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COVID Caseload Surges Linked to Doubled Mortality at Hardest-hit Hospitals

Analysis  |  By John Commins  
   July 06, 2021

Nearly 1 in every 4 deaths and almost 6,000 total deaths may have been attributable to hospital strain due to COVID-19.

COVID-related inpatient deaths doubled at hospitals hit hard by surging caseloads during the pandemic, a new National Institutes of Health study shows.

In a retrospective cohort study published this week in Annals of Internal Medicine, NIH researchers examined the records on 144,116 hospitalized patients cared for in 558 hospitals to see how COVID-19 surges affected patient outcomes.

The researchers devised a "unique surge index" that measured the strain on hospitals each month from COVID in relation to bed capacity and found that clusters of high–surge index hospitals experienced 2-fold greater mortality than in hospitals not experiencing surges.

The metric showed that nearly 1 in every 4 deaths and almost 6,000 total deaths may have been attributable to hospital strain due to COVID-19.

"These system perturbations have significant consequences for those who provide clinical care," corresponding author Vineet Chopra, MD, a hospitalist at Michigan Medicine, wrote in an accompanying editorial.

"First of all, providers are marshaled to deal with an adversary they know little about. They are then asked to do so in unfamiliar areas of the building, with people they may never have worked with before," he wrote.

"On top of this, new processes for critical clinical decisions, such as when to test for COVID-19, how to treat, when to intubate, or how to manage cardiac arrests, are introduced. As hospitals swell with cases and these rapid changes unfold, what happens to patients needing care for COVID-19?"

The findings come as healthcare providers grapple with the burgeoning global threat of a surging COVID-19 delta variant.

The authors suggest that many COVID-related deaths could be prevented with smart, coordinated regional public health strategies and health system interventions.

Chopra said an emphasis on bolstering staff is also critical because burnout and stress related to the pandemic are prompting many clinicians to leave the field.  

"The findings are sobering and provide several lessons," Chopra wrote. "First, we learn that clusters of high–surge index hospitals not only existed but varied across geography and time."

"Second, we witness the effect of therapeutics in the form of decreasing ICU admissions and mechanical ventilation rates."

"Third, we comprehend how detrimental COVID-19 surges were to clinical outcomes: After risk adjustment, patients cared for in the highest surge strata experienced 2-fold greater mortality than in hospitals not experiencing surges."

“These system perturbations have significant consequences for those who provide clinical care.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The findings come and healthcare providers grapple with the burgeoning global threat of a surging COVID-19 delta variant.

The study suggests that many COVID-related deaths could be prevented with smart, coordinated regional public health strategies and health system interventions.


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