Medicalised Hotel as an Alternative to Hospital Care for Management of Non-Critical COVID-19: A Prospective Cohort Study

Abstract

Background: COVID-19 entails large overloads of hospitals’ capacity. Alternatives to conventional hospitalization are key to optimize health systems resilience during outbreaks of the pandemic.Methods: From March 25th to May 25th 2020 the Hospital at Home Unit (HaH) of Hospital Clinic Barcelona adapted a 500-bed hotel for treating patients with non-critical COVID-19.Findings: 516 patients were admitted to the hotel during the study period. Median age was 57 . 5 years (IQR 45-70), 304 (59%) were referred from hospital wards and 196 (38%) from the emergency room. Median length of stay was 9 days in the hotel (IQR 6-13). Bilateral infiltrates were present in the chest x-ray of 348 (68%) patients. Treatment for COVID-19 was administered to 494 (96%) patients, 137 (27%) of whom had it interrupted due to adverse events. Complications after 14 days from symptoms onset were detected in 85 (16 . 5%) patients: 24 (5%) pulmonary embolism, 23 (4 . 5%) pulmonary fibrosis, 50 (9.7%) organising pneumonia, 133 (26%) neutropoenia. History of smoking, oxygen requirement, bacterial infection and prior ICU admission were predictors of subacture complications. Twenty-eight (5 . 5%) patients required transfer back to hospital. Chronic kidney disease, oxygen requirement and previous shock were predictors of readmission. Two patients (0 . 4%) died after hospital readmission.Interpretation: The adaptation of hotels for the management of COVID-19 patients seems to be safe and efficacious, therefore providing a suitable alternative to alleviate hospital overload during the pandemic. Accurate selection of patients for transfer based on the clinic and potential severity is key.Funding: None.Declaration of Interests: None of the authors declare competing interests with regards to the current work or at all.Ethics Approval Statement: The Ethical Board of the Hospital Clínic evaluated and approved the study protocol (HCB.2020.0443). A waiver for informed consent was granted due to the state of infectious disease emergency