Severity of coronavirus respiratory tract infections in adults admitted to acute care in Toronto, Ontario

Abstract

Background: The World Health Organization has highlighted the need for improved surveillance and understanding of the health burden imposed by non-influenza RNA respiratory viruses. Human coronaviruses (CoVs) are a major cause of respiratory and gastrointestinal tract infections with associated morbidity and mortality. Objectives: The objective of our study was to characterize the epidemiology of CoVs in our tertiary care centre, and identify clinical correlates of disease severity. Study design: A cross-sectional study was performed of 226 patients admitted with confirmed CoV respiratory tract infection between 2010 and 2016. Variables consistent with a severe disease burden were evaluated including symptoms, length of stay, intensive care unit (ICU) admission and mortality. Results: CoVs represented 11.3% of all positive respiratory virus samples and OC43 was the most commonly identified CoV. The majority of infections were community-associated while 21.6% were considered nosocomial. The average length of stay was 11.8 days with 17.3% of patients requiring ICU admission and an all-cause mortality of 7%. In a multivariate model, female gender and smoking were associated with increased likelihood of admission to ICU or death. Conclusion: This study highlights the significant burden of CoVs and justifies the need for surveillance in the acute care setting.

Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database

“…These risk factors were largely consistent with those reported previously. [6][7][8][9]14 However, we recognize that there may be additional risk factors not correlated with the CDC risk factors or variables included in the Charlson Comorbidity Index. For example, one in six patients with no CDC risk factors required an ICU stay.…”

“…Several studies have attempted to describe the presenting characteristics and associated hospital utilization by gender, age, and geography. [6][7][8][9] These initial studies have described COVID-19 hospitalized mortality rates ranging from 5% to 64% based on age and lengths of stay varying from 4-13 days. These studies were limited to narrow geographic areas of New York City, New York; Toronto, Canada; and Wuhan, China.…”

Epidemiology and Clinical Symptoms Related to Seasonal Coronavirus Identified in Patients with Acute Respiratory Infections Consulting in Primary Care over Six Influenza Seasons (2014–2020) in France

“…The World Health Organization has highlighted the need to improve epidemiological surveillance and knowledge of the health burden imposed by non-influenza respiratory viruses [15]. HCoVs are generally associated with mild upper respiratory tract infections [16], but severe infections with HCoV-229E, HCoV-NL63, and HCoV-OC43 have been reported [17][18][19].…”

Complicating Infections Associated with Common Endemic Human Respiratory Coronaviruses

“…Seasonal variation in coronavirus activity has been seen, with most activity occurring in the wintertime, with some exceptions. [45][46][47][48][49][50][51][52][53] A systematic review of seasonal incidence by Li et al 54 recently came to the same conclusion. A Brazilian study in contrast, found that 229E was more common in autumn.…”

“…Coronaviruses have been associated with exacerbations of chronic lung disease 64,67,74,77,82,92 ; smoking had been identified a possible cofactor for lower respiratory infection. 51,92,96 Some of these exacerbations required hospital admission, and fewer resulted in patient deaths. 67 A study in Italy 42 found OC43 to be more associated with lower respiratory tract infections, but this has not held in most other studies.…”