Tsiodras-Lytras paper: 1,500 fewer patients would have died with less NHS pressure, inequality

In a scientific paper entitled “Total patient load, regional disparities and in-hospital mortality of intubated COVID-19 patients in Greece, September 2020 to May 2021”, professors Theodoros Lytras and Sotiris Tsiodras, who are members of the National Committee on COVID-19, found that the lives of 1,500 intubated COVID-19 patients may have been saved had there been less pressure overall on the Greek National Health System.

The paper was published in the “Scandinavian Journal of Public Health”.

Method

The method of the study was described thusly, “Anonymized surveillance data were analyzed from all intubated COVID-19 patients in Greece between 1 September 2020 and 6 May 2021. Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates.

Conclusions

“Our results indicate that in-hospital mortality of severely ill COVID-19 patients is adversely affected by high patient load even without exceeding capacity, as well as by regional disparities. This highlights the need for more substantial strengthening of healthcare services, focusing on equity and quality of care besides just expanding capacity,” was the conclusion of the study.

The paper indicates that the death rate rises by 25 percent when over 400 NHS patients are intubated and by 57 percent when over 800 patients are intubated.

In summary, Lytras said in a tweet yesterday that the greater the number of patients intubated in the NHS, “the higher possibility of death per day of hospitalization gradually: + 25% for >400, up to + 57% for> 800 patients. Death rate at a hospital outside Attica is +35-40%.”

Intubation and mortality, unequal care between regions

The study also examined disparities in treatment capability and epidemiological data between regions and concluded, “Our results indicate that in-hospital mortality of severely ill COVID-19 patients is adversely affected by high patient load even without exceeding capacity, as well as by regional disparities. This highlights the need for more substantial strengthening of healthcare services, focusing on equity and quality of care besides just expanding capacity.”
The authors found that intubations in a hospital “outside of Attica” was linked to a 35 percent to 40 percent higher mortality.

Specifically, in Thessaloniki, despite the fact that the age of victims examined was lower than in Athens, mortality was 35 percent higher.

There is also a disparity between agricultural and urban areas in a class-based manner, with poor areas having greater mortality, despite the fact that the spread of the virus was greater in large urban centres.

87 percent higher mortality of intubated patients treated outside of ICUs

The study found that the mortality of intubated patients being treated outside of ICUs was a whopping 87 percent higher than patients in ICUs, although that pertains to five percent of intubated patients – according to the authors – outside ICUs.

Political battle royal over ICUs

“I have no indication that the mortality rate of those outside of ICUs is higher than those intubated in ICUs,” the PM told Tsipras in Parliament on 1 December.

That statement, combined with the findings of the study that drew public attention today, led to a war of words between the government and main opposition SYRIZA, which lambasted the government over its management of the pandemic and accused it of knowing and hiding the data from the Lytras-Tsiodras study, which was concluded in May.

Tsipras blasts Mitsotakis, government

In a tweet, main opposition leader Alexis Tsipras suggested the PM is a political fraudster.
“Tsiodras-Lytras study of 5/21: 87 percent higher mortality outside of ICUs. 38.5 percent of deaths would have been avoided if the NHS had been bolstered. Obviously, Mr. Mitsotakis knew that when he answered me in Parliament. Shall I call him a liar? A political fraudster? With 19,475 dead, words lose their meaning,” Tsipras wrote.

Government spokesman slams Tsipras

Government spokesman Yannis Economou today slammed Tsipras for allegedly skewing the meaning of the study and called him a “political destroyer”.

He charged that Tsipras is “attempting to bring to his own limited measurements a scientific study, with lies and the selective citing of the data, in a vulgar and cheap manner” and claimed that Tsipras “consciously conceals that in less than two years ICU beds were more than doubled, and that more healthcare workers were hired by the government.

Economou did not touch on the substance of the scientific paper.

“All this time, Mr. Tsipras coddled anti-vaxxers and deprived the country of the united front we needed to confront the pandemic in accord with scientific guidelines,” he said.

The data became known to the general public in Greece only yesterday, following a tweet by Lytras.

The grim data

The paper notes that 947 people died due to heightened pressure on the NHS, 133 because there was no ICU bed for them, and 656 because they were treated at a hospital outside of Attica.

1,500 lives could have been saved with less pressure on NHS

Tsiodras and Lytras concluded that over 1,500 lives could have been saved between September and May, 2020, if there were less pressure on the NHS.

Lytras said 1,535 lives could have been saved if all of the patients were hospitalised with smaller pressure on the NHS (a maximum of 200 intubated patients) if they had been treated in ICUs in Attica.

“With over 400 intubated patients, we lose patients who would have survived under different circumstances. Moreover, we have a glaring and unacceptable ‘healthcare inequality’ between Attica and the rest of Greece,” he said.

What determines patient survival, Lytras’ barb

The paper concludes that the survival of an intubated patients appears to depend on where they live and on the level of pressure on the NHS when they fell ill.

“Let every citizen judge whether this is acceptable and draw the conclusions,” Lytras said, noting that the study was concluded at the end of May and as was their (Tsiodras and Lytras) duty as servants of public health, they immediately and repeatedly shared the data to decision makers at the highest level.