Almost 90% of patients who died with COVID-19 had do-not-resuscitate (DNR) orders in place at the time of admission, thus illustrating the severity of their pre-existing conditions.
Clinics in Dermatology published the study at the end of last month, based on all patients in two hospitals in New Jersey who “had or developed COVID-19.” The dates covered in the survey are from March 15 to May 15 of this year.
The report records that 1,270 patients had or developed the illness, with 640 patients dying and 630 surviving. However, of those who died, “570 (89.1 percent)” had a DNR, leaving “70 (10.9 percent) without a DNR order at the time of admission.” In the interest of clarity, the study did not include patients who were given a DNR during the time they were in the hospital.
Of the 630 patients who survived, “180” or 28.6% had a DNR on admission, and “450” or 71.4% did not have one. Furthermore, the study found, “Among the 120 patients without COVID-19 who died during this interval, 110 (91.7 percent) had a DNR order when admitted.”
A DNR, as the study mentions, “is often linked to patients with severe illness, advanced age, poor disease prognosis, and deteriorating health status with impending death.”
The high death rates of patients surveyed who already had a DNR, points to the fact that the study “indicates that many patients who died in these hospitals were quite ill to begin with.”
Additionally, the study proved that patients who had a DNR, “had significantly higher numbers of comorbidities ([more than] 3 comorbidities) compared to patients with non-DNR status.” In fact, figures collated by the study show that the majority of patients with 2 comorbidities or more had DNR’s in place.
Not unexpectedly, the study found, “Patients with DNR had a poorer survival rate than non-DNR patients.”
Patients with DNR status thus were found to have “higher hazard ratios for risk of death.”
The study also mentioned the important aspect of “failure to rescue phenomenon,” whereby the very existence of a DNR, means that the patient receives less treatment. “A DNR order has been documented to negatively impact the implementation of other treatment modalities,” the report stated. “One explanation for these results is that more patients with a DNR order died because they were not resuscitated.”
“The increased mortality in DNR patients may have resulted from unmeasured severity of illness, transition to comfort care in accordance with a patient’s wishes, or failure to offer more aggressive care, such as a respirator, to patients with a DNR order.”
The report concluded by noting that DNR’s should be taken into account “in COVID-19 epidemiological studies to further understand mortality in this pandemic.”
“A DNR,” the website wrote, “is more enlightening than a simple analysis of comorbidities because it is indicative of disease severity.”
In recent days, a senior academic at Johns Hopkins University gave an in-depth analysis of U.S. COVID deaths, concluding that there is “no evidence that COVID-19 created any excess deaths. Total death numbers are not above normal death numbers. We found no evidence to the contrary.”
Blanket imposition of DNR’s in health settings
As alluded to in the close of the study, DNR’s can also be misused so as to lead to poor treatment. Indeed, during the recent national lockdown, DNR’s were widely placed upon patients in the U.K. in a “blanket” fashion.
So great was the concern about this that the Care Quality Commission (CQC) is conducting a review of the use of DNR’s during the coronavirus crisis after “concerns were widely reported that elderly and vulnerable people may be being subjected to DNACPR decisions without their consent or with little information to allow them to make an informed decision.”
Commenting on this, the BBC wrote, “It became clear that blanket use was in place in some care homes in the early weeks of the pandemic.” Care homes had “blanket orders in place covering groups of residents,” imposing DNR’s on them.
In practice, DNR’s are often put in place in response to the question posed as, “Is it worth it to put myself or my loved one through the traumatic process of resuscitation for a 1 to 2% chance of survival?”
A study conducted by the Queen’s Nursing Institute found that out of those surveyed, “one in ten of the institutions was ordered by [National Health Service] bosses to introduce DNRs without permission from the residents, family members or fellow staff, in order to free up hospital beds.”
One care worker reported that sometimes “changed without inclusion of family or the resident (where appropriate). Not always made including quality of life rather than disease and age.”
In an article in The Guardian, a doctor attempted to do away with rumors regarding blanket imposition of DNR’s, yet added that “no one can insist upon receiving CPR. Like all other medical treatments, CPR will only be administered if a doctor believes it is in the best interests of the patient.”
Clinics in Dermatology’s own survey noted, “Patients with severe COVID-19 whose physicians feel they need such measures short term to treat the disease may be discouraged from offering them if the patient has a DNR order. This may unnecessarily negatively impact patient care and increase mortality in COVID-19 patients.”