As COVID-19 cases increase in Lincoln and Nebraska, so do deaths

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In roughly the first six months of the coronavirus pandemic, 24 Lancaster County residents died of COVID-19, or an average of about four per month.

In the first three weeks of October, there have already been 17 coronavirus-related deaths of county residents.

“The last 30 days have been very different,” said Bob Ravenscroft, Bryan Health’s vice president of advancement.

At Bryan, 25 hospitalized COVID-19 patients have died in the past month, including people from other counties. In the previous six months combined, there were only 22.

Officials say Bryan has seen the age of its hospitalized patients skew older, many of them at higher risk of dying because of comorbidities, but the rise in deaths is primarily a direct result of more COVID-19 cases.

Lancaster County has seen half of its total COVID-19 cases just in the past two months, and cases have been soaring statewide, with Nebraska setting case records in consecutive weeks.

In Nebraska as a whole, about 22% of all COVID-19 deaths have occurred in the past month.

If there’s good news, Dr. John Trapp, a pulmonologist who is vice president of medical affairs for Bryan Medical Center, said the death rate has not spiked at the same rate of cases overall.

“The overall death rate is decreasing,” Trapp said, “but just with the higher spike in numbers, that percentage is still there.”

Trapp said the bulk of the cases continue to hit younger people who are less at risk of developing a serious illness, in large part because older residents continue to do a good job of limiting their potential exposure to COVID-19.

And for anyone who does end up hospitalized, doctors have learned how to better treat the disease over the past seven months.

Trapp said one area of emphasis at Bryan has been trying to keep patients off ventilators.

In the early days of the pandemic, he said the guidance was that people with low oxygen levels needed to be put on ventilators right away.

That thinking has changed over the past few months as doctors have found that other methods can be tried first.

“We went from a recommendation to intubate everybody to intubating only as a last resort,” Trapp said in an interview earlier this month.

He said he has seen patients in the hospital with oxygen levels below 80% (normal is 95% or above) who are able to talk, sit up and even eat lunch. Those people need supplemental oxygen but may not need a ventilator.

Among the treatments Bryan has used with COVID-19 patients needing oxygen support are bilevel positive airway pressure machines, similar to a CPAP, which provide supplemental oxygen to patients though a face mask or nasal plugs.

For those who do go on a ventilator, another treatment technique is “proning,” or putting patients on their stomachs rather than their backs for part of the time. It’s a procedure Bryan had only used with trauma patients, but recent studies have shown it can improve oxygenation for patients with respiratory issues caused by COVID-19.

Not only does keeping people off a ventilator reduce their chance of dying — Bryan officials have said about one of every three COVID-19 patients on a ventilator does not survive — it also is safer and less stressful for staff members, Trapp said.

“Once you intubate somebody, the level of intensity really increases,” he said, noting that ventilated patients require “enormous consumption of health care resources” that includes staff time and personal protective equipment.

Other treatments, such as steroids, the anti-viral drug remdesivir and convalescent plasma, all have played a role in reducing mortality, Trapp said.

CHI Health also has taken advantage of treatment improvements, said Dr. Nikhil Jagan, a pulmonologist and critical care lead at CHI St. Francis in Grand Island.

Like Bryan, CHI Health has used BiPAP machines and other treatments to keep as many people off ventilators as possible.

“We’ve been using a lot more of that to avoid putting people on ventilators, and it seems to be working,” Jagan said.

As of Wednesday, the health system had 128 COVID-19 patients across its 14 hospitals, and only nine of them were on ventilators.

He said people also seem to be coming to the hospital earlier than in the early days of the pandemic, meaning they are not as sick and may be more responsive to treatment and have better outcomes.

But as cases continue to rise, so will deaths. And the older the patients are, the higher their risk.

“It’s an inevitable result of more cases, especially in older age cohorts now, which happens when it spreads from the younger folks,” said Dr. Bob Rauner, president of Partnership for a Healthy Lincoln.

In Lancaster County, 77% of the people who have died of COVID-19 have been 60 or older, even though that group makes up less than 12% of overall cases.

In Nebraska as a whole, 91% of the deaths have occurred in people 55 and older, who account for only 24% of total cases.

According to statistics from the state, 13.5% of people 85 and older who contracted COVID-19 have died, while the fatality rate for those under age 35 is less than 0.05%.

Don’t be COVID soft target

The focus on deaths in COVID-19 is not telling the entire picture. Overall mortality and deaths are low, although not trivial in the elderly or those with co-morbidities.

Low death rate is cited as the reason people don’t think masking and limiting large gatherings are important. From the beginning of COVID, these are necessary to “flatten” the curve. Health care is not an unlimited resource, and when stretched, timeliness and quality of care are at risk.

We have seen a large surge of hospitalized patients in Lincoln, partially because of local patients but also transfers from surrounding areas. We have been able to handle this because Lincoln has an outstanding healthcare system which has been proactive from the beginning.

Capacity is made up of space, stuff and staff. I worry about the staff in the coming months if we don’t take this more seriously. Look at Wisconsin; their weak link currently is staff in dealing with their current COVID crisis. Once a COVID patient is admitted, they tend to be hospitalized for weeks, especially when admitted to ICU. When census is high, it is emotionally and physically exhausting to staff and contributes to burnout.

My plea is that we all come together and make the choices to limit the spread to protect hospital staff. You may not be a “vulnerable” individual but your actions could facilitate a chain of transmission to reach a vulnerable one amongst us. Make good choices and don’t be a soft target.

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