Clinical Trends Among U.S. Adults Hospitalized with COVID-19, March-December 2020

 Shikha Garg, MD, MPH, Kadam Patel, MPH, Huong Pham, MPH, Pam Daily Kirley, MPH, Breanna Kawasaki, MPH, Kimberly Yousey-Hindes, MPH, Evan J. Anderson, MD, Andrew Weigel, MSW, Patricia A. Ryan, MS, Libby Reeg, MPH, Kathryn Como-Sabetti, MPH, Sarah Shrum Davis, MPH, Alison Muse, MPH, Nancy M. Bennett, MD, MS, Laurie Billing, MPH, Melissa Sutton, MD, MPH, H. Keipp Talbot, MD, Mary Hill, MPH, Jonathan Wortham, MD, Lindsay Kim, MD, Fiona Havers, MD, MHS, COVID-NET Surveillance Team

doi: https://doi.org/10.1101/2021.04.21.21255473

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

PDF: https://www.medrxiv.org/content/10.1101/2021.04.21.21255473v1.full.pdf

Abstract

Background: The COVID-19 pandemic has caused substantial morbidity and mortality. Objectives: To describe monthly demographic and clinical trends among adults hospitalized with COVID-19 Design: Pooled cross-sectional Setting: 99 counties within 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) Patients: U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during March 1-December 31, 2020 Measurements: Monthly trends in weighted percentages of interventions and outcomes including length of stay (LOS), intensive care unit admissions (ICU), invasive mechanical ventilation (IMV), vasopressor use and in-hospital death (death). Monthly hospitalization, ICU and death rates per 100,000 population. Results: Among 116,743 hospitalized adults, median age was 62 years. Among 18,508 sampled adults, median LOS decreased from 6.4 (March) to 4.6 days (December). Remdesivir and systemic corticosteroid use increased from 2% and 19% (March) to 54% and 74% (December), respectively. Frequency of ICU decreased from 38% (March) to 21% (December). IMV (28% to 9%), vasopressors (23% to 9%) and deaths (14% to 9%) decreased from March to October; however, percentages of these interventions and outcomes leveled out or increased in November and December. Percentage of deaths significantly decreased over time for non-Hispanic White patients (p-value <0.01) but not non-Hispanic Black or Hispanic patients. Rates of hospitalization (105.3 per 100,000), ICU (20.2) and death (11.7) were highest during December. Limitations: COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. Conclusions: After initial improvement during April-October 2020, trends in interventions and outcomes worsened during November-December, corresponding with the 3rd peak of the U.S. pandemic. These data provide a longitudinal assessment of trends in COVID-19-associated outcomes prior to widespread COVID-19 vaccine implementation.

Competing Interest Statement

Dr. Evan Anderson reports grants from Pfizer, grants from Merck, grants from PaxVax, grants from Micron, grants from Sanofi-Pasteur, grants from Janssen, grants from MedImmune, grants from GSK, personal fees from Sanofi-Pasteur, personal fees from Pfizer, personal fees from Medscape, personal fees from Kentucky Bioprocessing, Inc, personal fees from Sanofi-Pasteur, outside the submitted work. Dr. William Schaffner reports personal fees from VBI Vaccines, outside the submitted work.

Funding Statement

This work was supported by the Centers of Disease Control and Prevention through an Emerging Infections Program cooperative agreement (grant CK17-1701) and through a Council of State and Territorial Epidemiologists cooperative agreement (grant NU38OT000297-02-00).

https://www.medrxiv.org/content/10.1101/2021.04.21.21255473v1