COVID-19 Update: Treatment Protocol, ICU Mortality

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Here are the coronavirus stories Medscape's editors around the globe think you need to know about today:

A Treatment Protocol That's Too Good to Be True?

The medical community is divided over the wisdom of promoting a new treatment protocol for COVID-19. Called MATH+, the acronym stands for methylprednisolone, ascorbic acid, thiamine, and heparin. Promoted by by Joseph Varon, MD, and a team of other physicians from around the US, MATH+ was modeled after a similar protocol used in treating sepsis. The protocol isn't exactly cookie cutter medicine either, because it is designed to be individualized to the patient.

Although some debate over certain elements of the protocol can be heard, the overriding concern is the lack of randomized trial data. But Varon pushes back on that criticism, because people are dying. "This is war. There's no time to double-blind anything." He's confident that the protocol will save lives,

MATH+ is still evolving, but, according to one of the protocol's originators, Paul Marik, MD, one foundational principle is constant: the reliance on cheap, safe, readily available drugs, rather than prohibitively expensive designer drugs with little evidence of effectiveness. Not yet published, the protocol is being widely disseminated through informal channels and the internet.

ICU Mortality Rates Dropping

The mortality rate among COVID-19 patients in the ICU has improved since the start of the pandemic.

A systematic review and meta-analysis of 24 studies across three continents involving 10,150 patients found that overall mortality from COVID-19 declined from 60% in March to 42% in May.

But it's not because the virus is any less virulent. It's plausible, the researchers say, that increasing knowledge and experience with COVID-19 disease and all of its manifestations are responsible for the gains in survival. The researchers emphasize that this new lower ICU mortality rate is still twice as high as that seen in patients with other viral pneumonias who require intensive care.

Death Toll by Election Day

A revised projection model from the University of Washington's Institute for Health Metrics and Evaluation (IHME) suggests that total US deaths from COVID-19 could reach 224,000 by November 1, an increase of 16,000 deaths over the previous forecast.

This dramatic rise in COVID-related mortality could be reduced by approximately 40,000 deaths if face coverings were worn universally by everyone, everywhere, except at home, according to an IHME statement.

Fauci Is Unfazed

Anthony Fauci, MD, knows how to turn the other cheek. When statements from the White House attempted to discredit him, according to a report by Reuters, and suggest that some of his statements about COVID-19 were wrong, the renowned infectious disease expert carried on.

Fauci has said he didn't understand the criticism coming from the White House, labeling such efforts "bizarre" in an interview with The Atlantic. He said he believed that the effort by some to malign him was a "big mistake."

According to CNN, a new Quinnipiac University poll shows the public has more trust in Fauci than President Trump when it comes to information regarding the pandemic.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 1700 throughout the world have died.

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

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