How data from intensive care units shows second wave won't be as deadly as the first

With coronavirus cases rising and hospitals filling up, it might be tempting to worry that Britain is heading for a second wave as deadly as the first – but new data from intensive care units is telling an altogether different story.

According to the most recent Intensive Care National Audit and Research Center report (Icnarc), the chance of surviving Covid for at least 28 days has risen from 61 per cent to 72 per cent between the two waves.

The fall is seen across all ages, although the news is even better for the under-70s. For those aged between 50 and 69, the risk of death in intensive care has almost halved, dropping from around 38 per cent to just over 20 per cent.

For the under-50s, the mortality risk has fallen from around 18 per cent to below 10 per cent.

Experts believe treatment improvements are starting to have a major impact – particularly the steroid dexamethasone, which prevents the devastating immune system overload that can trigger organ failure.

The drug – commonly used to treat arthritis, severe allergies and asthma – was rolled out across the NHS in June following successful trials by Oxford University, and was expected to have a major impact on the virus pandemic.

"I reckon about half of the improvement in the deaths was probably down to dexamethasone," said Paul Hunter, professor of medicine at the University of East Anglia.

"It's really interesting. The thing that got me is that although there is not much difference in the people going in, what really jumped out is the decline in the probability of deaths. For anyone under 70, deaths have nearly halved.

"If you're under 70 and go into intensive care now, you've got a good chance of surviving."

The team at Icnarc has compared 10,900 patients admitted up to August 31 with 1,233 who entered intensive care on September 1 or later.

In the second wave so far, of the 643 people whose outcomes are known, 14.1 per cent have died and 38 per cent discharged, with 47.9 per cent still receiving care.

Icnarc has warned that the figures are slightly skewed towards those who recover or die early. But at a similar point in the first wave in April, where the outcomes of 690 people were known, 15 per cent had died and just 15 per cent had been discharged, with 70 per cent still needing critical care.

The report also shows that far fewer people are needing intensive breathing or organ support compared to the first wave. While 58 per cent of those up to September 1 needed mechanical ventilation within the first 24 hours of admission, that number is now just 26 per cent – less than half.

Just 28 per cent now need advanced respiratory support, compared to 78 per cent in the first wave, and only 13 per cent require advanced cardiovascular support – fewer than half of those earlier in the year. Almost four times fewer people need kidney support, and three times fewer require neurological help.

Experts say it is possible that doctors have set a lower clinical threshold for admission to intensive care because the system is not as overloaded as during the first wave.

Yet the improvements have come even though patients are entering intensive care with roughly the same "Apache" score as the first wave – an indicator of the probability of dying based on age, oxygen levels, blood pressure, heart rate and blood cell counts.

So although patients are just as sick, they are far less likely to die.

The hopeful findings are not just positive news for lives saved but could also impact lockdown decisions. The average time spent in intensive care is now just five days, compared with 12 in the first wave, which should free up beds (the graphic below shows the locations of critically ill patients since September).

"There are significant differences in ICU admissions, outcomes and survival in those admitted since September 1 compared with the outbreak in spring," said Professor Carl Heneghan of the Centre for Evidence-Based Medicine at Oxford University.

"For every 100 people admitted to intensive care units after September 1, 12 more will survive to 28 days compared with before this date. In those admitted, their need for mechanically ventilatory support, their length of stay and need for renal support are all significantly lower. These improved outcomes are highly reassuring and leading to lower overall mortality of Covid-19.

"There is an urgent need to place the hospital data into context of what normally happens at this time of year. The lack of transparent data and the tendency to over predict and exaggerate the problems is not helping decision-makers and affecting policy."

Experts say it is crucial to match the admissions data to the discharge data to get a true picture of the pandemic.

Once we do, we will realise we are doing better than we think.

There is still a long way to go but, rather than wringing our hands, we should be celebrating the ingenuity of our scientists and doctors and realise just how far we have come.