Health Systems Must Remain Vigilant for COVID-19 Cases

New research and the U.S. Centers for Disease Control and Prevention estimate there have been hundreds of thousands of COVID-19 hospitalizations annually over the past three years.

A new study shows COVID-19 remains a serious threat, particularly for older adults.

The study, which was published by JAMA Internal Medicine, found there were an estimated 1.1 million hospitalizations and 101,300 deaths from October 2022 to September 2023. From October 2023 to September 2024, there were an estimated 879,100 hospitalizations and 100,800 deaths.

From October 2024 to September 2025, the U.S. Centers for Disease Control and Prevention estimate there were as many as 550,000 COVID-19 hospitalizations and as many as 64,000 deaths.

The study found that COVID-19 is particularly dangerous for older adults. From 2023 to 2024, people who were age 65 or older made up 17.7% of the U.S. population but accounted for 47.9% of COVID-19–associated illnesses, 64.3% of outpatient visits, 67.6% of hospitalizations, and 81.2% of deaths.

To remain vigilant for coronavirus cases, health systems and hospitals must have surveillance efforts in place to detect surges of the disease in their patient populations, according to clinical leaders at Cincinnati-based UC Health and New York City-based NYU Langone Health.

"We maintain surveillance and conduct a lot of communication with other health systems and public health agencies," says Dustin Calhoun, MD, medical director of emergency management at UC Health. "We want to keep an eye on what is happening not only in our own hospitals but also what is happening in the region and state."

It is helpful for health systems to work with partners to conduct surveillance of COVID-19 cases, Calhoun explains.

"In Ohio, The Health Collaborative is an organization that all of the health systems in our region use to work together to maintain knowledge about the prevalence of coronavirus," Calhoun says.

Health systems should conduct surveillance on coronavirus cases as part of a broad strategy to monitor respiratory virus infections, according to Michael Phillips, MD, chief epidemiologist at NYU Langone Health.

"Health systems need to have surveillance systems in place that can detect not only coronavirus but also influenza and respiratory syncytial virus," Phillips says. "The best way to do that is to set up a surveillance system where you can detect the number of people who have tested positive by their location."

NYU Langone Health uses its electronic health record as a cornerstone of the health system's coronavirus surveillance effort.

"We are a large health system, and our care sites are joined together by one electronic health record," Phillips says. "So, I can tell who tested positive for particular viruses on the previous day and their location such as an emergency department or ambulatory clinic."

In some states, health systems and hospitals cannot rely on public health agencies for timely coronavirus surveillance, Phillips explains.

"State by state, there are different surveillance systems for respiratory viruses, and many of them are not as timely as the surveillance system at NYU Langone Health," Phillips says. "You can get data, but it may be a week or two old."

In addition to monitoring the number of coronavirus cases in its patient population and where the cases are appearing, NYU Langone Health conducts surveillance on the strains of the virus that are present.

"We take the threat from coronavirus seriously at NYU Langone Health," Phillips says. "We sequence COVID viruses, so we know the subtypes that are in our patient population to be aware of particularly virulent strains."

Jennifer Forrester, MD, is medical director of infection prevention and antimicrobial stewardship as well as a former associate CMO at UC Health. Photo courtesy of UC Health.

Keeping Older Adults Safe

To avoid high rates of coronavirus hospitalizations and mortality among older adults, health systems should encourage this population to receive COVID-19 vaccination.

"Older adults should be up-to-date on their vaccinations, including vaccination for COVID-19," says Jennifer Forrester, MD, medical director of infection prevention and antimicrobial stewardship as well as a former associate CMO at UC Health. "Vaccination should be widely available to these patients, whether it is at a doctor's office, hospital, nursing facility, or pharmacy."

Vaccination of high-risk populations, such as older adults and immunocompromised individuals, is essential for health systems and hospitals to avoid surges of coronavirus, according to Phillips.

"Some folks, including older adults, require a booster after six months, which is something to be aware of," Phillips says. "Whenever older adults are in a medical facility, we should be flagging them to see whether they have been vaccinated."

Some patients are hesitant to receive COVID-19 vaccination, which is a major challenge for health systems, hospitals, and medical groups.

Clinicians must be committed to working with vaccine-hesitant patients, Forrester explains.

"I take time with patients who are hesitant about getting the COVID-19 vaccine, and I ask them why they are concerned about the vaccine," Forrester says. "For example, if they have gotten influenza vaccination, I ask them why they are concerned about the COVID-19 vaccine."

Forrester says some patients are wary of COVID-19 vaccination because the vaccines were developed quickly.

"For these patients, I tell them that COVID-19 vaccine development is a wonderful story about how advances can be made if systems come together in the right way and research funding is available," Forrester says. "The COVID-19 vaccine is an example of how things can be done quickly in medicine."

An erosion in patient trust regarding medicine and science is one of the biggest challenges in coronavirus care in general and vaccination in particular, according to Calhoun.

"In recent years, trust has eroded between patients and public health agencies as well as healthcare providers," Calhoun says. "So, maintaining trust with individual patients is important because they must have a trusted source of knowledge to try to understand what they should be doing to minimize their coronavirus risk."

Establishing trust with patients requires a reliance on data and a commitment to spend time on the effort, according to Calhoun. However, producing and providing accurate data does not necessarily overcome the trust gap that already exists.

"Promoting trust is a long game," Calhoun says. "Over time, you can show that a health system does not have a vested interest in anything other than the patient's health."

Dustin Calhoun, MD, is medical director of emergency management at UC Health. Photo courtesy of UC Health.

Rising to Financial Challenges

The primary financial challenge of caring for coronavirus patients is that serious illness can require care in an ICU, which is one of the most expensive care settings in a hospital.

"You have patients on respirators, and you must provide respiratory therapy that does not have to be provided for many other patients in the hospital," Forrester says. "ICU nurses are one-to-two, so you have one nurse for two patients. Cost is an issue for any patient who ends up in the ICU."

COVID-19 vaccination has been shown to reduce the risk of serious illness and hospitalization, so encouraging patients to get vaccinated is an effective strategy to reduce the need for ICU care and the associated cost burden.

"That's where you get the biggest bang for the prevention buck," Phillips says. "For older adults and anyone with underlying lung disease, getting vaccinated has a benefit for their health and keeps patients out of the ICU, which is huge financially for health systems."

Remdesivir, which is an antiviral medication used to treat some coronavirus patients in the inpatient setting, is expensive. Treating coronavirus patients in the early stage of infection with Paxlovid, which is relatively inexpensive, can avoid hospitalization and the need to utilize Remdesivir.

Health systems and hospitals should have care pathways in place to provide cost-effective care and boost clinical outcomes for coronavirus patients, according to Phillips.

"When a patient is admitted to a hospital with coronavirus, hospitals must have criteria to help clinicians know when they should start administering specific antiviral medications such as Remdesivir," Phillips says. "It could be that steroids or supplemental oxygen are indicated and following those guidelines help patients get better. Once a patient is hospitalized, having clearcut guidelines for care can reduce costs and improve outcomes."