“Although mortality in the second wave has been lower, the covid-19 has not been milder”

Madrid

Updated:12/29/2020 18:25h

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Deaths from covid-19 in Spain have already reached the figure of 50,000, that is, one for every 1,000 inhabitants. These are the data provided by the Ministry of Health, which only counts the cases confirmed by a positive PCR test.

But the true figure is much higher. Only in the first wave of the pandemic – until the month of May – more than 45,000 people died, according to the statistics of Deaths according to the cause of death of the Statistics National Institute, Meanwhile he Daily Mortality Monitoring System (MoMo) has registered an excess mortality of more than 70,001 people up to December 14 compared to last year.

However, although the first data suggest that mortality in this second wave has been lower, “the disease has not been milder.” Ricardo Gómez Huelgas, of the Hospital H. Regional University of Malaga, and José Manuel Casas Rojo, of the University Hospital Infanta Cristina de Parla (Madrid), from SEMI-COVID-19 registry, which provides information on the clinical characteristics of COVID-19 patients hospitalized in Spain during the first wave.

Our personal feeling, they affirm, is that “rather there has been a greater availability of resources and this has led to milder patients being admitted than in the first wave. Also younger, at least initially, although now we are also seeing elderly patients ».

For example, they indicate that in the US there has been a decrease in mortality and in age and severity at admission over the months. “We believe that this has also been the case here, and that by having greater diagnostic capacity we have been able to detect more cases, and therefore milder and in earlier phases, thus influencing lower in-hospital mortality.”

There has been a greater availability of resources and this has led to milder patients being admitted than in the first wave

Furthermore, they state, «we now know that several of the treatments that we used a lot in the first wave are ineffective, such as hydroxychloroquine or lopinavir-ritonavir. And also that corticosteroids have been shown to reduce mortality in patients who need oxygen.

And even though there is unfortunately no known effective treatment to fight the virus, “all of that knowledge has been applied to second wave patients. We have also gained a lot of experience in management, thanks to our activity in the first wave and also to clinical research, an example of which is the SEMI-COVID-19 registry.

Because the SEMI-COVID-19 Registry provides information on the clinical characteristics of patients with covid-19 hospitalized in Spain. And it concludes that in the first wave, the patients with COVID-19 hospitalized in Spain were mostly severe cases, since one in three patients developed respiratory distress and one in five patients died.

The SEMI-COVID-19 Registry provides information on the clinical characteristics of hospitalized patients with covid-19 in Spain

This registry, they comment, has allowed us, above all, “to know much better the type of patient with COVID-19 that we handle in hospitals and the risk factors for mortality.”

Thus, we now know that the main risk factor for death is “age, which doubles mortality every decade after the age of 60”.

Likewise, we have seen that these are “patients with a lot of comorbidity, especially cardiovascular: more than 50% are hypertensive, 40% have dyslipidaemia and 20% are obese and / or diabetic.”

The registry has especially studied some risk factors, such as «hypertension and hyperglycemia», Which are independently associated with mortality.

Furthermore, “we have detected groups of symptoms that are associated with a worse prognosis, such as fever, shortness of breath and cough, and others with better, alterations in taste and smell, when these patients require hospital care.”

The registry, whose first data have been published in the Spanish Clinical Journal, included 15,111 patients from 150 hospitals until June 30, 2020, most of them men and over 65 years of age and with diseases such as hypertension, dyslipidemia and diabetes.

We have detected groups of symptoms that are associated with a worse prognosis, such as fever, shortness of breath and cough, and others with better, alterations in taste and smell, when these patients require hospital care

In this second phase, Gómez Huelgas points out, another 2,600 from the first wave and 2,000 from the second have joined. “Although there are few second wave patients to make comparisons, the mortality does seem lower.”

The research is ongoing and there are already studies with registry data that will take into account geographical differences, the different peculiarities of the centers and even the differences in the results according to the time of the first wave.

All this information, they conclude, «will serve to improve our knowledge of the clinical aspects, diagnoses, therapeutics and prognoses of this disease ”.

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