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

Garg, Shikha; Patel, Kadam; Pham, Huong; Whitaker, Michael; O’Halloran, Alissa; Milucky, Jennifer; Anglin, Onika; Kirley, Pam Daily; Reingold, Arthur; Kawasaki, Breanna; Herlihy, Rachel; Yousey‐Hindes, Kimberly; Maslar, Amber; Anderson, Evan J.; Openo, Kyle P.; Weigel, Andrew; Teno, Kenzie; Ryan, Patricia; Monroe, Maya; Reeg, Libby; Kim, Sue; Como‐Sabetti, Kathryn; Bye, Erica; Davis, Sarah Shrum; Eisenberg, Nancy; Muse, Alison; Barney, Grant; Bennett, Nancy M.; Felsen, Christina B.; Billing, Laurie M; Shiltz, Jess; Sutton, Melissa; Abdullah, Nasreen; Talbot, H. Keipp; Schaffner, William; Hill, Mary; Chatelain, Ryan; Wortham, Jonathan M.; Taylor, Christopher A.; Hall, Aron J.; Fry, Alicia M.; Kim, Lindsay; Havers, Fiona

doi:10.7326/m21-1991

Cited by 51 publications

(44 citation statements)

References 39 publications

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“…Of note, as previously reported [1] , our patients with SC/Sβ + genotypes were less likely to be on HU than SS/Sβ 0 genotypes (Fisher's exact test, p-value = 0.002). While our 19% ICU admission rate is similar to the U.S. general population rate [23] , our 80% overall hospitalization is higher than the U.S. general population rate of 2% [22] but compatible with previously reported ranges in SCD between 41 and 76% for hospitalization and 11–20% for ICU [1] , [3] , [4] , [5] , [21] . Our higher-end hospitalization rate may reflect a conservative approach with our SCD patients.…”

Section: Discussionsupporting

confidence: 90%

Prognostic factors associated with COVID-19 related severity in sickle cell disease

Yurtsever

Nandi

Ziemba

et al. 2021

Blood Cells, Molecules, and Diseases

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Section: Discussionsupporting

confidence: 90%

Prognostic factors associated with COVID-19 related severity in sickle cell disease

Yurtsever

Nandi

Ziemba

et al. 2021

Blood Cells, Molecules, and Diseases

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“…Sampling weights are based on the probability of selection and adjusted for non-response; sample sizes vary by surveillance month, site and age group and are based on the total number of cases identified in each of these strata. 8 Monthly demographic and clinical data through June 2021 were the most recent data available at the time of this study.…”

Section: Methodsmentioning

confidence: 99%

COVID-19-associated hospitalizations among vaccinated and unvaccinated adults ≥18 years – COVID-NET, 13 states, January 1 – July 24, 2021

Havers

Pham

Taylor

et al. 2021

Preprint

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Background: As of August 21, 2021, >60% of the U.S. population aged ≥18 years were fully vaccinated with vaccines highly effective in preventing hospitalization due to Coronavirus Disease-2019 (COVID-19). Infection despite full vaccination (vaccine breakthrough) has been reported, but characteristics of those with vaccine breakthrough resulting in hospitalization and relative rates of hospitalization in unvaccinated and vaccinated persons are not well described, including during late June and July 2021 when the highly transmissible Delta variant predominated. Methods: From January 1-June 30, 2021, cases defined as adults aged ≥18 years with laboratory-confirmed Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) infection were identified from >250 acute care hospitals in the population-based COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). Through chart review for sampled cases, we examine characteristics associated with vaccination breakthrough. From January 24-July 24, 2021, state immunization information system data linked to both >37,000 cases representative cases and the defined surveillance catchment area population were used to compare weekly hospitalization rates in vaccinated and unvaccinated individuals. Unweighted case counts and weighted percentages are presented. Results: From January 1 - June 30, 2021, fully vaccinated cases increased from 1 (0.01%) to 321 (16.1%) per month. Among 4,732 sampled cases, fully vaccinated persons admitted with COVID-19 were older compared with unvaccinated persons (median age 73 years [Interquartile Range (IQR) 65-80] v. 59 years [IQR 48-70]; p<0.001), more likely to have 3 or more underlying medical conditions (201 (70.8%) v. 2,305 (56.1%), respectively; p<0.001) and be residents of long-term care facilities [37 (14.5%) v. 146 (5.5%), respectively; p<0.001]. From January 24 - July 24, 2021, cumulative hospitalization rates were 17 times higher in unvaccinated persons compared with vaccinated persons (423 cases per 100,000 population v. 26 per 100,000 population, respectively); rate ratios were 23, 22 and 13 for those aged 18-49, 50-64, and ≥65 years respectively. For June 27 - July 24, hospitalization rates were ≥10 times higher in unvaccinated persons compared with vaccinated persons for all age groups across all weeks. Conclusion: Population-based hospitalization rates show that unvaccinated adults aged ≥18 years are 17 times more likely to be hospitalized compared with vaccinated adults. Rates are far higher in unvaccinated persons in all adult age groups, including during a period when the Delta variant was the predominant strain of the SARS-CoV-2 virus. Vaccines continue to play a critical role in preventing serious COVID-19 illness and remain highly effective in preventing COVID-19 hospitalizations.

