Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic — United States, July 2020–July 2021

French, Geoffrey; Hulse, Mary; Nguyen, Debbie; Sobotka, Katharine; Webster, Kaitlyn; Corman, Josh; Aboagye‐Nyame, Brago; Dion, Marc; Johnson, Moira; Zalinger, Benjamin; Ewing, Maria

doi:10.15585/mmwr.mm7046a5

Cited by 121 publications

(107 citation statements)

References 6 publications

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“…Overall, our analyses suggest that part of these in-hospital mortality risk reductions could be sustained if hospital capacity is maintained and hospital-acquired infections are prevented. These findings are aligned with those from studies conducted worldwide 14,25,40-42 . Limited critical care resources and rapidly increasing staff-to-patient ratio could have influenced patient outcomes during periods of high transmission 29,43 .…”

Section: Discussionsupporting

confidence: 87%

Mortality trends and lengths of stay among hospitalized COVID-19 patients in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves

Xia

Mishra

et al. 2021

Preprint

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Background: Epidemic waves of COVID-19 strained hospital resources. We describe temporal trends in mortality risk and length of stay in intensive cares units (ICUs) among COVID-19 patients hospitalized through the first three epidemic waves in Canada. Methods: We used population-based provincial hospitalization data from Ontario and Qu&eacutebec to examine mortality risk and lengths of ICU stay. For each province, adjusted estimates were obtained using marginal standardization of logistic regression models, adjusting for patient-level characteristics and hospital-level determinants. Results: Using all hospitalizations from Ontario (N=26,541) and Qu&eacutebec (N=23,857), we found that unadjusted in-hospital mortality risks peaked at 31% in the first wave and was lowest at the end of the third wave at 6-7%. This general trend remained after controlling for confounders. The odds of in-hospital mortality in the highest hospital occupancy quintile was 1.2 (95%CI: 1.0-1.4; Ontario) and 1.6 (95%CI: 1.3-1.9; Qu&eacutebec) times that of the lowest quintile. Variants of concerns were associated with an increased in-hospital mortality. Length of ICU stay decreased over time from a mean of 16 days (SD=18) to 15 days (SD=15) in the third wave but were consistently higher in Ontario than Qu&eacutebec by 3-6 days. Conclusion: In-hospital mortality risks and lengths of ICU stay declined over time in both provinces, despite changing patient demographics, suggesting that new therapeutics and treatment, as well as improved clinical protocols, could have contributed to this reduction. Continuous population-based monitoring of patient outcomes in an evolving epidemic is necessary for health system preparedness and response.

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Section: Discussionsupporting

confidence: 87%

Mortality trends and lengths of stay among hospitalized COVID-19 patients in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves

Xia

Mishra

et al. 2021

Preprint

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“…This might reflect increased replication of Omicron in the upper versus lower respiratory tract, which could also contribute to more efficient transmission, resulting in increased absolute 21 numbers of hospitalizations. Booster vaccination has the potential to decrease hospital burden and improve clinical outcomes 22 . Although the sample size and follow-up period were not sufficient in our study or other studies to assess potential waning VE against hospitalization with Omicron, our results of waning VE against Omicron infection after dose 3 of mRNA-1273 underscores the importance of monitoring VE against hospitalization with Omicron infection.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of mRNA-1273 against SARS-CoV-2 Omicron and Delta variants

Tseng

Ackerson

Luo

et al. 2022

Nat Med

467

334

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron (B.1.1.529) variant is highly transmissible with potential immune escape. We conducted a test-negative case–control study to evaluate mRNA-1273 vaccine effectiveness (VE) against infection and hospitalization with Omicron or Delta. The large, diverse study population included 26,683 SARS-CoV-2 test-positive cases with variants determined by S gene target failure status (16% Delta and 84% Omicron). The two-dose VE against Omicron infection at 14–90 days was 44.0% (95% confidence interval, 35.1–51.6%) but declined quickly. The three-dose VE was 93.7% (92.2–94.9%) and 86.0% (78.1–91.1%) against Delta infection and 71.6% (69.7–73.4%) and 47.4% (40.5–53.5%) against Omicron infection at 14–60 days and >60 days, respectively. The three-dose VE was 29.4% (0.3–50.0%) against Omicron infection in immunocompromised individuals. The three-dose VE against hospitalization with Delta or Omicron was >99% across the entire study population. Our findings demonstrate high, durable three-dose VE against Delta infection but lower effectiveness against Omicron infection, particularly among immunocompromised people. However, three-dose VE of mRNA-1273 was high against hospitalization with Delta and Omicron variants.

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“…Booster vaccination has the potential to decrease hospital burden and improve outcomes. 22 While the sample size and follow-up period were not sufficient in our study or other studies to assess potential waning VE against hospitalization with omicron, our results of waning VE against omicron infection after dose 3 of mRNA-1273 underscores the importance of monitoring VE against hospitalization with omicron. This study provides novel data complementing recent reports of the effectiveness of other COVID-19 vaccines against omicron infection and has several strengths and limitations.…”

Section: Discussionmentioning

confidence: 64%

Effectiveness of mRNA-1273 against SARS-CoV-2 omicron and delta variants

Tseng

Ackerson

Luo

et al. 2022

Preprint

141

191

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Background The recently emerged SARS-CoV-2 omicron variant raised concerns around potential escape from vaccine-elicited immunity. Limited data are available on real-world vaccine effectiveness (VE) of mRNA-1273 against omicron. Here, we report VE of 2 or 3 mRNA-1273 doses against infection and hospitalization with omicron and delta, including among immunocompromised individuals. Methods This test negative study was conducted at Kaiser Permanente Southern California. Cases were individuals aged ≥18 years testing positive by RT-PCR with specimens collected between 12/6/2021 and 12/23/2021 with variant determined by spike gene status. Randomly sampled test negative controls were 5:1 matched to cases by age, sex, race/ethnicity, and specimen collection date. Conditional logistic regression models were used to evaluate adjusted odds ratio (aOR) of vaccination with mRNA-1273 doses between cases and controls. VE(%) was calculated as (1-aOR)x100. Results 6657 test positive cases (44% delta, 56% omicron) were included. The 2-dose VE against omicron infection was 30.4% (95% CI, 5.0%-49.0%) at 14-90 days after vaccination and declined quickly thereafter. The 3-dose VE was 95.2% (93.4%-96.4%) against delta infection and 62.5% (56.2%-67.9%) against omicron infection. The 3-dose VE against omicron infection was low among immunocompromised individuals (11.5%; 0.0%-66.5%). None of the cases (delta or omicron) vaccinated with 3 doses were hospitalized compared to 53 delta and 2 omicron unvaccinated cases. Conclusions VE of 3 mRNA-1273 doses against infection with delta was high and durable, but VE against omicron infection was lower. VE against omicron infection was particularly low among immunocompromised individuals. No 3-dose recipients were hospitalized for COVID-19.

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Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic — United States, July 2020–July 2021

Cited by 121 publications

References 6 publications

Mortality trends and lengths of stay among hospitalized COVID-19 patients in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves

Mortality trends and lengths of stay among hospitalized COVID-19 patients in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves

Effectiveness of mRNA-1273 against SARS-CoV-2 Omicron and Delta variants

Effectiveness of mRNA-1273 against SARS-CoV-2 omicron and delta variants

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