As COVID-19 becomes an endemic respiratory pathogen we ultimate contend with, the capacity to treat and manage severe infections and reduce mortality is that much more important. The Centers for Disease Control and Prevention (CDC) noted an age-adjusted 47% decline in deaths from 2021 (when the first vaccines were rolled out) to 2022, with most deaths occurring in hospitals.1 Long-term care facilities and nursing homes were hubs for transmission early in the pandemic and as a result, have been spaces for increased scrutiny to prevent COVID-related deaths. Currently, the CDC reports 1.1% of deaths reported are due to COVID-19 in the last week, which is a 37.5% change from the prior week.2
What You Need to Know
There has been a significant improvement in managing severe COVID-19 infections, with the CDC reporting a 47% decline in age-adjusted mortality rates from 2021 to 2022, primarily due to advancements in vaccines, treatments, and hospital care.
The study found that hospitalized COVID-19 patients treated with remdesivir and dexamethasone had significantly lower 14- and 28-day mortality rates compared to those treated with dexamethasone alone.
The findings emphasize the importance of ongoing treatment evaluations and updates to clinical recommendations, particularly for patients requiring supplemental oxygen, as the understanding of severe COVID-19 and its management continues to evolve.
Treatment for COVID-19 has evolved since the start of the pandemic but with time, so has improvements in our understanding of severe disease and how to best manage hospitalized patients. A new study published in Clinical Infectious Diseases evaluated mortality risk in hospitalized patients treated with remdesivir + dexamethasone compared to those treated with dexamethasone alone.3 The researchers performed retrospective analysis with patient-level data from PINC AI Healthcare Database during the Omicron period (December 2021 to April 2023). 151,215 hospitalized patients for COVID-19 were included in the study, with roughly 40% (61,236), receiving remdesivir + dexamethasone treatment and 24% (36,489) on dexamethasone monotherapy within their first 48 hours of admission.
[We covered inpatient care in our COVID-19 Therapeutic Management and Prevention roundtable series. Interested readers can watch the specific episode on this topic, COVID-19 Therapy Roundtable: Addressing Inpatient Clinical Care.]
The majority of patients in both groups were aged 65 or older, 51% were female, and most were White and non-Hispanic. In terms of comorbidities, the most common was cardiovascular disease, followed by diabetes, chronic obstructive pulmonary disease, and renal disease. Propensity scores (PS) were estimated via logistic regression for baseline oxygen requirement categories.
The authors reported that “mortality rates in the PS matched cohort were significantly lower for remdesivir + dexamethasone versus dexamethasone monotherapy across all baseline supplemental oxygen groups. For the no supplemental oxygen charges (NSOc) group, 5.6% and 7.2% of remdesivir + dexamethasone patients died within 14 and 28 days, respectively, compared to 6.1% and 7.7% of dexamethasone monotherapy patients. For patients receiving low flow oxygen (LFO), 6.1% and 8.1% of remdesivir + dexamethasone patients died within 14 and 28 days, respectively, compared to 7.7% and 9.7% of dexamethasone monotherapy patients.” The significant reduction in 14- and 28- day mortality for those hospitalized COVID-19 patients treated with remdesivir + dexamethasone points to an increasing need to continue treatment evaluations and update recommendations, especially for those patients requiring supplemental oxygen.
References
1.Ahmad FB, Cisewski JA, Xu J, Anderson RN. COVID-19 Mortality Update — United States, 2022. MMWR Morb Mortal Wkly Rep 2023;72:493–496. DOI: http://dx.doi.org/10.15585/mmwr.mm7218a4
2.CDC. COVID Data Tracker. December 21, 2024. https://covid.cdc.gov/covid-data-tracker/#maps_percent-covid-deaths
3.Essy Mozaffari, Aastha Chandak, Robert L Gottlieb, Chidinma Chima-Melton, Mark Berry, Thomas Oppelt, Jason F Okulicz, Alpesh N Amin, Tobias Welte, Paul E Sax, Andre C Kalil, Lower Mortality Risk Associated With Remdesivir + Dexamethasone Versus Dexamethasone Alone for the Treatment of Patients Hospitalized for COVID-19, Clinical Infectious Diseases, 2024;, ciae477, https://doi.org/10.1093/cid/ciae477
