The most risk factor is
Case 285
【Discussion】
There are seven waves of COVID19 pandemic in Japan since its initial emergence; the number of patients with COVID-19 on the peak day of the first wave, 720 on 2020 04 11; the second peak 1,605 on 2020 08 07; the third peak, 7,956 on 2021 01 08; the fourth peak 7,234 on 2021 05 08; the fifth peak 25,995 on 2021 08 20; the sixth peak on around 100,000 on 2022 02 03: the seventh peak on 260,943 (1).
During the seventh wave, 4 patients with COVID-19 passed away in Hannan Municipal Hospital. They were patients from out-of-Hannan-city and admitted via Osaka follow-up center. The mean intervals from the onset to admission were 6 days (3 – 9) and the mean intervals from the admission to death were 7 days (2 – 11). The gender and ages were; 3 women, 1 man and 79, 86, 86 & 92, respectively. The underlying diseases are; Case 1, dementia, IV degree of nursing care, liver cirrhosis, brain infarction (right hemiparesis), diabetes mellitus; Case 2, Alzheimer dementia, schizophrenia, femoral bone neck fracture; Case 3, diabetes mellitus: Case 4, Brain hemorrhage, Parkinson, stomach fistula. Present illnesses are; Case 1, right pleural effusion, hepatic encephalopathy; Case 2, aspiration pneumonia; Case 2, aspiration pneumonia; Case 3, aspiration pneumonia: Case 4, aspiration pneumonia. The clinical severity of COVID-19 was Moderate II in Case 1 and Severe in Case 2, 3, 4 according to medical guideline of version 7 (2), Moderate II indicates SpO2 less than 93 % with necessity of O2 inhalation and Severe indicates the situation of under intensive care unit or artificial respirator required. PF ratio (PaO2/FIO2) of Case 1, 2, 3 and 4 was 260, 105, 160 and 125, respectively. Three patients experienced vaccination three times and one patient was not described in her chart on vaccination.
Chest CT findings are; right massive pleural effusion plus right lower lobe consolidation in Case 1; ground glass and consolidation opacity in the whole lung in Case 2; bilateral pleural effusion and consolidation of right lower lobe in Case 3: consolidation of bilateral lower lobes in Case 4. These findings are not compatible with typical findings of COVID-19 but aspiration pneumonia.
According to statics of Health, Labor and Welfare Ministry of Japan (1), the death number in 2018 before COVID-19 pandemic was 3733/day: the death number by pneumonia was 364/day (pneumonia 259/day plus aspiration pneumonia 105/day). Although the death number implies increases each year, the main reason is dying of old age but not pandemic of COVID-19. Although it is true that there are some people who die from COVID-19, four patients in our hospital die from aspiration pneumonia rather than COVID-19 itself. It implies that COVID-19 is not a disease of lethal at present when vaccination prevails nationwide.
【Summary】
We listed four cases with COVID-19 who died from 2022 07 31 to 2022 08 31. The mean intervals from the onset to admission were 6 days (3 – 9) and the mean intervals from the admission to death discharge were 7 days (2 – 11). All patients were more than 79 ages and owned various underlying diseases such as dementia (3/4), diabetes mellitus (2/4), Parkinson disease (1/4), brain infarction (1/4), brain hemorrhage (1/4), gastric fistula (1/4) and liver cirrhosis (1/4). Present illnesses were aspiration pneumonia (3/4), liver failure (1/4) and sepsis (1/4). They experienced vaccination three times (3/4) and unknown (1/4). Although COVID clinical degree was moderate II in 1/4 and severe 3/4 according to guideline, it was thought that the clinical severity of illness was dependent on worsening of their underlying diseases rather than COVID-19.
【References】
1.Japanese Ministry of Health, Labor Welfare Homepage (in Japanese)
2.Medical guideline for new type corona virus infection version 7
2022.12.9