Incidentally Detected SARS‐COV‐2 Among Hospitalized Patients in Los Angeles County, August to October 2020

Tsai, Jennifer; Traub, Elizabeth; Aoki, Kymberly; OYong, Kelsey; Sato, Heidi; Rizik-Baer, Daniel

doi:10.12788/jhm.3641

Cited by 17 publications

(14 citation statements)

References 2 publications

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“…The high frequency of incidental COVID-19 infection among hospitalized patients detected using the case definition based on lack of oxygen requirement exceeds the rates reported in previous studies that used more stringent case definition based on complete absence of COVID-19 symptoms (2) or were performed during periods of the pandemic prior to the Omicron variant surge (3). However, the high frequency of incidental COVID-19 is very similar to measurements based on case definition of severe COVID-19 (6) or correlates such as administration of steroid treatment (5) during the Omicron surge.…”

contrasting

confidence: 58%

“…While preventing infection was the initial focus of the COVID-19 pandemic response, with increasing population immunity and variant transmissibility, the current focus has shifted to reducing hospitalization and deaths, particularly in vulnerable communities (1). During the recent surge in disease activity driven by the Omicron variant, an increased proportion of "COVID-19 hospitalizations" were incidentally discovered infections in patients newly hospitalized for other reasons (2)(3)(4)(5)(6), resulting in decreased measurements of in-hospital disease severity and mortality compared to prior disease surges (6-9). However, estimates of the proportion of total COVID-19 hospitalizations accounted for by these incidental infections range widely from 15% to 68% (2-6), due to heterogeneity in case definitions for these incidental infections and variability across populations with respect to vaccination status and other risk factors for severe COVID-19.…”

mentioning

confidence: 99%

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A More Accurate Measurement of COVID-19 Hospitalizations

Kawaguchi

Torres

et al. 2022

Preprint

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COVID-19 hospitalizations are a key indicator of the SARS-CoV-2 pandemic. The US Centers for Disease Prevention and Control describes oxygen supplementation as a measure of severe disease. SARS-CoV-2 PCR positive patients hospitalized without hypoxia or requiring oxygen may have been identified incidentally due to routine screening practices. We describe the application of a revised case definition for COVID-19 hospitalization based on the case-patient oxygen requirement on admission. Using data collected from consecutive SARS-CoV-2 PCR positive hospital admissions in December 2021 and January 2022 at a large safety net hospital in Los Angeles County, we highlight differences between patients hospitalized with COVID-19 (i.e., no oxygen requirement on admission or `incidental` infection) and those hospitalized for COVID-19 (i.e., oxygen requirement on admission). We conducted multivariable modeling to determine the effect of age as a positive predictor of COVID-19 hospitalization and vaccination or prior infection as a negative predictor. The revised case-definition resulted in a substantial decrease in the number of COVID-19 hospitalizations during the study period: 67.5% of SARS-CoV-2 PCR positive hospital admissions were not for COVID-19 but with COVID-19. A revised case-definition for COVID-19 hospitalization that includes the oxygen requirement on admission is needed to more accurately monitor the pandemic and inform public health policy.

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confidence: 58%

mentioning

confidence: 99%

A More Accurate Measurement of COVID-19 Hospitalizations

Kawaguchi

Torres

et al. 2022

Preprint

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“…Pregnant women were excluded from the analysis because previous studies reported that delivery is a common reason for hospital admission in patients with incidental SARS-CoV-2 infections. 12 See also Figure S1 . …”

Section: Resultsmentioning

confidence: 99%

A multi-country analysis of COVID-19 hospitalizations by vaccination status

Gonçalves,

Jassat,

Baruch

et al. 2023

Med

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“…The percentage of hospitalizations classified as incidental COVID-19 varies. Prior to the Omicron variant surge, a report from Los Angeles County Public Health found that 12% of hospitalizations during August–October 2020 were classified as incidental COVID-19 [ 30 ]. In a cohort of fully vaccinated patients with breakthrough SARS-CoV-2 infections in Yale New Haven Health System, 46% of hospitalizations were classified as incidental COVID-19 [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Distinct Clinical Presentations and Outcomes of Hospitalized Adults with the SARS-CoV-2 Infection Occurring during the Omicron Variant Surge

et al. 2023

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The COVID-19 Omicron variant has imposed a tremendous burden on healthcare services. We characterized the types of the Omicron variant-associated hospitalizations and their associations with clinical outcomes. Consecutive adults hospitalized with COVID-19 during the Omicron variant surge period of 1–14 January 2022, were classified into one of three groups based on their clinical presentations on admission: Group 1—primary COVID-19; Group 2—extrapulmonary manifestations of COVID-19; and Group 3—incidental COVID-19. Of the 500 patients who were hospitalized, 51.4% fell into Group 1, 16.4% into Group 2, and 32.2% into Group 3. The patients in Groups 1 and 2 were older, with higher proportions of comorbidities than patients in Group 3. The Group 1 patients had the highest mortality rate (15.6%), followed by Group 2 (8.5%), and Group 3 (0.6%), with adjusted odds ratios (OR) of 22.65 (95% confidence interval [CI], 2.75–239.46; p = 0.004) and 10.95 (95% CI, 1.02–117.28; p = 0.048), respectively, compared to Group 3. Those in Group 1 showed a greater utilization of intensive care services (15.9%), followed by Group 2 (10.9%), and Group 3 (2.5%), with adjusted ORs of 7.95 (95% CI, 2.52–25.08; p < 0.001) and 5.07 (95% CI, 1.34–19.15; p = 0.017), respectively, compared to Group 3. The patients in Groups 1 and 2 had longer hospitalization stays than the patients in Group 3 (p < 0.001 and p = 0.002, respectively). Older age (≥65 years) was an independent factor associated with longer hospital stays (OR = 1.72, 95% CI, 1.07–2.77). These findings can help hospitals prioritize patient care and service planning for future SARS-CoV-2 variants.

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Incidentally Detected SARS‐COV‐2 Among Hospitalized Patients in Los Angeles County, August to October 2020

Cited by 17 publications

References 2 publications

A More Accurate Measurement of COVID-19 Hospitalizations

A More Accurate Measurement of COVID-19 Hospitalizations

A multi-country analysis of COVID-19 hospitalizations by vaccination status

Distinct Clinical Presentations and Outcomes of Hospitalized Adults with the SARS-CoV-2 Infection Occurring during the Omicron Variant Surge

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