Some improvements in the treatment of COVID-19 that have resulted in reduced mortality rate include the use of Remdesivir in the early COVID-19 treatment cycle, critical care-guided early intervention, and early detection of high-risk patients, and the use of dexamethasone on critical COVID-19 patients.
1. Treatment with Remdesivir (GS-5734™)
- Remdesivir, an antiviral product, is currently being tested in multiple international trials for its effectiveness in treating COVID-19 patients. In the US, this drug has gained the status of “Emergency Use Authorization (EUA)” from the FDA department. “According to the results of the Phase 3 SIMPLE-Severe trial, the use of Remdesivir in COVID-19 patients showed an improvement in the clinical recovery of patients and a 62 percent reduction in the risk of mortality compared to the standard care treatment regimen.”
- “The mortality rate for patients receiving Remdesivir treatment was 7.6 percent on day 14 compared with 12.5 percent among non Remdesivir patients.”
- Atlantic Health Systems’ CEO, Brian Gragnolati, revealed that the seven hospitals in their health system had changed several things in their COVID-19 treatment regimen, which has led to lower mortality in their COVID-19 patients. One of the changes includes the use of Remdesivir in the early treatment process.
2. Treatment with Dexamethasone
- A controlled, open-label trial conducted by The RECOVERY Collaborative Group and funded by the Medical Research Council and National Institute for Health Research, found that the use of glucocorticoids in treating COVID patients can “reduce progression to respiratory failure and death.” The study evaluated the effectiveness of dexamethasone, a synthetic glucocorticoid, based on a 28-day mortality outcome.
- According to the study results, the incidence of death was lower in patients receiving dexamethasone than in patients receiving standard care; the death incidence rate was significantly lower in patients who were receiving dexamethasone, along with invasive mechanical ventilation or were receiving dexamethasone and oxygen without invasive mechanical ventilation.
- This RECOVERY trial was conducted on patients hospitalized with COVD19 in the United Kingdom.
- As per an official press release from the World Health Organization (WHO), the initial results from dexamethasone’s clinical trial conducted in the UK are very impressive. “According to the findings shared with WHO, for patients on ventilators, the dexamethasone treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was reduced by about one fifth.”
- The researchers from the University of Oxford found that COVID-19 deaths in England fell from 6% to 1.5% between April and June. One of the causes of this decline is the significant changes in the treatment of COVID-19, particularly the use of dexamethasone on critical patients.
- “Other trials have been conducted in six European countries, the United States, Canada, Brazil, New Zealand, Australia, and China, for testing the effectiveness of corticosteroids in reducing mortality rates in COVID-19 patients.”
3. Inflammatory Cytokine Blockade Treatment
- “Multiple clinical trials are testing the efficacy of inflammatory mediators like IL-1, IL-6, TNF-α, GM-CSF, M-CSF, IFN-γ, JAK1/JAK3, CCR2, CCR5, and complement C3/C5″ in the treatment of COVID-19 patients.c
- “Two research studies used the IL-1 receptor antagonist anakinra to treat COVID-19 patients and reported reduced mortality rates (Cavalli et al., 2020; Huet et al., 2020).” The first study observed a “10% mortality rate in COVID-19 patients put on a treatment regimen involving standard care and high-dose anakinra; however, 44% mortality rate was observed in “standard-care only” patients.”
- The second study evaluated two groups; “anakinra treatment and a retrospective control group.” The control group had a 73 percent mortality or admission to ICU rate for invasive mechanical ventilation in COVID-19 patients; however, the anakinra treatment group only had a 25 percent mortality rate.
4. Mesenchymal Stem Cell Treatment
- “Cell‐based therapy to reduce mortality from COVID‐19: Systematic review and meta‐analysis of human studies on acute respiratory distress syndrome,” is a research study that provides evidence about the impact of cell therapy with mesenchymal stromal cells on the overall mortality rate of COVID-19 patients.
- This research study reviewed the results of multiple studies about the impact of cell therapy with mesenchymal stromal cells. According to the research, one of the research studies conducted in China observed a decreased mortality rate in the MSC treatment group patients suffering from COVID‐19 pneumonia.
