Abstract
BackgroundSeasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Whereas sharp inclines in hospital volume were accompanied by overt increases in case fatality rates during the very early phases of the pandemic, the relative impact during later phases of the pandemic are less clear. We sought to characterize how the 2020 winter surge in COVID-19 volumes impacted case fatality in an adequately-resourced health system.MethodsWe performed a retrospective cohort study of all adult diagnosed with COVID-19 in a large academic healthcare system between August 25, 2020 to May 8, 2021, using multivariable logistic regression to examine case fatality rates across 3 sequential time periods around the 2020 winter surge: pre-surge, surge, and post-surge. Subgroup analyses of patients admitted to the hospital and those receiving ICU-level care were also performed. Additionally, we used multivariable logistic regression to examine risk factors for mortality during the surge period.ResultsWe studied 7388 patients (aged 52.8 ± 19.6 years, 48% male) who received outpatient or inpatient care for COVID-19 during the study period. Patients treated during surge (N = 6372) compared to the pre-surge (N = 536) period had 2.64 greater odds (95% CI 1.46–5.27) of mortality after adjusting for sociodemographic and clinical factors. Adjusted mortality risk returned to pre-surge levels during the post-surge period. Notably, first-encounter patient-level measures of illness severity appeared higher during surge compared to non-surge periods.ConclusionsWe observed excess mortality risk during a recent winter COVID-19 surge that was not explained by conventional risk factors or easily measurable variables, although recovered rapidly in the setting of targeted facility resources. These findings point to how complex interrelations of population- and patient-level pandemic factors can profoundly augment health system strain and drive dynamic, if short-lived, changes in outcomes.
Highlights
Seasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems
Patients during the surge period exhibited greater rates of obesity, hypertension and diabetes mellitus when compared to the pre-surge and post-surge periods
Advances in standards of care including the use of monoclonal antibodies, steroids and Remdesivir [17], among others, as well as more robust supply chains [18, 19] were present during the Winter surge period evaluated in the current study—allowing for a more focused evaluation of the excess patient volume effect on COVID19 case outcomes at a health system level
Summary
Seasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Case fatality, are known to increase during periods of strain on healthcare systems caused by excess patient volume [1, 2]. Reports from the initial phase of the pandemic are limited to the effects of the earlier SARS-CoV-2 variants, and more recently emerged variants are known to have differential impacts on clinical outcomes [10]. Amidst ongoing regional surges of COVID-19, related in part to recently emerged SARS-CoV-2 variants, more uptodate information is needed regarding how the pressures of COVID-19 surges on health systems can impact outcomes—especially during the winter season, when colder weather tends to increase both viral transmissibility and patient-level susceptibility to more severe types of illness [11]. The more transmissible SARS-CoV-2 variants and the overall epidemiologic persistence of COVID-19 across all communities have led to surges that continue to impose dynamic challenges for all health systems
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