Hospital intensive care units were among the darkest settings at the height of the coronavirus pandemic.
For many patients, once their condition worsened to the point of needing critical care, it “really was like Russian roulette” whether they would survive their illness, explained Dr. Shelley Schmidt, a pulmonary and critical care physician for Spectrum Health in West Michigan.
In recent months, however, there have been fewer COIVD patients in the ICU than at any other time throughout the 30-month pandemic. As of Friday, Sept. 23, there were 121 COVID patients in ICU beds across the state — down from about 400 this time last year and around 1,000 at the peak of the omicron surge.
“We continue to have a kind of smoldering handful of patients with COVID that do come into the ICU,” said Dr. Schmidt. “When one heads out, another one comes in. It’s just been kind of a slow smolder all summer long.”
Since May, the rate of hospitalized COVID patients winding up in the ICU has fluctuated between 10% and 15%. That rate was near 40% two years ago, and spent nearly all of 2021 above 20%.
Similarly, ventilators have been needed in about 5% or less of COVID hospitalizations over the last four months, according to state health department data. That number peaked at close to 30% in 2020 and was greater than 10% for much of the first two years of the pandemic.
Health officials credit better and more accessible treatment options like antivirals and monoclonal antibodies for the improvement. As COVID patients in the ICU have declined, physicians have noted a steady stream of prescriptions for antivirals and monoclonal antibodies.
Doctors also point to vaccines, which have proven effective at preventing severe illness from COVID, even with newer strains of the virus that have gotten better at evading prior immunity.
“Vaccinated people who wind up in the ICU tend to be older adults and people with medical problems, especially immunocompromised,” said Dr. Dennis Cunningham, director of infection control and prevention for Henry Ford Health. “I’m not seeing healthy vaccinated people in the intensive care unit.”
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In most cases, the ICU is where patients are sent when their condition and treatment require more consistent monitoring. The unit has smaller caregiver-to-patient ratios, and treatments often include equipment to replace organ function — such as a ventilator in the case of COVID.
Schmidt estimated that the average ICU stay was about four days pre-COVID. Many COVID patients however wound up in the unit for weeks, adding to the strain on health systems.
At times earlier in the pandemic, patients with few to no underlying health conditions might have wound up in the ICU with severe illness from a coronavirus infection. Schmidt said that’s less the case now, as COVID patients in the ICU typically have other health factors that are contributing to their illness.
Across the state at Beaumont Health in Royal Oak, Dr. Felicia Ivascu serves as medical director of the hospital’s extracorporeal membrane oxygenation (ECMO) program. ECMO is reserved for the sickest patients with a mortality rate of 80% or greater without the treatment, which involved taking blood out of the body and into a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back into the body.
“Throughout much of the pandemic we had a constant flow of patients being referred that were severely ill and needing ECMO,” Ivascu said. “For the first time, we’ve seen a drop-off in the patients that are sick enough to require ECMO from COVID.”
Henry Ford Health had 74 COVID patients with COVID across its system earlier this week, with 30 in the ICU and about 15 on ventilators.
“These are some of the lowest numbers we’ve seen throughout the pandemic,” Cunningham said. “I don’t mean to trivialize the fact that we have 30 patients with COVID in our critical care units, but it’s so much lower than it was during the peaks of the pandemic.”
COVID treatments like antiviral medications are available to individuals who meet criteria of being at risk of severe illness from COVID-19. That includes obesity and being overweight, which physicians have found to be common traits among hospitalized COVID patients. Dr. Schmidt recommends talking with your doctor before an infection to see if you’d qualify for treatment if you were to test positive for SARS-CoV-2.
Ivascu agreed that improved treatment options deserve credit for the reduction in COVID patients needing critical care. She also pointed to changes in the virus itself, making it less deadly compared to earlier strains.
“We definitely are not seeing the mortality from it that we did in the beginning of the pandemic,” she said. “We still have a ways to go but it’s definitely hopeful.”
As of Friday, Michigan hospitals were treating 1,096 adults and 46 pediatric patients with confirmed or suspected cases of COVID-19. Those rates are similar to where they were this time last year, before surging in the winter and peaking with about 5,000 hospitalizations and 860 COVID patients in the ICU in January.
Health officials are optimistic about the improved COVID situation, though they remain cautious regarding what the upcoming cold and flu season has in store. It remains important to get vaccinated against COVID and influenza, and to stay vigilant if you become symptomatic.
“Unfortunately a lot of people are still getting COVID and still getting sick from COVID,” Schmidt said. “Just as important as in the beginning of the pandemic is for people to be conscious if they’re feeling ill and they have a fever, to stay home and get tested because there are patients who are immunocompromised and COVID would make things more difficult for them.”
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