ObjectiveTo understand the epidemiology and burden of severe coronavirus disease 2019 (covid-19) during the first epidemic wave on the west coast of the United States.DesignProspective cohort study.SettingKaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state.Participants1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9 596 321 healthcare plan enrollees. Analyses of hospital length of stay and clinical outcomes included 1328 people admitted by 9 April 2020 (534 in northern California, 711 in southern California, and 83 in Washington).Main outcome measuresCumulative incidence of first acute hospital admission for confirmed covid-19, and subsequent probabilities of admission to an intensive care unit (ICU) and mortality, as well as duration of hospital stay and ICU stay. The effective reproduction number (RE) describing transmission dynamics was estimated for each region.ResultsAs of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100 000 cohort members in northern California, 23.3 per 100 000 in southern California, and 14.7 per 100 000 in Washington. Accounting for censoring of incomplete hospital stays among those admitted by 9 April 2020, the estimated median duration of stay among survivors was 9.3 days (with 95% staying 0.8 to 32.9 days) and among non-survivors was 12.7 days (1.6 to 37.7 days). The censoring adjusted probability of ICU admission for male patients was 48.5% (95% confidence interval 41.8% to 56.3%) and for female patients was 32.0% (26.6% to 38.4%). For patients requiring critical care, the median duration of ICU stay was 10.6 days (with 95% staying 1.3 to 30.8 days). The censoring adjusted case fatality ratio was 23.5% (95% confidence interval 19.6% to 28.2%) among male inpatients and 14.9% (11.8% to 18.6%) among female inpatients; mortality risk increased with age for both male and female patients. Reductions in RE were identified over the study period within each region.ConclusionsAmong residents of California and Washington state enrolled in Kaiser Permanente healthcare plans who were admitted to hospital with covid-19, the probabilities of ICU admission, of long hospital stay, and of mortality were identified to be high. Incidence rates of new hospital admissions have stabilized or declined in conjunction with implementation of social distancing interventions.

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Acute sepsis-related neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality and represents a key mediator of long-term adverse outcomes following sepsis.

In a retrospective cohort study based on data from adult members of a large integrated health system, the authors assessed the contribution of age, sex, race/ethnicity, neighborhood of residence, comorbidities, and measures of acute physiology to rates of COVID-19 testing, infection, hospitalization, mortality, and other health outcomes.

skinny labeling, our findings suggest that generic drug entry for susceptible brand-name drugs could be delayed by multiple years. A limitation of the study is that our strict criteria for determining susceptibility to skinny labeling may have underestimated the delay.Despite the practice of skinny labeling being explicitly permitted by statute, recent court decisions have increased the financial risk of generic manufacturers considering using a skinny label by subjecting them to claims for inducement of patent infringement. 5 Subjecting generic manufacturers to heightened risk of legal damages for their skinny labels could reduce incentives to use this pathway and lead to delays in generic competition that lowers prices for patients and the health care system.The US Congress and the FDA could consider actions to ensure that skinny labeling remains an attractive pathway for generic manufacturers. Skinny labels prevent brand-name drug manufacturers from delaying competition by obtaining patents covering subsequent FDA-approved indications of their drugs.