Surge in Incidence and Coronavirus Disease 2019 Hospital Risk of Death, United States, September 2020 to March 2021

Abstract

Objectives Studies of the early months of the COVID-19 pandemic indicate that patient outcomes may be adversely affected by surges. But the impact on in-hospital mortality during the largest surge to date, September 2020-March 2021, has not been studied. This study aimed to determine if in-hospital mortality was impacted by the community surge of COVID-19. Methods A retrospective cohort study of 416,962 adult COVID-19 patients admitted immediately before or during the surge at 229 U.S. academic and 432 community hospitals in the Vizient Clinical Database. The odds ratios of death among hospitalized patients during each phase of the surge was compared with the corresponding odds prior to the surge and adjusted for demographic, comorbidity, hospital characteristic, length of stay and complication variables. Results The unadjusted proportion of deaths among discharged patients was 9% in both the pre-surge and rising surge stages but rose to 12% during both the peak and declining surge intervals. With the pre-surge phase defined as the referent, the risk-adjusted odds ratios (aORs) for the surge periods were rising, 1.14 (1.10-1.19), peak 1.37 (1.32-1.43), and declining, 1.30 (1.25-1.35). The surge rise in-hospital mortality was present in seven of nine geographic divisions and greater for community hospitals than for academic centers. Conclusions These data support public policies aimed at containing pandemic surges and supporting health care delivery during surges.

Correlates of Coronavirus Disease 2019 Inpatient Mortality at a Southern California Community Hospital With a Predominantly Hispanic/Latino Adult Population

“…Thus, our finding may be a result of our retrospective design or due to unaccounted variability in disease severity and duration, corticosteroid timing, dose, indication, and days of therapy, because anecdotally we observed corticosteroid prescriptions substantially incongruent with recommended regimens [ 95 ] in our population (D. G., unpublished observations, 2022). Other explanations include surges in inpatients with COVID-19, as has been previously reported during the time period of our study [ 96 , 97 ], particularly in Hispanic/Latino patients [ 96 ] and for community hospitals [ 97 ]. Our observation of increased COVID-19 mortality associated with temporal surges in COVID-19 inpatients at our hospital supports this possibility.…”

Risk of COVID‐19 Hospitalization and Protection Associated With mRNA Vaccination Among US Adults With Psychiatric Disorders

“…However, previous research has evaluated these disorders in relation to severe COVID‐19 and COVID‐19 VE [ 26 , 27 , 28 , 29 , 30 , 31 ]. Tenth, data on neurodevelopmental disorders (aside from attention‐deficit hyperactivity disorder) were also not examined but have been reported in another VISION Network study [ 32 ].…”

Safety, Surge, and Strain: Where and When Does Risk Occur in Critical Care?*

“…A study of the Veteran’s Healthcare databases revealed a doubling of ICU mortality during high-demand versus low-demand periods (5). Significant mortality increases occurred (OR 1.23 vs. baseline) in the United Kingdom as the occupancy of intensive care beds exceeded 85% (6) and in the United States during peak pandemic weeks (OR 1.37 vs. baseline) (7). Investigators have found effects on mortality during surge for specific conditions as well—for example, an increase in non-ST-elevation myocardial infarction mortality of over 50% (8).…”