..
COVID data have always been mushy, lagging, and incomplete. No single metric can account for the number of patients, how sick they are, what their care demands, how many health-care workers are around to help them, or how close those workers are to their breaking point. We have no straightforward way to measure exactly how stressed the health-care system is.
…Debating how many patients are in the hospital with COVID or for COVID distracts from the most important question of the moment: As Anne Sosin, a public-health practitioner at Dartmouth College, wrote to me on Twitter, “What is or will be too much for our health systems and workforce to bear?” The U.S. is about to learn the answer the hard way.
COVID-Hospitalization Numbers Are as Bad as They Look
Many supposedly “incidental” infections aren’t really incidental, and cannot be dismissed.
By Ed Yong
January 13, 2022
More Americans are now hospitalized with COVID-19 than at any previous point in the pandemic. The current count—147,062—has doubled since Christmas, and is set to rise even more steeply, all while Omicron takes record numbers of health-care workers off the front lines with breakthrough infections. For hospitals, the math of this surge is simple: Fewer staff and more patients mean worse care. Around the United States, people with all kinds of medical emergencies are now waiting hours, if not days, for help.
Some reporters and pundits have claimed that this picture is overly pessimistic because the hospitalization numbers include people who are simply hospitalized with COVID, rather than for COVID—“incidental” patients who just happen to test positive while being treated for something else. In some places, the proportion of such cases seems high. UC San Francisco recently said a third of its COVID patients “are admitted for other reasons,” while the Jackson Health System in Florida put that proportion at half. In New York State, COVID “was not included as one of the reasons for admission” for 43 percent of the hospitalized people who have tested positive.
But the “with COVID” hospitalization numbers are more complicated than they first seem. Many people on that side of the ledger are still in the hospital because of the coronavirus, which has both caused and exacerbated chronic conditions. And more important, these nuances don’t alter the real, urgent, and enormous crisis unfolding in American hospitals. Whether patients are admitted with or for COVID, they’re still being admitted in record volumes that hospitals are struggling to care for. “The truth is, we’re still in the emergency phase of the pandemic, and everyone who is downplaying that should probably take a tour of a hospital before they do,” Jeremy Faust, an emergency physician at Brigham and Women’s Hospital, in Massachusetts, told me.
Some COVID-positive patients are unquestionably hospitalized for COVID: They are mostly unvaccinated, have classic respiratory problems, and require supplemental oxygen. Omicron might be less severe than Delta, but that doesn’t make it mild. “If a virus that causes less severe lung disease affects an extraordinarily large proportion of the population, you’ll still get a lot of them in the hospital with severe lung disease,” Sara Murray, a hospitalist at UC San Francisco, told me. The proportion of such patients varies around the country: In areas where Omicron has taken off, it’s lower than in previous surges, but it remains high in communities that still have a lot of Delta infections or low vaccination rates, as The Washington Post has reported. At the University of Nebraska Medical Center, “the vast majority of our COVID-positive cases are at the hospital for reasons related to their COVID infection,” James Lawler, an infectious-disease physician, told me.
At the other extreme, there are patients whose COVID infection is truly incidental. They might have gone to an emergency room with a broken limb or a ruptured appendix, only to realize when they got tested that they also have asymptomatic COVID. Many health-care workers told me that they’ve treated such patients—but rarely. “It happens, but it’s not a big proportion,” Craig Spencer, an emergency physician at Columbia University Medical Center, told me.
The problem with splitting people into these two rough categories is that a lot of patients, including those with chronic illnesses, don’t fit neatly into either. COVID isn’t just a respiratory disease; it also affects other organ systems. It can make a weak heart beat erratically, turn a manageable case of diabetes into a severe one, or weaken a frail person to the point where they fall and break something. “If you’re on the margin of coming into the hospital, COVID tips you over,” Vineet Arora, a hospitalist at the University of Chicago Medicine, told me. In such cases, COVID might not be listed as a reason for admission, but the patient wouldn’t have been admitted were it not for COVID. (Some people might have chronic conditions only because of an earlier COVID infection, which can increase the risk of diabetes, heart problems, and other long-term complications.) “These incidental infections are not so incidental for people with chronic conditions,” Faust said. “Whether they live to see the age of 60 or 90 depends on things just like this.”
