Do we have evidence that hospitalization of COVID19 patients is actually saving significant numbers of lives?
I’ve now seen multiple studies suggesting that up to 80 or 90 percent of patients who end up on ventilators ultimately die. At this point, I guess there’s no way to know if the other 10 percent would have lived without the ventilators. From what I can tell, most other hospitalized patients are getting supplemental oxygen, IV fluids and antibiotics. I have not seen any evidence on the effectiveness of these treatments. Many of those patients live, but we don’t know whether they would have recovered without hospitalization. It would obviously be impossible to do a RCT on that at the moment.
Answering the question about the efficacy of hospitalization would seem to be critical, though, since, as best I can tell, the main justification for shutting down society now is to prevent our health care system from being overwhelmed – especially the supply of ventilators. If our hospitals are overwhelmed, not only COVID19 patients, but others with treatable injuries/diseases might die. But if hospitalization is not actually saving COVID19 patients in large numbers, then all the costly social interventions we are implementing now are mostly just delaying the spread of infection. Still, I recognize that it’s possible that this delay could save lives in one of two ways (or maybe there are more I’m not thinking of?).
1. We use the time to get better at testing. Then, when we lift the social distancing measures in a month or two, we have the ability to quickly test and isolate infected individuals and their close contacts. Maybe we also have anti-body tests so we can avoid quarantining immune individuals. This keeps the rate of spread relatively low until we have better treatments or a vaccine for those who haven’t been infected yet. It’s possible that “at-risk” groups will have to stay isolated during this time until we get effective treatments/vaccine. I haven’t seen any estimates of how effective this kind of strategy might be – i.e., over a course of 18 months (the time to develop/deploy a vaccine) how many infections would this prevent?
2. We could keep the social distancing policies in place until we get a vaccine/treatment. But if estimates of 18+ months to a vaccine are correct, I suspect the economic costs will be too high to bear to wait it out this way. So this is probably not in the cards.
If the number of lives we can save with #1 is relatively low (I have no idea what the number is), and if #2 is off the table, then we are really just delaying most deaths, at great social cost. It might be better to prevent our hospitals from being overwhelmed by doing better triage for admission – especially to ICU beds and ventilators (what percent of people over age 75 survive after going on a ventilator?), and working on getting people other treatments (oxygen, etc.) at home. At a minimum, it seems like the intense energy and resources focused on ventilators now might be misplaced.
For what it is worth, I’m not a skeptic of the current social distancing policies. I’m pretty sure I’d be doing all this and more if I were in charge. But I’d also be looking for evidence that what we are doing is the best course of action, given the massive costs.
That is an email from a very smart person. To that tally we also must add the negative that hospitals often become a vector for the further spread of the virus.
So what does the best evidence say here?