The Use of Infectious Diseases Hospital Resources During the COVID-19 Epidemic Depending on Patient Characteristics

Abstract

Background. The research of infectious hospital bed use and infectious patients’ characteristics during the COVID-19 pandemic allows proposing effective management strategies for possible future epidemics.Aim of study. The analysis of infectious bed fund use at the N.V. Sklifosovsky Research Institute for Emergency Medicine (the Institute) and the characteristics of admitted patients with COVID-19 in order to determine the factors that are important for improving the medical care provision.Material and methods. The data of 3365 patients treated at the Institute from March 2020 to June 2021 was used. Among them 1778 males, median age 62, average length of stay 11.2, mortality rates 17.8%, non-invasive mechanical ventilation was used for 21.5% of patients, invasive one — for 16%. For comparing the patients according to various characteristics, Fisher’s exact test and Pearson’s correlation coefficient were used. Length of stay was compared to exponential distribution using Pearson’s chi-squared test. Comorbidity was measured using the Charlson Comorbidity Index. For all calculations R software environment was used. Survival curves were obtained via the Kaplan-Meier method. Statistical significance was less than 0.05.Results. Periods of increase and decrease in hospitalization number correspond to an increase and decrease in the detection of COVID-19 cases in Moscow without lag. Intensive care for COVID-19 patients was needed in 96% of cases, readmissions to intensive care – 37%. The effective ratio of intensive care to hospital beds was determined to be higher than 2/1. The improvement in resuscitation capacity helps to avoid overload with an increase in the number of patients treated. When a patient is admitted in satisfactory condition, mortality is practically zero, while with increasing severity, mortality reaches 30–100%. The mortality rates of patients treated with the help of respiratory support is 7–40 times higher than in patients with spontaneous breathing. Higher values of the Charlson Comorbidity Index correspond to increased risks of severe course and death for patients.Conclusion. When providing medical care during the increase in number of infectious disease daily cases, the amount of deployed intensive care units becomes of a paramount importance. To determine the size of the bed fund, it is possible to use readily available estimates of the proportion of the population at risk of an adverse outcome from an infectious disease, based on the value of the Comorbidity Index.