Abstract
BackgroundThe aim of this study is to quantify the hospital burden of COVID-19 during the first wave and how it changed over calendar time; to interpret the results in light of the emergency measures introduced to manage the strain on secondary healthcare.MethodsThis is a cohort study of hospitalised confirmed cases of COVID-19 admitted from February–June 2020 and followed up till 17th July 2020, analysed using a mixture multi-state model. All hospital patients with confirmed COVID-19 disease in Regione Lombardia were involved, admitted from February–June 2020, with non-missing hospital of admission and non-missing admission date.ResultsThe cohort consists of 40,550 patients hospitalised during the first wave. These patients had a median age of 69 (interquartile range 56–80) and were more likely to be men (60%) than women (40%). The hospital-fatality risk, averaged over all pathways through hospital, was 27.5% (95% CI 27.1–28.0%); and steadily decreased from 34.6% (32.5–36.6%) in February to 7.6% (6.3–10.6%) in June. Among surviving patients, median length of stay in hospital was 11.8 (11.6–12.3) days, compared to 8.1 (7.8–8.5) days in non-survivors. Averaged over final outcomes, median length of stay in hospital decreased from 21.4 (20.5–22.8) days in February to 5.2 (4.7–5.8) days in June.ConclusionsThe hospital burden, in terms of both risks of poor outcomes and lengths of stay in hospital, has been demonstrated to have decreased over the months of the first wave, perhaps reflecting improved treatment and management of COVID-19 cases, as well as reduced burden as the first wave waned. The quantified burden allows for planning of hospital beds needed for current and future waves of SARS-CoV-2 i.
Highlights
On the 9th of January 2020, the health authorities in China reported that a novel strain of coronavirus, later named SARS-CoV-2, was the causative agent for many of the severe acute respiratory syndromes occurring in the area of Wuhan [1]
In response to the emerging situation, several pre-pandemic measures were implemented by the Italian Ministry of Health and by Regione Lombardia
On 20/02/2020 the first Italian patient was diagnosed with Covid-19 in the Lombardia town of Codogno, which soon became the Italian epicenter of the pandemic
Summary
On the 9th of January 2020, the health authorities in China reported that a novel strain of coronavirus, later named SARS-CoV-2, was the causative agent for many of the severe acute respiratory syndromes occurring in the area of Wuhan [1]. The number of confirmed infected patients rose to 403 by the following week, with 213 patients admitted to hospitals [5] This abrupt rise in the number of confirmed cases, peaking eventually on the 20th of March 2020, put a large strain on the healthcare system in Lombardia [6], an Italian region of approximately 10 million inhabitants of whom 41% over 55 years of age (Additional file 1: Appendix A.1.1). The Regional Unit of Coordination for Hospital Admission collected data on the number of vacant beds daily and redirected patients with the purpose of redistributing the burden among the 17 first-responder hub hospitals (the “hub-and-spoke” model) especially involved during the initial phase of the pandemic and among all hospitals in the region. The aim of this study is to quantify the hospital burden of COVID-19 during the first wave and how it changed over calendar time; to interpret the results in light of the emergency measures introduced to manage the strain on secondary healthcare
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