For Coloradans who have been hospitalized because of COVID-19, outcomes have been slowly but steadily improving: Fewer of those hospitalized are being put on ventilators and the mortality rate for those requiring hospitalizations is coming down.
The improved outcomes have accompanied generally declining numbers of new COVID-19 cases in Colorado, down from a peak in new cases in late April. But in the past week, the number of new daily cases has climbed somewhat.
Improved therapeutic care and better case management, as well as changes in behaviors, were credited by a panel of hospital chief medical officers with causing the improved outcomes.
The doctors representing Banner Health, Boulder Community Health, Centura Health, Denver Health, HCA Healthcare/Health ONE, SCL Health and UCHealth presented the outcome data Tuesday. It included 95% of all coronavirus hospitalizations in Colorado, going back to early March, they said.
Overall, the mortality rate for COVID-19 patients who have been hospitalized in Colorado has come down to 11% in May from 15% in March. The biggest improvement in mortality rates came among those younger than 30, whose mortality rate dropped to zero in May, and those 60 or older, for whom the mortality rate rose from 23% to 26% in April, but dropped to 19% in May.
Among all age groups, the portion of patients who have been put on a mechanical ventilator has also come down, the data show.
The doctors explained that as the medical community has learned more about the virus, the choice has been made more often to let patients continue their hospital treatment without being put onto the ventilator, despite low blood-oxygen levels that would otherwise lead a doctor to order a ventilator.
“As we have progressed collaboratively over the past three months, we've learned so much about how to appropriately care for patients,” said Dr. Shauna Gulley, chief clinical officer at Centura Health. “One of the most important things we learned early on was that permissive hypoxia, or allowing oxygen levels to float a little lower than normal, made a big difference in how we care for our patients.”
Putting a person on a mechanical ventilator is an invasive procedure that can add risk because it can cause damage to the airway or lead to an infection, the doctors said. They’ve learned to listen more to the patients, they explained, and if the patient does not appear to be in a crisis, they won’t necessarily be intubated with a ventilator, despite the low blood oxygen levels.
Overall, the portion of hospitalized COVID-19 patients who are being put on a ventilator has dropped by more than half. Where 29% of hospitalized COVID-19 patients in Colorado were being ventilated in March, 13% were in May.
Another factor helping the improvement in overall hospitalization outcomes is the age mix of hospitalized patients. In March, 54% of hospitalizations from COVID-19 were patients 60 years old or older, but that number has dropped to 44% in May, the data show. Now younger Coloradans are making up a larger portion of the hospitalizations. Coloradans younger than 50 went from 24% of hospitalizations in March to 36% in May.
The shift toward more transmissions among younger Coloradans reflects an effective messaging campaign, the hospital representatives said. Older Coloradans are continuing to distance themselves socially, preventing as many transmissions as took place in March and April. At the same time, younger Coloradans have become more mobile since social distancing policies have been reduced, leading to some increase in transmission among them.