.
…In fairness, there’s no easy way to tell, for example, whether a COVID-positive person’s heart attack was triggered by their infection or whether it would have happened anyway. But health problems don’t line up to afflict patients one at a time. They intersect, overlap, and feed off one another. The entire for-COVID-or-with-COVID debate hinges on a false binary. “The health-care system is in crisis and on the verge of collapse,” Spencer said. “It doesn’t matter whether it’s with or for. It’s a pure deluge of numbers.”
Even the truly incidental cases increase the strain. COVID-positive people must be kept apart from other patients, which complicates hospitals’ ability to use the beds they have. These patients need to be monitored in case their infection progresses into something more severe. If they start dying for unrelated reasons, their family won’t be allowed into their room. The health-care workers who treat them need to wear full personal protective equipment. If they need follow-up care, they can’t be discharged to a nursing home or similar facility. They’re taking up space and attention when hospitals are short on both. “If you’re 90 percent full and you suddenly have 10 percent more patients, I don’t care if it’s half COVID, all COVID, incidental COVID—it just matters that you’re full,” Faust said.
.
…Debating how many patients are in the hospital with COVID or for COVID distracts from the most important question of the moment: As Anne Sosin, a public-health practitioner at Dartmouth College, wrote to me on Twitter, “What is or will be too much for our health systems and workforce to bear?” The U.S. is about to learn the answer the hard way.
..
“There a lot of patients who have some sort of chronic disease, whether it’s mental health issues, depression, addiction, they’re on dialysis, and so they rely on services that are outside the hospital to take care of them,” said Dr. Mucio Kit Delgado, an ER doctor at Penn Presbyterian Medical Center emergency department in Philadelphia. But if they test positive, “the amount of places becomes very limited to where they can go. And so then, they just get stuck in your emergency department.”
Many patients hospitalized for other ailments are also testing positive for Covid
Patients taken to the hospital with Covid — instead of for Covid — may be earlier in the course of the disease and far more contagious, doctors say.
Jan. 9, 2022, 4:12 AM +08 / Updated Jan. 9, 2022, 10:22 PM +08By Berkeley Lovelace Jr.
As the super contagious omicron variant of the coronavirus spreads, hospitals are seeing a growing trend: Patients admitted for other ailments are also testing positive for Covid-19. Doctors say it may mean more people have asymptomatic or undiagnosed disease than the current data show.
Across NewYork-Presbyterian Hospital’s 10 campuses, just less than half of patients are admitted with Covid, meaning they were hospitalized for a non-Covid related issue but were also tested and found to be carrying the virus. Statewide the figure is 43 percent, according to state data.
“I’ve admitted patients with abdominal pain, I’ve admitted patients with chest pain who had no symptoms of respiratory illness, cough or Covid, and they just ended up being Covid positive,” said Dr. Rahul Sharma, the emergency physician-in-chief for the NewYork-Presbyterian/Weill Cornell Medical Center.
Hospitals across the country are also seeing a greater proportion of these so-called incidental Covid cases amid the omicron surge.
In Austin, Texas, some local hospitals report that 30 percent to 40 percent of the patients admitted for other reasons are also Covid positive, Dr. Desmar Walkes, medical director/health authority for the city of Austin and Travis County, said a news call Thursday.
Dr. Ryan Maves, an infectious disease and critical care physician at the Wake Forest School of Medicine in North Carolina, said he is also seeing more of these cases than usual, although he added most are mild or asymptomatic.
Health experts say the emerging trend of patients admitted to the hospital with Covid — instead of for Covid — may actually be a good sign, as it supports growing evidence that omicron, already the dominant strain in the United States, is less likely to cause severe illness than earlier variants were, especially in people who are fully vaccinated and boosted.
But it also complicates how one views a Covid hospitalization in the U.S., they said. Similar to previous Covid waves, patients infected with the virus are quickly filling up hospital beds, overwhelming hospital staff and delaying elective procedures, but not as many of them will suffer from struggling to breathe and needing supplemental oxygen, among other conditions.