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“…§ Unadjusted age-specific monthly population-based hospitalization rates (hospitalizations per 100,000 persons) among all adults aged ≥18 years irrespective of pregnancy status during January-August 2021 were calculated by dividing the total number of hospitalized COVID-19 patients by population estimates within each age group in the surveillance catchment area. ¶ Using previously described methods (2), clinical outcomes data were collected on a representative sample of hospitalized adults stratified by age and site of admission during † Selected counties in California, Colorado, Connecticut, Georgia, Iowa, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah can be found at https://www.cdc.gov/mmwr/volumes/69/ wr/mm6915e3.htm. § https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covid-net/purposemethods.html ¶ Rates cannot be stratified by pregnancy status because the underlying population of pregnant women in the catchment area is unknown.…”

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confidence: 99%

“…§ Unadjusted age-specific monthly population-based hospitalization rates (hospitalizations per 100,000 persons) among all adults aged ≥18 years irrespective of pregnancy status during January–August 2021 were calculated by dividing the total number of hospitalized COVID-19 patients by population estimates within each age group in the surveillance catchment area. ¶ Using previously described methods ( 2 ), clinical outcomes data were collected on a representative sample of hospitalized adults stratified by age and site of admission during January–August 2021. Using a standardized case report form, trained surveillance staff members abstracted data on sampled cases (updated monthly) from medical charts that included a discharge disposition.…”

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confidence: 99%

“…Chi-square testing was used to compare differences between the pre-Delta and Delta periods; p-values <0.05 were considered statistically significant, adjusted for multiple comparisons using the Bonferroni correction method. Unless otherwise noted, percentages presented are weighted to account for the probability of selection for sampled cases ( 2 ). All analyses were conducted using SAS statistical software survey procedures (version 9.4; SAS Institute).…”

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confidence: 99%

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Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance — COVID-NET, 14 States, January–August 2021

Taylor¹,

Patel²,

Pham³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).In mid-June 2021, B.1.671.2 (Delta) became the predominant variant of SARS-CoV-2, the virus that causes COVID-19, circulating in the United States. As of July 2021, the Delta variant was responsible for nearly all new SARS-CoV-2 infections in the United States.* The Delta variant is more transmissible than previously circulating SARS-CoV-2 variants (1); however, whether it causes more severe disease in adults has been uncertain. Data from the CDC COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system for COVID-19-associated hospitalizations, were used to examine trends in severe outcomes in adults aged ≥18 years hospitalized with laboratory-confirmed COVID-19 during periods before (January-June 2021) and during (July-August 2021) Delta variant predominance. COVID-19-associated hospitalization rates among all adults declined during January-June 2021 (pre-Delta period), before increasing during July-August 2021 (Delta period). Among sampled nonpregnant hospitalized COVID-19 patients with completed medical record abstraction and a discharge disposition during the pre-Delta period, the proportion of patients who were admitted to an intensive care unit (ICU), received invasive mechanical ventilation (IMV), or died while hospitalized did not significantly change from the pre-Delta period to the Delta period. The proportion of hospitalized COVID-19 patients who were aged 18-49 years significantly increased, from 24.7% (95% confidence interval [CI] = 23.2%-26.3%) of all hospitalizations in the pre-Delta period, to 35.8% (95% CI = 32.1%-39.5%, p<0.01) during the Delta period. When examined by vaccination status, 71.8% of COVID-19-associated hospitalizations in the Delta period were in unvaccinated adults. Adults aged 18-49 years accounted for 43.6% (95% CI = 39.1%-48.2%) of all hospitalizations among unvaccinated adults during the Delta period.

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

Abstract: This study used data from a national CDC network to examine trends related to COVID-19 hospitalization, care, and clinical outcomes across the United States.

Cited by 51 publications

References 39 publications

Prognostic factors associated with COVID-19 related severity in sickle cell disease

Prognostic factors associated with COVID-19 related severity in sickle cell disease

COVID-19-associated hospitalizations among vaccinated and unvaccinated adults ≥18 years – COVID-NET, 13 states, January 1 – July 24, 2021

Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance — COVID-NET, 14 States, January–August 2021

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