Sunday 24 September 2023

Young people with severe covid-19 battle up to three weeks before dying

These young people take longer to die because they have fewer diseases and are more resistant; the average age of critically ill patients decreased by 19 years .

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23 September 2023 - At The Banks - Source: BCCR

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QCOSTARICA – The head of Nursing at Hospital México, Silvia Beirute, said it last month when she recounted the ordeal of witnessing the death of young people from causes related to covid-19.

Emergency Service at Hospital México with care for patients with covid-19. Photo: Hospital México

“There are a lot of young people fighting. Those who are dying are people in their 40s, so the suffering changes. Young people, young people! Why? Why? It hurts to see young people pass away,” Beirute said at the time.

The bitter experience that she and her team go through on a daily basis was corroborated by the mortality data from covid-19 that the Ministry of Health revealed on June 22.

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According to these figures, 33.3% of the deaths registered in this new pandemic wave occur in the group of people between 50 and 64 years old, and another 32.7% among those between 23 and 49 years old.

The advance of vaccination shifted the curve of cases in older adults, who were initially the most affected by this disease.

Today, younger people are at the highest risk for both mortality and morbidity from this cause.

Roy Wong, an epidemiologist with the Costa Rican Social Security Fund (CCSS), confirms an additional element that Silvia Beirute mentioned in her May account: younger people, when they become severely ill from covid-19, take longer to die.

“Their condition of being younger allows them to better defend themselves not only from a SARS-CoV-2 infection (the new coronavirus that causes covid-19) but also from decompensation of a background condition.

“The organism is struggling not to succumb to the infection, the hospitalization is prolonged, and it leaves us at a point where mortality is also delayed by this phenomenon,” explained the doctor.

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Beirute had also explained in May the reasons why, according to her, the younger cling to so much life:

“They are people with small children and they don’t want to leave them, and they express it. ‘Help me!’ they say. Here we see the helplessness felt by the Nursing and the doctors, who cannot rescue that life, and the person saying to me: ‘Help me, help me!’ ” she indicated.

At Hospital México it is known as door 11, but it is more than a door in an area of the Emergency service, exclusively for the care of patients with covid-19. In the image, a photo from last May with one of a patient who died there. Photo: Hospital México

Wong confirms the validity of this assessment by detailing that, on average, the delay in the fatal outcome of severe cases in young people is seen about three weeks after admission to the hospital.

This also explains, in part, the reasons why in recent weeks there has been a decrease in the number of new confirmed cases and in total hospitalizations, but not in the number of deaths.

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Currently, an average of 20 patients die every day, reported the Vice Minister of Health, Pedro González Morera, when updating the epidemiological data on June 22.

Who dies today from covid?

Wong explains that the country does not have a precedent for what is currently happening with mortality.

“About four or five weeks ago we began a process of deceleration of the case curve. Most likely associated with the protection of vaccination towards more advanced groups in life, we have this shift towards earlier ages in this new wave, which we are still experiencing.

“Of the serious cases, the average age of involvement in serious diseases has shifted to 19 years less, on average, in relation to what we had last year, in a non-vaccinated period (without vaccine against covid),” explained Wong.

In other words, the average age of involvement in severe cases is decreasing, while the average age of vaccination coverage is rising, in close correlation with the strategy of first protecting the groups considered, until recently, as the most vulnerable.

The youngest, Wong explains, are people who, although it is true, develop a serious condition, do not have other associated diseases or comorbidities.

Nor do they have a vulnerability that generates, early, a decompensation of their underlying illnesses, or to die at the beginning of a serious condition.

This explains the longer hospitalizations in these age groups, and the fact that many of those who develop severe or serious conditions take longer to die.

Who has this serious disease?

The three main factors are diabetes, hypertension and obesity as chronic conditions, and the stellar ones, which lead to a person losing the battle and dying to the virus.

“We are not talking about these diseases together (when a person has several at the same time). We are talking about individual presentation, exacerbated even more if they are presented together.

“These people are the ones that we are seeing with the greatest impact on mortality and severe morbidity in the younger age group,” said Wong.

The doctor emphasized that the vaccine is a very important step, but clarifies the vaccine does not confer 100% protection, even with the two doses.

He also points out, it should be considered that the expected level of immunity is reached two weeks after the application of the first dose: “It is not that I was vaccinated yesterday and today I am protected,” he insisted.

Immunity is not black and white: when the vaccine is given, Wong explains, it begins an increasing process of response.

“Immunity of up to 80% can be achieved in a sequential process, where the defense system has to respond to this immunity induced by the vaccine,” explained the specialist.

Therefore, as has been said so many times, the protection of the vaccine must be complemented with the measures that are already known: use of a mask, hand washing, physical distancing, coughing and sneezing protocol, and maintaining the social bubble.

This is especially important to take into account, at a time when a new variant, the so-called Delta, could enter the country, much more contagious and with more severe symptoms in the young population, according to other countries where it already circulates.

“In a globalized world, it would be unrealistic to say that it will not reach Costa Rica. It will come, sooner or later. The question is when. Possibly, here we will move the curve again.

“If at this moment there is a phenomenon towards younger people, possibly this will reverse the curve for us. We have to be prepared, individually and collectively, to be able to face it,” Wong concluded.

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