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Utah researchers find ways to identify patients susceptible to COVID-19-related death

State reports another 906 cases and 2 new deaths Wednesday

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Sara Haight and Alta Findlay administer a COVID-19 test at a testing site run by the Salt Lake County Health Department at Glendale Middle School in Salt Lake City on Tuesday, Sept. 15, 2020.

Spenser Heaps, Deseret News

SALT LAKE CITY — Doctors are finding out more about which patients fare the worst with COVID-19, but the new knowledge doesn’t warrant relaxed rules concerning face coverings and social distancing.

“All advances in treating patients in the hospital ... pale in comparison to our efforts in the community to stay engaged and slow the spread of disease,” Dr. Brandon Webb, an infectious disease physician at Intermountain Healthcare, said Wednesday.

The Utah Department of Health announced 906 new COVID-19 cases on Wednesday, which brings the total number of infections to 73,042 in the state since mid-March. Of those, the health department estimates 55,141 have recovered.

Of those who have not recovered, 459 people in Utah have died with COVID-19, including two new deaths announced on Wednesday by the health department.

“Fortunately,” said Intermountain Healthcare critical care doctor and researcher, Dr. Samuel Brown, Utah’s death rate resulting from the virus has been very low.

Despite that, the Intermountain researchers have used common blood tests to identify some diagnostic criteria that has helped identify patients who are the most susceptible to severe and often deadly complications from COVID-19, particularly because of COVID-19 associated hyperinflammatory syndrome.

Diagnosing this hyperinflammatory syndrome is very important, the researchers said. With a new scoring system, clinicians can now identify patients early and ideally prescribe treatments before the condition progresses and causes patients to deteriorate to critical levels.

They’re hoping it will save more lives — in Utah and across the globe.

“In most people, the immune system gets rid of the virus. ... We are finding that a subset of people in whom their immune system puts out a stick of dynamite to blow away the infection rather than the precise work the immune system would do,” Brown said.

Biological markers used to develop the new diagnostic criteria include elevated ferritin levels, the presence of C-reactive protein, a rise in triglyceride levels in the body, as well as the d-dimer inflammatory marker, which tracks damage to blood vessels. Each can be detected during a simple blood test.

“When the immune system goes wild, it causes more damage,” Brown said, adding that in COVID-19 patients, blood clotting becomes an issue, which ultimately results in the failure of some organs.

They found that people whose immune systems ultimately kicked into overdrive to fight off the novel coronavirus tend to have a much greater risk of needing a ventilator and other poor outcomes, Webb said.

The local study was applied to nearly 300 patients admitted to Utah hospitals between mid-March and May, including a representative portion of Hispanic and Pacific Islanders in Utah, but lacking in other populations, Brown said. He said they have reached out to other states for more data to see if the same applies to more diverse populations.

Brown said physicians continue to learn about new treatments to target the ever-invasive COVID-19 “using the greatest wisdom, empathy and knowledge” we have.

“The ultimate goal of everything that we’re doing is to save lives and prevent severity,” Webb added. The diagnostic criteria he developed, he said, helps get “the right treatment to the right patients early, in an effort to preempt the development of this severe complication that does result in death in some patients.”

So far, the population most greatly affected is those over age 65 and people with certain existing medical issues, including chronic respiratory disease, heart problems and obesity, to name a few.

COVID-19 is “ruthlessly Darwinian — it loves more than anything to attack the vulnerable,” Brown said.

However, once this COVID-19-associated hyperinflammatory syndrome sets in, Brown said, a patient’s age or whether they have underlying conditions doesn’t matter. It makes treatment more complex and death more likely.

So, the trick is to use readily available steroids and other medications to keep patients from getting to the point of needing more invasive steps to prevent death.

Both researchers said that masks have become an important part of their ongoing research, and more importantly that when worn appropriately in the community, face coverings help to slow the spread of disease, resulting in fewer patients ending up in the hospitals and “unnecessary illness and lives lost,” Webb said.

Their findings are published in the medical journal the Lancet Rheumatology.

Utah’s health department reports 203 people are currently hospitalized throughout Utah. And two new deaths have been added to the state’s COVID-19 death toll, which has reached 459 lives lost to the virus.

The new deaths include a Washington County man older than age 85, and a Davis County man between the ages of 65 and 84. Both were residents at long-term health care facilities at the time of their deaths.

The state has tested 829,970 people, an increase of 8,106 since Tuesday, the health department reports.

Utah’s rolling seven-day average for positive tests is 1,017 per day, with a percent positivity of 13.6%.