Community spread of COVID-19 linked to patient survival rates in area hospitals – ScienceDaily

“We know that individual risk factors such as age and gender, comorbidities such as obesity, and whether a person resides in a nursing home are all part of what determines whether patients get a good or a bad result. But our research shows that it also matters where a patient is admitted, ”said lead researcher David Asch, MD, director of the Center for Health Care Innovation and professor of medicine at the University of Pennsylvania.

The team analyzed nearly 40,000 patients with COVID-19 admitted to 955 hospitals across the country between January 1 and June 30, 2020. They looked at what proportion of those patients died in hospital within 30 days. following admission or have been returned to a hospice, which could also signal probable death from the virus. They found that on average, nearly 12% of patients admitted with COVID-19 to hospitals nationwide died, but death rates in hospitals with the best results were 9% compared to nearly 16% for the group of hospitals with the worst results. .

The data was also split into two periods – one spanning from January to the end of April – widely considered to be the most difficult time of the first wave of COVID-19 – and another from the beginning of May to the end of June. . – when the number of cases started to decline. Over the two time periods, 398 of the hospitals studied had enough COVID-19 patients to allow comparison of mortality. Patients in the early period had a mortality rate of over 16 percent compared to about 9 percent in the May-June group. All but one of the hospitals improved their survival rates – in fact, 94% improved their numbers by 25% or more.

“The results of COVID-19 in US hospitals have improved remarkably and remarkably quickly,” said Natalie Sheils, PhD, research scientist at UnitedHealth Group. “But a death rate of over 9 percent among hospital patients is still very high, and COVID-19 remains a very dangerous disease.”

While this data may be correlated with better knowledge of COVID-19 and the treatment for its patients, the analysis found a different predominant factor.

“The improvement, in general, probably comes from the experience in managing the oxygenation of these patients, as well as new treatments like dexamethasone,” Asch explained. “But what explains the variation in results between hospitals and the variation in their improvement is an entirely different story. The factor most strongly associated with the results or their improvement, based on our data, was the spread of COVID-19 in the hospital. surrounding community. “

The team found that hospitals in counties with higher rates of COVID-19 cases had worse outcomes. Hospitals located in counties where case rates have declined have seen the greatest improvement over time.

“With the current surge this winter, I’m concerned that hospitals are giving up some of the positive gains from the summer,” Asch said. “Not only will the crude number of deaths increase, but death rates may also increase.”

The association between high community case rates and high mortality is what prompted the goal to ‘flatten the curve’. The idea was to keep the rates as low as possible – even over a longer period of time – because the cases coming all of the sudden were worse than the cases spread out over time. The results of this study seem to support this view. While the vaccines are approved for emergency use, widespread immunization of the general public is likely months away.

“If it is the community burden of COVID-19 that determines the quality of our inpatients, as our study shows, then the best advice has not changed: stay separate, wash your hands, mask yourself” , Asch said. “The hospitals need our help.”

Other study authors included Nazmul Islam, Yong Chen, Rachel M. Werner, John Buresh, and Jalpa A. Doshi.