Do Mechanically Ventilated COVID-19 Patients Present a Higher Case-Fatality Rate Compared With Other Infectious Respiratory Pandemics? A Systematic Review and Meta-Analysis

Abstract

BackgroundEarly reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV).ObjectiveOur aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)-associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1).Materials and MethodsWe searched PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane Library for relevant studies published between December 2019 and April 2021 for COVID-19, between January 2002 and December 2008 for SARS, between January 2012 and December 2019 for MERS, and between January 2009 and December 2016 for influenza (H1N1).ResultsOverall, this study included 81 peer-reviewed studies, pertaining to 65,058 patients requiring IMV: 61 studies including 62,809 COVID-19 patients, 4 studies including 148 SARS patients, 9 studies including 875 MERS patients, and 7 studies including 1226 influenza (H1N1) patients. The CFR for COVID-19 patients requiring IMV was not significantly different from the CFR for SARS and influenza (H1N1) patients (45.5% [95% confidence interval (CI), 38.5%–52.8%] vs. 48.1% [95% CI, 39.2%–57.2%] and 39.7% [95% CI, 29.3%–51.3%], respectively). However, CFR for COVID-19 patients was significantly lower compared with that for MERS patients (CFR, 70.6%; 95% CI, 60.9%–78.8%).ConclusionsCOVID-19 patients requiring IMV show a similar CFR compared with SARS and H1N1 influenza patients but a lower CFR compared with MERS patients. To improve survival in future pandemics, we recommend examining the pros and cons of the liberal use of endotracheal intubation and considering drafting guidelines for the selection of patients to intubate and the timing of intubation.

The effect of COVID-19 vaccination on 30-day mortality after cardiac surgery – Insights from the Israel national registries

“…First, we examined a relatively long period prior to vaccination (between March and December 2020) while most studies focused on a short period, mainly at the beginning of the outbreak. As time went on, countries managed to obtain sufficient equipment, including mechanical ventilators, and to have improved staffing and care processes [ 1 ]. Another possible cause for the disparity is that high-income countries, as compared to mid and low-income countries, had better access to ventilators and medicines early in the pandemic.…”

“…Obviously, different countries started the pandemic with different healthcare system capacities and abilities and last, another possible factor, different countries used different strategies to contain the pandemic. Several countries used a “mitigation” strategy and some a “containment” strategy and therefore there were different rates of morbidity and mortality in different countries [ 1 ].…”

“…In December 2019, a novel coronavirus (SARS-CoV-2) pandemic, also termed COVID-19, emerged, and rapidly spread across the globe, leading to extreme public health measures including widespread lockdowns. A published meta-analysis reported that increasing age and comorbidities, such as diabetes, renal failure, and cardiovascular diseases, were significant risk factors for COVID-19 [ 1 ]. Patients with pre-existing conditions who had low physiological reserve were particularly vulnerable to COVID-19 due to its effects on multiple organs, including the cardiovascular system [ 2 ].…”

The COVID-19 Pandemic Increased the Incidence of New-Onset Type One Diabetes in Children

“…Previous data had demonstrated that the rubella [11] and mumps viruses [12] were responsible for early-onset diabetes in children, and vaccinations against these two viruses have effectively eliminated this causative link. In December 2019, a novel coronavirus SARS-CoV-2 infection, also known as the COVID-19 pandemic, spread to most countries in the world, leading to extreme public health measures, including widespread lockdowns [13]. It has been hypothesized that, like the SARS-CoV-1 virus, the SARS-CoV-2 virus also binds to the ACE2 receptor, which is widely expressed in pancreatic cells.…”