ABSTRACT
Background. The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods. This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave;patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality;secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results. 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion. Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorlycontrolled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a 'miracle drug'.
ABSTRACT
Background. The COVID-19 pandemic has disproportionately impacted minorities in the United States. John H. Stroger Jr. Hospital (JSH) is a tertiary care hospital within the safety-net system for Cook County in Chicago, Illinois. In this study we report demographics, clinical characteristics and outcomes of patients admitted with COVID-19 in our hospital during the spring surge of 2020. Methods. A retrospective study was done including patients > 18 years of age admitted to JSH with positive PCR for SARS-CoV2 from March 18 to May 30th, 2020. Outcomes, clinical and demographic characteristics were extracted from the electronic medical record. Moderate and severe disease were defined as radiographic evidence of pulmonary infiltrates and SpO2 > 94% on room air or SpO2< 94% on room air, respectively. Bivariate analysis and logistic regression were performed to assess for risk factors for admission to the intensive care unit and mortality. Results. 625 patients were included, 424 (68%) were male. Median age was 44 years (44,63). 364 (58%) were Hispanic and 222 (36%) non-Hispanic Blacks. 113 (18%) of patients presented with mild disease, 204 (33%) with moderate disease, 298 (48%) with severe disease. 73 patients (12%) died. 153 (24%) required ICU admission, 84 (13%) required intubation [Table 1]. In bivariate analysis, increasing age and diabetes (DM) were associated with increased mortality and ICU admission (p=0.001, Tables 2 and 3). Race/ethnicity was not associated with increased mortality or ICU admission. In the multivariate analysis, elevated glucose on admission regardless of DM and CKD were associated with mortality (p < 0.001). Conclusion. JSH is a safety net hospital that provides care for the most vulnerable population of Chicago. The proportion of Hispanic patients increased in the later weeks of the pandemic until they represented most of the inpatient population and presented with more severe disease (Figure 1). Although race was not associated with mortality or ICU admission, the high prevalence of chronic diseases such as hypertension and DM in our population may explain the higher rate of admissions. Strengthening of preventive medicine and social engagement with minorities must be a crucial effort to decrease the burden of COVID-19 in this population. Graph showing disease severity on admission by Race/Ethnicity (upper). Notice the predominance of severe disease (orange) in Hispanic patients. Graph showing Race/ Ethnicity Distribution by Week (lower). Notice the gradual increase and predominance of Hispanic patients (orange) in the later weeks of the study period compared to Black (blue) and White (green) patients.