In two renowned hospitals in Manhattan, in New York, more than a third of the people who received intensive medical treatment have died since the outbreak of the corona virus because there, as elsewhere, doctors have reached the limits of their capacities and also because many complications caused by the sars-CoV-2 virus were initially misjudged. At Milstein Hospital, with 700 beds, and Allen Hospital, with a bed capacity of 230, not only lung failure but also circulatory and renal failure were observed, all three of which are among the more frequent complications in the Covid 19 pandemic. Intensive care beds in both hospitals were increased from 129 to 282, as many people were admitted to hospital at the very beginning of the spread of the virus. By April 1, 2020, the number of people admitted was 1,150, of whom 257 received intensive medical care. 79 percent of them required invasive mechanical ventilation, i.e. 203 patients and 3 percent (6 patients) an extracorporeal membrane oxygenation, or ECMO for short. In addition to the known lung failure, 170 patients were also affected by circulatory failure; these 66 percent required vasopressors, substances that support or raise blood pressure. 79 patients, i.e. 31 percent of the 257 intensive care patients, received renal replacement therapy because of the diagnosis of renal failure. Every effort was made to save as many patients as possible. Medications with hydroxychloroquine and Remedesivir were also used. In 185 patients the malaria drug was supposed to be effective and in 23 patients the Ebola drug, which was supposed to be an antiviral agent, was supposed to be successful. However, 101 of the patients receiving intensive medical care, i.e. 39 percent, died in the end, even though every effort was made to save the lives of the seriously infected patients. Risk factors such as chronic lung diseases, chronic cardiovascular diseases, a higher age of the patients, an elevated interleukin-6 inflammation maker as well as an elevated D-dimere value in the blood of those affected, which indicates thromboses, often led to a fatal outcome of the infection, with women and men being equally affected. The increased risk of thrombosis associated with Covid-19 lung disease was initially underestimated by the medical staff of many hospitals worldwide, not only in Manhattan. Nor did doctors initially believe that the „cytokine storm“ in patients with Covid-19 would be alleviated when they started high-dose intravenous treatment with the interleukin-1 receptor antagonist anakinra (anti-rheumatic drug), which was only given to 17 percent (44 patients) of intensive care patients in New York. A randomized study is now to show whether this will lead to better treatment results in the future.
Source: Aerzteblatt