Hospitalizations may become a less reliable gauge of the pandemic’s toll going forward, experts say.
“I still think hospitalization data is the best data we have,” said Dr. Stephen Schrantz, an infectious disease expert at UChicago Medicine, “but it is probably only useful as a relative value, meaning Covid is up or down, and not accurate as far as actual cases.”
Covid could worsen underlying illnesses
Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital, said hospital staff shouldn’t “downplay” patients admitted with Covid because they are often earlier in the course of their disease and may be far more contagious to others, including to at-risk patients and health care workers.
Doctors also still must be careful not to dismiss patients who test positive for Covid but are not presenting the more obvious symptoms because the virus could be exacerbating an underlying medical condition, said Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto.
..
While patients having COVID incidentally is less worrying than them having severe COVID, it does not mean that there is nothing to worry about.
The complications of having COVID while also having other medical problems could still severely harm patients, Strain said.
Many people hospitalized in the Omicron surge are there for other reasons and have only mild COVID-19
Joshua Zitser and Kieran Corcoran Jan 1, 2022, 1:17 AM
- Some patients counted in COVID hospitalization stats are there for other reasons.
- These “incidental” cases were found to be prominent in England and South Africa.
- Experts including Dr. Anthony Fauci have also pointed to the phenomenon in the US.
A significant proportion of people hospitalized with COVID-19 in recent weeks were admitted for other reasons, according to health officials and government data.
The exact scale of the phenomenon in the US is not recorded in federal statistics, but has been noted anecdotally.
And Dr. Anthony Fauci, the chief medical adviser to the White House, described the phenomenon, specifically in children, in a Wednesday night interview with MSNBC.
Since all hospital admissions are tested for COVID-19, Fauci said, many are “hospitalized with COVID, as opposed to because of COVID.” The real reason for hospitalization might be “a broken leg, or appendicitis, or something like that,” he continued.
Julie Zauzmer Weil, a Washington Post reporter, said that a similar thing can happen with adults. Citing an unnamed DC-area health official, Weil wrote in a series of tweets that people with mild COVID who test positive are still counted in the headline hospitalization stats.
Other countries have produced data noting the same phenomenon of “incidental” COVID cases. In data published Friday by the UK National Health Service, 33% of the 8,321 COVID-positive cases in England on December 28 were admitted to the hospital for a different reason.
.
While patients having COVID incidentally is less worrying than them having severe COVID, it does not mean that there is nothing to worry about.
David Strain, a senior clinical lecturer at the England’s University of Exeter medical school, told The Guardian that incidental admission can still be concerning.
“We [have] seen many other people who have been otherwise stable [with] chronic diseases such as heart failure , ulcerative colitis etc that caught COVID and had a rapid deterioration,” he told the outlet.
The complications of having COVID while also having other medical problems could still severely harm patients, Strain said.
..
Our Most Reliable Pandemic Number Is Losing Meaning
A new study suggests that almost half of those hospitalized with COVID-19 have mild or asymptomatic cases.
By David Zweig
September 14, 2021
.
From the start, COVID hospitalizations have served as a vital metric for tracking the risks posed by the disease. Last winter, this magazine described it as “the most reliable pandemic number,” while Vox quoted the cardiologist Eric Topol as saying that it’s “the best indicator of where we are.” On the one hand, death counts offer finality, but they’re a lagging signal and don’t account for people who suffered from significant illness but survived. Case counts, on the other hand, depend on which and how many people happen to get tested. Presumably, hospitalization numbers provide a more stable and reliable gauge of the pandemic’s true toll, in terms of severe disease. But a new, nationwide study of hospitalization records, released as a preprint today (and not yet formally peer reviewed), suggests that the meaning of this gauge can easily be misinterpreted—and that it has been shifting over time.
