes-preliminary-results-about-dexamethasone-use-in-treating-critically-ill-covid-19-patients

https://www.who.int/publications/i/item/who-r-d-blueprint-covid-19-informal-consultation-on-the-potential-inclusion-of-favipiravir-in-a-clinical-trial

  Claim

Facebook users

Organization
As healthcare professionals learn more about COVID-19, people’s chances of survival increase, partly because they have learned about something called “happy hypoxia” and possible treatments

Verdict:

Unsubstantiated (insufficient data)

 August 19, 2020


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