COVID-19 Update: Critical Care Data on Risk Factors and Outcomes

Good to see you all again. Today is going to be update on the situation of patients in the critical care units. This data is actually from the United Kingdom, from an institution called the Intensive Care and National Audit Research Center. If you want to just skip to the gist of things and bypass all the data points. The gist is that patients are doing better in the ICUs than we originally thought. Still pretty bad, but it's looking to be a little better. That's a basic gist, if you want to know the gist. Basic cut to the chase. I do want to go over the data a little bit just to help us understand the situation of patients in the icu, because ultimately that's what we're talking about here. If someone gets sick, the 80% gets sick, they'll be better and most of us will never know. 15 to 20% that end up in the hospital, that's important, but most will go home. It's the 5% that need intensive care. That's what this is talking about and that's what we're going to talk about. So anyway, a little bit about this data. It was published on April 4. The Intensive Care National Audit Research center for the United Kingdom, it's their biggest organization that looks at how patients are cared for intensive care units, looks at the quality of care, patient survivability, data points. It's just, it's a really good organization that creates really good quality data. This is looking at a report of about 210 ICUs in the UK and about 2,900 patients. So this is a decent sized pool. The important things to remember is one, this is the intensive care unit. So this is the sick of the sick of the sick. The second thing is that it is an intensive care unit organization. So they're going to have very strict criteria about who's sick, who's not sick, about who has a chronic illness, what a chronic illness is someone I see in my clinic as an outpatient, you know, I might say you have chronic bronchitis. They might not give a patient that criteria because they're gonna be very strict with their criteria and it is the United Kingdom. And so their system's a little different. They are a little ahead of us as far as the way things are going. About three or four weeks. Some of the projections are changing. We should be peaking in the next week and New York, the projections are all changing. The gist is that we're peaking a little earlier than we thought. The numbers aren't quite as high now. They're suggesting the United States will have about 84,000 deaths, which is much, much, much less than the original numbers. That's all good data as well. This report does not deal with that. However, it's still patients in the uk. So what did they see? So patients who made in the ICU in the UK, the average age was about 61 years of age. 50% of the patients were between 52 and 70 years of age. So it's an older population, but 25% of patients were less than 52. So almost a quarter of the patients are admitted to the intensive care unit in the United Kingdom were less than 52. So there were some young people, younger people actually being admitted, and about 25% were over 70. The one interesting thing is the ratio was about 73% males to 27% females. So it was a two to a three to two ratio of males to females, 27% female, I'm sorry, 73%. So a three to one ratio of males to females. The interesting thing about that is that we were saying initially that was about 60, 40 split between males to females. It actually ended up being a higher. For the number of people in the intensive care unit in England, again, about 73% males and 27% females. There's been a lot of information about pregnancy. If you get pregnant, if you're a woman, what's your risk? Well, this information was very, very reassuring. About 0.3% of the women. So of that 27% of women, of patients who are women, 0.3% were pregnant, so very uncommon. And about 1.7% were pregnant within six weeks of the ICU. Admission point is, is that 97.79% of the patients were not pregnant. What that means is pregnancy is not a risk factor. Just being pregnant is not a risk factor. And that's correlating. That basically is what we've been thinking the whole time. As far as ethnicity, most of the data was from the London area, which is a very diverse area. I don't want to say too much about this data because I don't understand all the nuances of British life and the mixture of ethnicity, but 64% of patients were white, 13% were black, 13% were Asian, 1.2% are mixed race. Now, in England and the verbiage I'm using is verbiage in the article from the uk, it's not my personal verbiage, but the interesting thing is there is a very large Asian population and interracial population that they use the word mixed in England, we're seeing in New Orleans a larger percentage of people in the ICUs being of African American descent. But New Orleans is going to have a larger African American population than, say, London. So I don't really know what to make of the ethnicity breakdown from this particular study. The BMI weight. This is important stuff. There's been talk