- “Clinical Study of Mesenchymal Stem Cell Treatment for Acute Respiratory Distress Syndrome Induced by Epidemic Influenza A (H7N9) Infection: A Hint for COVID-19 Treatment,” is an analysis of the available literature on the impact of stem cell therapy on the overall mortality rate of COVID-19 patients. According to this research study, MSC-based cell therapy is an alternative treatment approach for COVID-19 in severe ARDS patients.
- Early phase studies with limited subjects in China have highlighted that MSC treatment on COVID-19 patients can be useful in reducing the overall mortality rate; however, more research is needed for confirming the effectiveness of the treatment.
5. Treatment with SNG001
- A Southampton based pharmaceutical company called Synairgen recently announced the results from “the clinical trial of SNG001, which is an inhaled formulation of interferon beta.” SNG001 was being tested in hospitalized patients of COVID-19, and the preliminary results from the study show that patients receiving SNG001 were at lesser risk of developing severe COVID-19 symptoms (those which could require ventilation or could cause death) as compared to patients receiving placebo.
- The study’s preliminary results highlighted that “the risk of developing severe COVID-19 symptoms that required ventilation or caused death during the treatment period of 16 days was reduced by 79 percent for patients receiving SNG001 compared to those who received placebo.”
- According to an open-label, single-center, randomized trial conducted in Iran, the patients receiving interferon beta-1a had lower 28-day overall mortality.
A Case Study on Jiangsu Province
- Jiangsu is a province in China that controlled the increasing number of Novel Coronavirus Pneumonia patients by applying an early detection and critical care-dominated treatment approach. The first part of the approach was focused on rigorous screening and detection of NCP patients, followed by continuous monitoring; the monitoring data were used to categorize high risk and low-risk NCP patients.
- “For patients who showed signs of ARDS or extensive pulmonary effusion in CT scan, high-flow nasal cannula oxygen therapy (HFNC) or non-invasive mechanical ventilation (NIV) was used to maintain positive end-expiratory pressure (PEEP) to prevent alveolar collapse.”
- Hospitals generally use prone positioning techniques for ARDS patients, hospitals in Jiangsu used awake prone positioning in NCP patients.
- A “clinical experts-guided hierarchical management” was set up in the province to provided guided support for the NCP patients. “Early screening of critically ill patients and critical care-guided early intervention proved extremely helpful in reducing Jiangsu’s NCP patients’ mortality.”
We prioritized listing the improved treatment methods applied by hospitals that have resulted in reduced mortality rates in COVID-19 patients; however, we were unable to list such treatment methods due to the lack of relevant information in the public domain. However, we have provided examples of treatment methods that contributed to reduced mortality in COVID-19 patients. These examples include the use of awake prone positioning, the use of Remdesivir in the early treatment cycle, the use of dexamethasone in critical COVID-19 patients, the use of inflammatory mediators like IL-1 for treating COVID-19 patients.
We have included examples of studies involving hospitalized COVID-19 patients in countries like the US, UK, China, who are involved in the testing of these treatment regimens and have also provided their impact on the mortality rates; however, examples of specific hospitals were not found.
To find the examples of specific hospitals, we searched through research studies published by US health systems or individual hospitals and specialist doctors on effective treatment approaches; however, no relevant techniques were found. We also used the National Clinical Trials Registry to search for treatment approaches that are currently under trial for COVID-19 treatment; we found trials that were testing the prone positioning technique for the treatment of COVID-19 patients, but these trials were still in process and have not produced any preliminary results.
Next, we tried finding relevant research briefs from organizations like AAFP Foundation to find any relevant updates on new techniques that have been proved effective in the treatment of COVID-19 and have had any impact on the overall mortality rate of COVID-19 patients. But, we found no relevant mentions of such treatment techniques.
Lastly, we tried searching for ongoing clinical trials that are evaluating available treatment methods for COVID-19. Solidarity is a clinical trial that was launched by the WHO; we were hoping to find relevant treatment techniques on Solidarity’s portal, but we only found some treatment options (remdesivir, dexamethasone and others) that are available for COVID-19.
Most of the studies included in the research have only shared preliminary results and are still undergoing trials, and some of these research studies have a limited research scope. Most research studies in the public domain are either non-conclusive due to limited research scope or are still under trial; more research is required to find effective treatment approaches for COVID-19.