How do COVID-19 progress and what causes death?
Since President Donald Trump and his wife Melania were tested positive for the Covid-19 a number of people voiced their speculations on “What would happen to him?” If one were to be objective the answer would be, we really don’t know and only time will tell.
This would be good time to answer these questions: What are the signs, symptoms and stages of COVID-19, and what causes death in COVID-19? How long do you spend in the ICU with COVID-19? How long do you have COVID-19 before you die?
What are the stages and symptoms of COVID-19?
- Day 1: The symptoms usually start with a fever, a dry cough and mild breathing issues which may get worse over the next week. You also may have symptoms of a sore throat, coughing up mucus, diarrhea, nausea, body aches and joint pain.
- Day 7: Breathing may become difficult or laboured. This is called dyspnoea.
- Day 9: Sepsis (secondary blood bacterial infection) may start, the body’s extreme response to the infection can lead to low blood pressure and organ failure or injury.
- Day 10-12: People who have mild COVID-19 start to have an improvement in their fever and cough, but in serious cases their fever and cough continues.
- Acute respiratory distress syndrome (ARDS) starts to be diagnosed, this is a respiratory problem when there is widespread inflammation in the lungs.
- Day 12: This is the median day to be admitted into the intensive care unit (ICU).
- Day 15: Acute kidney and cardiac injury becomes evident with kidney and heart failure.
- Day 18.5: The median time it takes from the first symptoms of COVID-19 to death is 18.5 days.
- Day 22: This is the median amount of days it takes for COVID-19 survivors to be released from hospital
A study published in The Lancet studied the patients who were hospitalized with COVID-19 and compared details of the patients who passed away and patients that survived.
This figure below shows the progression and duration of the major symptoms of COVID-19 in survivors and non-survivors for hospitalized patients in the study.
Facts and figures of patients who were hospitalized with COVID-19
Figures from the above study show:
- 191 people hospitalized with COVID 19
- 28% (54) patients died from COVID-19
- 72% (137) patients survived COVID-19
- 26% (50) of patients went into intensive care unit (ICU)
- 78% (39) patients who went into ICU passed away
- 22% (11) patients who went to ICU survived
- 8 days was the median length of stay in ICU
- 11 days was the median total length of stay in hospital
- 22 days was the time from first symptom until discharge from hospital for survivors
- 5 days from first symptoms until death for non-survivors
- 20 days median length of time for viral shedding, starting at first day of symptoms
- 52 years old median age for survivor
- 69 years old median age for non-survivor
What health complications of COVID-19 cause you to die?
Initially when the Covid pandemic started not much was understood about its many complications. Now we have a better understanding of its various serious complications in some people and are able to address it with better therapeutics and medical management. COVID-19 is well known for breathing problems, but other health complications also contribute towards the death from COVID-19. It is often a combination of these health problems that cause the body to fail and ultimately result in death.
What blood tests can be used to help determine the severity level of COVID-19 illness?
Lymphocyte levels: In COVID-19 survivors the blood lymphocyte counts are high and increase after day 7, when compared to patients that pass away who have severely low lymphocyte counts
D-dimer, high-sensitivity cardiac troponin I, serum ferritin, lactate dehydrogenase, and IL-6 levels: These were all clearly elevated in non-survivors compared to the survivors. These levels in non-survivors all increased dramatically after approximately 2 weeks.
Summary
- What is the death rate for people hospitalized with COVID-19? 28%
- What is the survival rate for people hospitalized with COVID-19? 72%
- What rate of hospitalized COVID-19 patients go into the intensive care unit (ICU)? 26%
- What percentage of COVID-19 patients who go into the ICU die? 78%
- What percentage of COVID-19 patients who go into the ICU survive? 22%
- How many days from onset of first symptoms of COVID-19 until ICU admission? 12 days (median)
- What is the median length of stay in ICU for COVID-19 patients? 8 day (median)
- How many days is the median hospital stay for COVID-19 patients? 11 days
- How long does it take from the first COVID-19 symptoms until hospital discharge? 22 days (median)
- How long is viral shedding in COVID-19 patients, starting from the first day of symptoms? Until death or in survivors it is 20 days (median)
- What is the average age of a hospitalized COVID-19 survivor? 52 years old
- What is the average age of a hospitalized COVID-19 who dies? 69 years old
- How many days from first COVID-19 symptoms until death for hospitalized patients? 18.5 days
Note: With better understanding of the pathophysiology of Covid-19 lead to improvement in the treatment and management of the Covid-19 resulting out comes in care of critical cases being improved. Anecdotally an ER nurse that worked in a New York hospital during the height of Covid-19 crises told me that initially intubated cases had about 15-20% chance of survival but after a few weeks it was reversed to 70% were extubated and improved. She said initially they were very much in the dark what they were dealing with and felt helpless and overwhelmed seeing many very sick patients dying.
