Most people with COVID-19 recover without needing intensive care. Only the sickest patients are admitted to intensive care units, and only patients who cannot breathe adequately without help are placed on ventilators. Those very sick patients have an increased chance of dying from COVID-19.

The most accurate current estimates of how many people survive intensive care and ventilation treatment are around 60%, measured at 30 days. But the proportion varies widely.

An early report from China found 23 of 29 people in intensive care died, (approximately a 20% survival rate). Concern was also raised by a report from the US that appeared at first to show a very high death rate but was later corrected to show that most of the patients in the study were still alive in hospital.

These estimates vary because it depends on who is admitted to intensive care and who is ventilated, which differs between countries. Treatments for very sick people with COVID-19 are also improving over time as doctors understand more about the underlying disease.

Where did the story come from?

A report on the news website Bloomberg initially said that 88% of people put on ventilators in intensive care in the New York area died. However, this was based on a misunderstanding in the research. Only 3% had recovered and been discharged, 24.5% had died, but most (72%) remained in hospital.

What is the basis for the claim?

Bloomberg reported a study published in the Journal of the American Medical Association, which looked at what happened to 5,700 people with COVID-19 in intensive care in hospitals in the New York City area.

The initial study reported on people who had been discharged or died. Only 38 of 320 people who had been on ventilators had been discharged, 282 had died, giving a death rate for this group of 88%. But a clarification to the study states: “As of April 4, 2020, for 1,151 patients requiring mechanical ventilation, 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital”. We don’t know what happened to those who were still in hospital at the time the study was reported.

An earlier study from China also showed poor outcomes for people needing mechanical ventilation. The Lancet medical journal reported: “The ICU [intensive care unit] mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.”

A study by the Scottish Intensive Care Society found that from the 1st  March to the 2nd  May, 472 patients with COVID-19 were admitted to intensive care in Scotland. Of these, 60% survived, measured at 30 days. Patients who needed “advanced respiratory support” were less likely to survive for 30 days (56% survived) than those who needed non-invasive or other respiratory support (80% survived).

The report showed that 45% of all ICU patients recovered and were discharged, 33% died and 21% were still in intensive care on the 2nd  May.

What do trusted sources say?

The WHO and NHS have not yet commented on the survival rates for people with COVID-19 given mechanical ventilation. However, in the last month or more, many clinical guidelines have been published rapidly to inform those responsible for clinical care.

Analysis by EIU Healthcare, supported by Reckitt Benckiser

Citation

  1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775 https://jamanetwork.com/journals/jama/fullarticle/2765184

Reading list

  1. Scottish Intensive Care Society Audit Group report on COVID-19. 13 May 2020. Management Information Report published by Public Health Scotland. Available at https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/scottish-intensive-care-society-audit-group-report-on-covid-19/ (Accessed 19 May 2020)
  2. National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines
  3. Centres for Disease Control. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
  4. National Institute for Clinical and Care Excellence: 19 rapid guidelines on COVID-19