COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment

Abstract

Background We evaluated the clinical outcomes, functional burden, and complications one month after COVID-19 infection in a prospective United States Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. Methods MHS beneficiaries presenting at nine sites across the United States with a positive SARS-CoV-2 test, a COVID-19 like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and ICD-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. Results A total of 1,202 participants were enrolled. There were 1,070 laboratory confirmed SARS-CoV-2 cases and 132 SARS-CoV-2 negative participants. In the first month post-symptom onset among the SARS-CoV-2 positive cases, there were 214 hospitalizations, 79% requiring oxygen, 22 ICU admissions, and 9 deaths. Risk factors for COVID-19 associated hospitalization included race (increased for Asian, Black, and Hispanic compared to non-Hispanic White), age (age 45-64 and 65+ compared to <45), and obesity (BMI>=30 compared to BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen and 31% had not returned to normal daily activities at one-month post-symptom onset. Conclusions Older age, reporting Asian, Black or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by one month.

SARS-CoV-2 BA.1 variant is neutralized by vaccine booster–elicited serum but evades most convalescent serum and therapeutic antibodies

“…2 ). These individuals were enrolled in the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study ( 26 ). Genotypes of the infecting variants were sequenced for all cases ( Table 2 , tables S1 and S2).…”

“…The EPICC study is a cohort study of U.S. Military Health System (MHS) beneficiaries that includes those with a history of SARS-CoV-2 infection ( 26 ) . Eligibility criteria for enrollment included those presenting to clinical care with COVID-19-like illness and for SARS-CoV-2 PCR testing.…”

“…The EPICC study is a cohort study of U.S. Military Health System (MHS) beneficiaries that includes those with a history of SARS-CoV-2 infection (26) Study procedures for these participants with SARS-CoV-2 infection included collection of demographic data and completion of a clinical case report form (CRF) to characterize acute COVID-19 illness. Biospecimen collection included serial serum samples for immune response analysis and upper respiratory specimen swabs for virological analysis.…”

Post-vaccination Omicron infections induce broader immunity across antigenic space than prototype mRNA COVID-19 booster vaccination or primary infection

“…The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a cohort study of U.S. Military Health System (MHS) beneficiaries that includes enrollment and longitudinal follow up of those with a history of SARS-CoV-2 infection (Richard et al, 2021). Eligibility criteria for enrollment included presenting to clinical care with COVID-19-like illness and being tested for SARS-CoV-2 by polymerase chain reaction (PCR) assay.…”

The changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool

“…The symptoms described in this study are in line with other working age and active population and cohort studies. (23)(24)(25)(26)(27) Post-COVID-19 syndrome incidence Despite the increase in referrals and symptom burden in this population between the wave one and two, there was a substantial decrease in incidence in post-COVID-19 syndrome (43% vs 2%), although the incidence is likely to be arti cially high in the rst wave due to widespread testing restrictions. This study cannot determine the reasons behind this, however, potential explanations include better awareness of the condition (6) and self-management resources (28), the impact of vaccinations ( 29) and the changing nature of COVID-19 variants (30)(31).…”