ABSTRACT
Objective: To characterize COVID-19 patients in Indiana, United States, and to evaluate their demographics and comorbidities as risk factors to COVID-19 severity. Materials and Methods: EHR data of 776 936 COVID-19 cases and 1 362 545 controls were collected from the COVID-19 Research Data Commons (CoRDaCo) in Indiana. Data regarding county population and per capita income were obtained from the US Census Bureau. Statistical analysis was conducted to determine the association of demographic and clinical variables with COVID-19 severity. Predictive analysis was conducted to evaluate the predictive power of CoRDaCo EHR data in determining COVID-19 severity. Results: Chronic obstructive pulmonary disease, cardiovascular disease, and type 2 diabetes were found in 3.49%, 2.59%, and 4.76% of the COVID-19 patients, respectively. Such COVID-19 patients have significantly higher ICU admission rates of 10.23%, 14.33%, and 11.11%, respectively, compared to the entire COVID-19 patient population (1.94%). Furthermore, patients with these comorbidities have significantly higher mortality rates compared to the entire COVID-19 patient population. Health disparity analysis suggests potential health disparities among counties in Indiana. Predictive analysis achieved F1-scores of 0.8011 and 0.7072 for classifying COVID-19 cases versus controls and ICU versus non-ICU cases, respectively. Discussion: Black population in Indiana was more adversely affected by COVID-19 than the White population. This is consistent to findings from existing studies. Our findings also indicate other health disparities in terms of demographic and economic factors. Conclusion: This study characterizes the relationship between comorbidities and COVID-19 outcomes with respect to ICU admission across a large COVID-19 patient population in Indiana.
ABSTRACT
Clinical evaluation should guide those needing immediate investigation. Strict adherence to COVID-19 protection measures is necessary. Alternative ways of consultations (telephone, video) should be used. Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged. Patients with moderate or severe clinical features need urgent investigation and management. Patients with active Cushing's syndrome, especially when severe, are immunocompromised and vigorous adherence to the principles of social isolation is recommended. In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at 3 and 6 months or deferred until the prevalence of SARS-CoV-2 has significantly decreased; however, those individuals should be encouraged to maintain social distancing. Diagnostic pathways may need to be very different from usual recommendations in order to reduce possible exposure to SARS-CoV-2. When extensive differential diagnostic testing and/or surgery is not feasible, it should be deferred and medical treatment should be initiated. Transsphenoidal pituitary surgery should be delayed during high SARS-CoV-2 viral prevalence. Medical management rather than surgery will be the used for most patients, since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients. The risk/benefit ratio of these recommendations will need re-evaluation every 2-3 months from April 2020 in each country (and possibly local areas) and will depend on the local health care structure and phase of pandemic.