If you want to make sense of the number of COVID hospitalizations at any given time, you need to know how sick each patient actually is. Until now, that’s been almost impossible to suss out. The federal government requires hospitals to report every patient who tests positive for COVID, yet the overall tallies of COVID hospitalizations, made available on various state and federal dashboards and widely reported on by the media, do not differentiate based on severity of illness. Some patients need extensive medical intervention, such as getting intubated. Others require supplemental oxygen or administration of the steroid dexamethasone. But there are many COVID patients in the hospital with fairly mild symptoms, too, who have been admitted for further observation on account of their comorbidities, or because they reported feeling short of breath. Another portion of the patients in this tally are in the hospital for something unrelated to COVID, and discovered that they were infected only because they were tested upon admission. How many patients fall into each category has been a topic of much speculation. In August, researchers from Harvard Medical School, Tufts Medical Center, and the Veterans Affairs Healthcare System decided to find out.
Researchers have tried to get at similar questions before. For two separate studies published in May, doctors in California read through several hundred charts of pediatric patients, one by one, to figure out why, exactly, each COVID-positive child had been admitted to the hospital. Did they need treatment for COVID, or was there some other reason for admission, like cancer treatment or a psychiatric episode, and the COVID diagnosis was merely incidental? According to the researchers, 40 to 45 percent of the hospitalizations that they examined were for patients in the latter group.
The authors of the paper out this week took a different tack to answer a similar question, this time for adults. Instead of meticulously looking at why a few hundred patients were admitted to a pair of hospitals, they analyzed the electronic records for nearly 50,000 COVID hospital admissions at the more than 100 VA hospitals across the country. Then they checked to see whether each patient required supplemental oxygen or had a blood oxygen level below 94 percent. (The latter criterion is based on the National Institutes of Health definition of “severe COVID.”) If either of these conditions was met, the authors classified that patient as having moderate to severe disease; otherwise, the case was considered mild or asymptomatic.
The study found that from March 2020 through early January 2021—before vaccination was widespread, and before the Delta variant had arrived—the proportion of patients with mild or asymptomatic disease was 36 percent. From mid-January through the end of June 2021, however, that number rose to 48 percent. In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease.
This increase was even bigger for vaccinated hospital patients, of whom 57 percent had mild or asymptomatic disease. But unvaccinated patients have also been showing up with less severe symptoms, on average, than earlier in the pandemic: The study found that 45 percent of their cases were mild or asymptomatic since January 21. According to Shira Doron, an infectious-disease physician and hospital epidemiologist at Tufts Medical Center, in Boston, and one of the study’s co-authors, the latter finding may be explained by the fact that unvaccinated patients in the vaccine era tend to be a younger cohort who are less vulnerable to COVID and may be more likely to have been infected in the past.
Among the limitations of the study is that patients in the VA system are not representative of the U.S. population as a whole, as they include few women and no children. (Still, the new findings echo those from the two pediatric-admissions studies.) Also, like many medical centers, the VA has a policy to test every inpatient for COVID, but this is not a universal practice. Lastly, most of the data—even from the patients admitted in 2021—derive from the phase of the pandemic before Delta became widespread, and it’s possible that the ratios have changed in recent months. The study did run through June 30, however, when the Delta wave was about to break, and it did not find that the proportion of patients with moderate to severe respiratory distress was trending upward at the end of the observation period.
.
One of the important implications of the study, these experts say, is that the introduction of vaccines strongly correlates with a greater share of COVID hospital patients having mild or asymptomatic disease. “It’s underreported how well the vaccine makes your life better, how much less sick you are likely to be, and less sick even if hospitalized,” Snyder said. “That’s the gem in this study.”
.
But the study also demonstrates that hospitalization rates for COVID, as cited by journalists and policy makers, can be misleading, if not considered carefully. Clearly many patients right now are seriously ill. We also know that overcrowding of hospitals by COVID patients with even mild illness can have negative implications for patients in need of other care. At the same time, this study suggests that COVID hospitalization tallies can’t be taken as a simple measure of the prevalence of severe or even moderate disease, because they might inflate the true numbers by a factor of two. “As we look to shift from cases to hospitalizations as a metric to drive policy and assess level of risk to a community or state or country,” Doron told me, referring to decisions about school closures, business restrictions, mask requirements, and so on, “we should refine the definition of hospitalization. Those patients who are there with rather than from COVID don’t belong in the metric.”
David Zweig is a writer based in New York. He is the author of the nonfiction book Invisibles and the novel Swimming Inside the Sun.
..
weehingthong 