Incidence, clinical outcomes, and transmission dynamics of hospitalized 2019 coronavirus disease among 9,596,321 individuals residing in California and Washington, United States: a prospective cohort study

Lewnard, Joseph A; Liu, Vincent X; Jackson, Michael L.; Schmidt, Mark; Jewell, Britta L; Flores, Jean; Jentz, Chris; Northrup, Graham R.; Mahmud, Ayesha S.; Reingold, Arthur; Petersen, Maya; Jewell, Nicholas P.; Young, Scott D.; Bellows, Jim

doi:10.1101/2020.04.12.20062943

Cited by 34 publications

(39 citation statements)

References 26 publications

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“…Moreover, in contrast to our study, the US and Canadian estimates were not adjusted for the sensitivity of RT-PCR assays and health seeking behaviors, and thus may be underestimated. Our estimated hospitalization rate for a 4-month COVID-19 outbreak was much higher than that for a 3-6-month COVID-19 outbreak in the US and Québec (370 vs. 50-114 per 100,000 persons) [27][28][29][30] . We estimated that 76% of medically-attended cases were hospitalized in Wuhan, while only 18% were hospitalized in the US 30 .…”

Section: Discussioncontrasting

confidence: 56%

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

et al. 2020

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The novel coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, where the initial wave of intense community transmissions was cut short by interventions. Using multiple data sources, here we estimate the disease burden and clinical severity by age of COVID-19 in Wuhan from December 1, 2019 to March 31, 2020. Our estimates account for the sensitivity of the laboratory assays, prospective community screenings, and healthcare seeking behaviors. Rates of symptomatic cases, medical consultations, hospitalizations and deaths were estimated at 796 (95% CI: 703–977), 489 (472–509), 370 (358–384), and 36.2 (35.0–37.3) per 100,000 persons, respectively. The COVID-19 outbreak in Wuhan had a higher burden than the 2009 influenza pandemic or seasonal influenza in terms of hospitalization and mortality rates, and clinical severity was similar to that of the 1918 influenza pandemic. Our comparison puts the COVID-19 pandemic into context and could be helpful to guide intervention strategies and preparedness for the potential resurgence of COVID-19.

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Section: Discussioncontrasting

confidence: 56%

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

et al. 2020

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“…Our estimated hospitalization rate for a four-month COVID-19 outbreak was much higher than that for a three-to-six-month COVID-19 outbreak in the US and Qué bec (370 vs. 47-114 per 100,000 persons) 27,28,29,30 . We estimated that 76% of medicallyattended cases were hospitalized in Wuhan, while only 18% were hospitalized in the US 30 . The difference between these estimates could be explained by the potential different clinical thresholds for hospitalization.…”

Section: Discussioncontrasting

confidence: 56%

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

Yang

Chen

Deng

et al. 2020

Preprint

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The pandemic of novel coronavirus disease 2019 (COVID-19) began in Wuhan, China, where a first wave of intense community transmission was cut short by interventions. Using multiple data source, we estimated the disease burden and clinical severity of COVID-19 by age in Wuhan from December 1, 2019 to March 31, 2020. We adjusted estimates for sensitivity of laboratory assays and accounted for prospective community screenings and healthcare seeking behaviors. Rates of symptomatic cases, medical consultations, hospitalizations and deaths were estimated at 796 (95%CI: 703-977), 489 (472-509), 370 (358-384), and 36.2 (35.0-37.3) per 100,000 persons, respectively. The COVID-19 outbreak in Wuhan had higher burden than the 2009 influenza pandemic or seasonal influenza, and that clinical severity was similar to that of the 1918 influenza pandemic. Our comparison puts the COVID-19 pandemic into context and could be helpful to guide intervention strategies and preparedness for the potential resurgence of COVID-19.

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“…Several studies have been published after our search dates which provide additional LoS estimates from outside of China. A study of 5700 patients from hospitals in the New York area reported comparable estimates for total LoS (median 4.5; IQR 2.4-8.1) [51]; however, studies from Northern Italy [52], Japan [53], and California and Washington [50] reported longer estimates of LoS. Therefore, the total LoS outside of China may in fact be longer than what we concluded.…”

Section: Limitations and Biasescontrasting

confidence: 41%

“…Two studies [27,38] were included in the review which reported LoS by age, and they both found longer LoS associated with older age groups. In addition, two studies of LoS from the USA which were published after the search dates also reported a trend for longer LoS in older age groups [50,51]. Studies also reported LoS by disease severity; however, the definitions of disease severity were not consistent across studies, so we did not summarise by this.…”

Section: Summary Of Findingsmentioning

confidence: 98%

COVID-19 length of hospital stay: a systematic review and data synthesis

Rees

Nightingale

Jafari

et al. 2020

BMC Med

556

410

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Background: The COVID-19 pandemic has placed an unprecedented strain on health systems, with rapidly increasing demand for healthcare in hospitals and intensive care units (ICUs) worldwide. As the pandemic escalates, determining the resulting needs for healthcare resources (beds, staff, equipment) has become a key priority for many countries. Projecting future demand requires estimates of how long patients with COVID-19 need different levels of hospital care. Methods: We performed a systematic review of early evidence on length of stay (LoS) of patients with COVID-19 in hospital and in ICU. We subsequently developed a method to generate LoS distributions which combines summary statistics reported in multiple studies, accounting for differences in sample sizes. Applying this approach, we provide distributions for total hospital and ICU LoS from studies in China and elsewhere, for use by the community. Results: We identified 52 studies, the majority from China (46/52). Median hospital LoS ranged from 4 to 53 days within China, and 4 to 21 days outside of China, across 45 studies. ICU LoS was reported by eight studies-four each within and outside China-with median values ranging from 6 to 12 and 4 to 19 days, respectively. Our summary distributions have a median hospital LoS of 14 (IQR 10-19) days for China, compared with 5 (IQR 3-9) days outside of China. For ICU, the summary distributions are more similar (median (IQR) of 8 (5-13) days for China and 7 (4-11) days outside of China). There was a visible difference by discharge status, with patients who were discharged alive having longer LoS than those who died during their admission, but no trend associated with study date. Conclusion: Patients with COVID-19 in China appeared to remain in hospital for longer than elsewhere. This may be explained by differences in criteria for admission and discharge between countries, and different timing within the pandemic. In the absence of local data, the combined summary LoS distributions provided here can be used to model bed demands for contingency planning and then updated, with the novel method presented here, as more studies with aggregated statistics emerge outside China.

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Incidence, clinical outcomes, and transmission dynamics of hospitalized 2019 coronavirus disease among 9,596,321 individuals residing in California and Washington, United States: a prospective cohort study

Cited by 34 publications

References 26 publications

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

COVID-19 length of hospital stay: a systematic review and data synthesis

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