about weight and how if you're overweight, your bmi is over 30, you have about 400% increased risk for complications of COVID 19 in the ICU, 0.7% had a BMI less than 18.5. So if you're slender, it was very, very, very unlikely for you even to make it to the ICU. About a quarter had a BMI between 18 and 25, 35% had a BMI between 25 and 30, 30% was over, was 30 to 40 and 7% was over 40. So, you know, almost about 40% were overweight, about a third were. About 4% were obese, about a third were overweight and the rest were normal weight. So there was about a four, three, you know, three fold more risk of the individual instance of people in the ICU being overweight than normal weight. The question I have is, is a BMI a surrogate marker for age? Younger people tend to, in general be slender, older people tend to weigh more. So that's one of the things this study didn't really say. I would question, you know, does a bmi, is there a direct correlation or just is that another way of saying, hey, these are younger, slender, more healthy people versus older overweight individuals? Anyway, 62% of the people that were admitted to the ICU actually put on ventilators. So that's a pretty significant number. About 4.7% of these people had comorbidities. 2.3% were immunocompromised. So a lot didn't have comorbidities and a lot did not and were not immunocompromised. But we already talked about how they classify comorbidities in England. This is an intensive care unit, so it's going to be a little different than how we do things. We need more data to really ferret out some of these things and hopefully, as we learn more from what's going on in the United States, we'll get more data to really figure some stuff out of the outcomes. So they only had outcomes for 690 patients, which is kind of interesting. There were 2,900. So what that means is the rest of these patients are still there, they're still in the icu. So we just need more data. But this is what we got right now. Of the 690 patients, 344 discharged alive, about 50% died in the ICU. So in England, if you make it, if you get admitted to the ICU, about 50% of people to date die in the ICU. However, most of the patients are still in the ICU as of April 4th. So that kind of is a little less than our numbers we've been quoting before, between 50 to 90%. But the point is that's a lot of, if you're that sick, you know, you're pretty sick. I think that just reiterates to me the goal for any intervention is to keep people out of the hospital, to keep people's immune system up, to keep them safe as possible so that they don't have to go to the intensive care unit. About 67% require advanced care support. Within those about the death rate was about 67%. I think the big point of all this data, and I could keep on going through numbers, is that it kind of goes back to our original stuff. You know, 80% of people get better, 20% of people get hospitalized, about 5% go to the ICU. And if you go to the ICU, you're really, really sick with this entity. If you get that far, you have a high risk of mortality or death. I think our goal is to get less people in the hospital and keeping people out of the hospital. And that's where I think working with a good primary care practitioner or a functional medicine integrative practitioner can be very beneficial. Just to boost your immune system, to help increase your respiratory tract status, your nutritional status, to minimize exposure. These are all great, great things. On that note, we did put together our survival guide. It's out now. It's a COVID 19 survival guide. It's available on our website, richmondfunctionalmedicine.com There'll be links below to look at that. That should be a resource for everybody. It's free. Just download it, use it as you will share it. If this information has been helpful, like us share information, this information becomes more available and easier to find the more people like it and share it. So if you think this is useful, again, this is more numbers and stats than actual feel good information. But I think it's important to look at the data. It hasn't really changed a whole lot of my opinion about the disease. It's just reiterated that you don't want to go to the icu. If you're male, you're much more likely to get the complications of this. And this one was interesting that the weight did not seem to be as big of an issue. I mean, definitely being overweight does increase your risk, but they didn't really differentiate weight and age, which was one of my questions about the data itself. That's it. We we'll continue to be doing updates as new information comes out. The next update, what's the next update going to be on? The next update, yes, is going to actually be on to cough or not to cough, to mask or not to mask. There's an interesting article that came out talking about coughing and particularization of the air, which I think will be useful as far as knowing why we should wear masks. And so that's going to be the next thing we'll be talking about. Everybody stay safe, be well, and hope you all have a great day.