Abstract
Epidemiologic and syndromic surveillance metrics traditionally used by public health departments can be enhanced to better predict hospitalization for coronavirus disease (COVID-19). In Montgomery County, Maryland, measurements of oxygen saturation (SpO2) by pulse oximetry obtained by the emergency medical service (EMS) were added to these traditional metrics to enhance the public health picture for decision makers. During a 78-day period, the rolling 7-day average of the percentage of EMS patients with SpO2 <94% had a stronger correlation with next-day hospital bed occupancy (Spearman ρ=0.58, 95% CI 0.40-0.71) than either the rolling 7-day average of the percentage of positive tests (ρ=0.55, 95% CI: 0.37-0.69) or the rolling 7-day average of the percentage of emergency department visits for COVID-19–like illness (ρ=0.49, 95% CI: 0.30-0.64). Health departments should consider adding EMS data to augment COVID-19 surveillance and thus improve resource allocation.
Highlights
On March 5, 2020, Montgomery County, Maryland, a densely populated county neighboring Washington, DC, reported its first cases of coronavirus disease (COVID-19); this prompted the county health department to develop a daily surveillance report [1]
By March 27, this report included the following information: daily and cumulative confirmed COVID-19 cases; percentage of reverse transcription polymerase chain reaction (RT-PCR) tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19; acute and intensive care unit beds occupied in the county’s seven hospitals; daily emergency department encounters for COVID-19–like illness; and daily emergency medical service (EMS) calls and acuity indicators, including the number of patients with a pre-hospital pulse oximetry value (SpO2) below
Emergency department syndromic data were retrieved from the Montgomery County Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) using the COVID-19–like illness query published by the National Syndrome Surveillance Program; this query is defined as fever plus cough, difficulty breathing, or shortness of breath, and it includes International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes for COVID-19 [3]
Summary
On March 5, 2020, Montgomery County, Maryland, a densely populated county neighboring Washington, DC, reported its first cases of coronavirus disease (COVID-19); this prompted the county health department to develop a daily surveillance report [1]. By March 27, this report included the following information: daily and cumulative confirmed COVID-19 cases; percentage of reverse transcription polymerase chain reaction (RT-PCR) tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19; acute and intensive care unit beds occupied in the county’s seven hospitals; daily emergency department encounters for COVID-19–like illness; and daily emergency medical service (EMS) calls and acuity indicators, including the number of patients with a pre-hospital pulse oximetry value (SpO2) below. It was noted that the percentage of EMS patients with SpO2
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