Even during the Corona period, there is sometimes good news from the intensive care units. It is the beautiful individual cases that doctors and nurses can celebrate there again and again: With all the suffering that occurs every day in the intensive care units, there are also Covid sufferers every day who, after weeks of struggling with death, still come back to life and can be transferred to the normal ward. These cases have recently become relatively more frequent in the statistics. Germany’s university hospitals are currently reporting that the mortality of their Covid 19 intensive care patients has dropped significantly after the first wave. While at the beginning of the pandemic, between January and April 2020, 21 percent of intensive care patients died, between May and September 2020 it was only 13 percent. The number of ventilated patients who succumbed to their Covid 19 disease also fell during this time – from 40 to 34 percent.
“With all the depressing developments and the great burden on the staff, this is at least a positive signal,” says Jürgen Schüttler, director of the anesthesiological clinic at the University Clinic Erlangen and first author of the data analysis, for which 14 university clinics joined forces and data from their more than 1,300 patients have evaluated from this time. “We’re able to cope better with the disease and save more people’s lives.”
From Schüttler’s point of view, the main reason for this is the gain in experience. “You have learned little by little what the best therapy is,” says the anesthetist. The initially used drug hydroxychloroquine is no longer used, but the value of anticoagulants and anti-inflammatory drugs is now known. “The increased experience is a major reason for the increased chances of survival”, confirms the infectiologist Clemens Wendtner, whose team at the Munich Clinic Schwabing has treated almost 2500 Covid patients.
According to Schüttler, the mortality of the severely affected patients has not increased again since the end of the evaluation – not even now, since the mutant B.1.1.7 is spreading, which, according to British data, is associated with an increased mortality rate. “Our figures do not yet confirm this experience from Great Britain,” said Schüttler. “But what we can see: That the deterioration in the course of the disease with B.1.1.7 is more dynamic than with the old virus variant.” The infected get to the intensive care unit faster.
Something else has changed since summer 2020: The Covid intensive care patients are now younger, the effect of the vaccinations is noticeable. “We see fewer people over 80,” says Schüttler, “and we see more patients between 50 and 70 years of age.” This is also the case with Clemens Wendtner in Schwabing: “We currently have a patient born in 1984 with us and another patient born in 1977,” says Wendtner. “Overall, we see a 15 to 20 year drop in the average age.”
However, last year, too, the patients in the intensive care units were not as old as the average age at death of all Covid-19 patients of over 80 years would suggest. The 1318 patients who were treated at the 14 university hospitals between January and September 2020 were only 61 years old on average, the ventilated patients were 64 years old.
The high proportion of men is striking. The data from the university clinics once again confirm that men are at a particularly high risk of a severe course of Covid: 64 percent of their intensive care patients were male, among the ventilated patients it was even 75 percent. Across Germany, according to the Robert Koch Institute (RKI), women and men were infected with Sars-CoV-2 about equally often. However, men “get seriously ill more often and die twice as often as women,” explains the RKI. The risk of needing ventilation is also twice as high for men as for women.
“The reasons for this are still unclear,” says Bernhard Zwißler, director of anesthesiology at Munich University Hospital. Pre-existing illnesses may play a role: Men suffer more than women from cardiovascular diseases, which are considered a significant risk factor for a severe course of Covid-19. In addition, women are generally awarded a better immune defense.
But there is also a possible molecular mechanism: The Sars-CoV-2 virus attacks human cells via a molecule called ACE2 on the surface of the cells. This molecule is found in higher concentrations in men, as scientists from the University Medical Center Groningen discovered last May. An international working group with the participation of the Charité and the Helmholtz Center Munich has just shown that not only men but also smokers and the elderly have a particularly large number of these door openers for Sars-CoV-2 viruses on their cells. Covid-19 hits all of these groups particularly hard. The connection is becoming increasingly clear, says Bernhard Zwißler.
Regardless of the reason for the gender difference, men and women could soon be dependent on an intensive care bed again much more often. “The number of occupied intensive care beds is already rising steeply,” says Clemens Wendtner. There is no end in sight, because this number follows the number of infections, which has risen dramatically since March 11, by about three to four weeks. If the development continues like this, the good survival figures of intensive care patients will no longer be maintained, Wendtner fears: “If we get capacity problems and can no longer adequately care for the patients, then mortality will inevitably rise.”