Many regions of the world have experienced the COVID-19 pandemic in waves, but the death rates now seem to be falling across the globe. This is indeed baffling as there have been no miracle drugs, no new technologies and no great advances in treatment strategies for the disease that has infected more than 50 million and killed more than 1.2 million around the world. 

Some researchers, including Dr Bharath Kumar Tirupakuzhi Vijayaraghavan, an intensive care specialist at the Apollo Main Hospital and Honorary Senior Fellow at The George Institute for Global Health, India attribute this to hard-earned experience, a better understanding of how to use steroids and a shift away from unproven drugs and procedures. He also pointed out to dropping fatality rates in his hospital. In April, up to 35% of those in the unit with COVID-19 perished, and about 70% of those on ventilators died. Now, the intensive-care mortality rate for people with the illness is down to 30%, and for those on ventilators it is around 45–50%.

The article in Nature entitled “Why do COVID death rates seem to be falling?” observes that in the early days of the pandemic, COVID-19 was viewed as something frightening and new — and worthy of resorting to unproven interventions in a desperate act to save patients. This included the use of hydroxychloroquine, an anti-malarial drug.

“Unfortunately, a lot of the initial discourse was complicated by noise about how this disease was entirely different or entirely new,” says Dr Bharath. “This distraction caused more harm — we were all probably poised to go off track.”

Thus far, steroids have been shown to be beneficial in reducing deaths and the anti-viral drug Remedisvir may have a benefit on time to recovery if given early. Ongoing studies include use of antibodies against SARS-CoV-2 — either purified antibodies administered individually or in cocktails, or antibody-rich blood plasma taken from people recovering from the disease. Interestingly, the ICMR-led PLACID trial did not show a benefit of convalescent plasma.

In response to the pandemic, many hospitals rapidly expanded their numbers of intensive-care beds bringing in extra staff from other departments. Over time, those staff members have become more familiar with intensive care, learning to recognize the patterns that can signal when a patient is about to deteriorate. And hospitals have learnt to triage those who have risk factors for more severe disease, placing them under more careful observation.

Researchers have struggled to understand whether COVID-19 death rates are truly dropping. Reacting to the Nature article, Prof Vivekanand Jha, Executive Director, George Institute for Global Health India, says: “Countries like India have seen a second and even a third wave but we are not quite sure why the case fatality rate seems to be low now compared to a few months earlier.”

Read the full article in Nature.

Senior Research Fellow Rohina Joshi was announced a winner of The Sax Institute Research Action Award at their annual awards evening hosted virtually today, November 11.

Associate Professor Joshi was recognised for her work to improve the quality of death certification of home deaths in the Philippines.

The Sax Institute Research Action Award was first established in 2015 to recognise early- to mid-career researchers whose work has had a significant impact on health policy, programs or service delivery. Each winner receives a certificate and a prize of $5,000.

In the Philippines, as in many developing countries, most deaths occur at home rather than in a medical facility. A death certificate is needed for burial, but doctors may have very little to go on to identify the cause of death, which is often reported in vague terms such as “old age” or “respiratory failure”.

Associate Professor Joshi and her team worked closely with the Philippines Department of Health to develop a software decision support tool for verbal autopsies, called SmartVA. The tool provides the doctor with a series of standardised questions to ask a relative of the deceased, which then gives recommendations for causes of death.

In several Philippines municipalities it is now a requirement for physicians to use SmartVA to certify deaths where there is no access to medical records.

“It’s been incredibly rewarding to see our work have such a significant impact on the quality of health data collected in the developing world. Thanks to its success in the Philippines, we’re now rolling out SmartVA in a number of other countries, including Papua New Guinea, Peru and Colombia,” said Associate Professor Joshi.

Sax Institute CEO Professor Sally Redman said A/Prof Joshi’s work showed the power of Australian-based research to drive positive change in the delivery of health programs and services, not just in this country but across the world.

It is so encouraging to see early- and mid-career researchers showing such talent and determination in bringing about the change we need,” she said.