Abstract
ObjectiveThe COVID-19 pandemic demonstrates the need for understanding pathways to healthcare demand, morbidity, and mortality of pandemic patients. We estimate H1N1 (1) hospitalization rates, (2) severity rates (length of stay, ventilation, pneumonia, and death) of those hospitalized, (3) mortality rates, and (4) time lags between infections and hospitalizations during the pandemic (June 2009 to March 2010) and post-pandemic influenza season (November 2010 to February 2011) in England. MethodsEstimates of H1N1 infections from a dynamic transmission model are combined with hospitalizations and severity using time series econometric analyses of administrative patient-level hospital data. ResultsHospitalization rates were 34% higher and severity rates of those hospitalized were 20%–90% higher in the post-pandemic period than the pandemic. Adults (45–64-years-old) had the highest ventilation and pneumonia hospitalization rates. Hospitalizations did not lag infection during the pandemic for the young (<24-years-old) but lagged by one or more weeks for all ages in the post-pandemic period. DiscussionThe post-pandemic flu season exhibited heightened H1N1 severity, long after the pandemic was declared over. Policymakers should remain vigilant even after pandemics seem to have subsided. Analysis of administrative hospital data and epidemiological modelling estimates can provide valuable insights to inform responses to COVID-19 and future influenza and other disease pandemics.
Highlights
Since the turn of the 21st century, countries worldwide have encountered multiple health emergencies, including the 2003 SARS epidemic, 2009 influenza A/H1N1 pandemic, 2014 Ebola epidemic, and the ongoing 2019 COVID-19 pandemic, which led to steep and sudden surges in healthcare demand as well as high mortality and morbidity
This study demonstrates that the use of comprehensive data on H1N1 infections and sophisticated time series econometrics to extract H1N1-specific hospitalizations, severity, and mortality improves upon previous literature
Our study addresses three questions: (1) of those individuals who were infected with H1N1, how many were hospitalized?; (2) of those individuals hospitalized, how many suffered from pneumonia, were ventilated, and how long was their length of stay?; and (3) of those affected by H1N1, how many died? About 3 in 4 H1N1 hospitalizations were recorded as unspecified Influenza-like Illness (ILI) cases in the data
Summary
Since the turn of the 21st century, countries worldwide have encountered multiple health emergencies, including the 2003 SARS epidemic, 2009 influenza A/H1N1 pandemic, 2014 Ebola epidemic, and the ongoing 2019 COVID-19 pandemic, which led to steep and sudden surges in healthcare demand as well as high mortality and morbidity In this most recent pandemic, the need for rapid response to the influx of COVID-19 patients was first evidenced by China’s construction of two 1000-bed hospitals in. Studies range from 4228 (Louie et al, 2009) to 13,286 (Campbell et al, 2011) to 19,000 (MacIntyre et al, 2018) H1N1 hospitalizations with a pneumonia co-infection per 100,000. These wide variations can be explained by differences in testing regimes across hospitals and community settings, asymptomatic infections which leave many patients undiagnosed, differences in hospital practices, small and unrepresentative samples, and other factors (Bolotin et al, 2012; Campbell et al, 2011; Capelastegui et al, 2012; Kwok et al, 2017; Reed et al, 2009; Shrestha et al, 2011)
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