Impact of the COVID-19 Epidemic on Death Among Critically Ill Patients (preprint)

Backgrounds: The coronavirus disease 2019 (COVID-19) epidemic is a major public health problem worldwide. This study estimated the impact of SARS-CoV-2 in terms of the excess mortality from any cause during the COVID-19 epidemic in the Republic of Korea. Methods: The excess mortality, ICU admissions and hospital admissions during the COVID-19 epidemic was analyzed using the number of deaths over the past 5 years (2015–2019) in Korea. The numbers of total deaths and COVID-19–related deaths were counted from January 2020 through May 2022, using public data from the Korean Statistical Information Service (KOSIS) of Statistics Korea. Data of hospital admissions were obtained from Health Insurance Review and Assessment (HIRA) service and KOSIS of Statistics Korea. Results: These numbers were compared with nationwide mortality data from January 1, 2015, through December 2019. There were more than 24,000 reported deaths officially across Korea from January 2020 through May 2022. Excess mortality was observed nationwide in March, August, October, November, and December 2020; January, March, July, and August 2021; and October 2021 through May 2022, which was consistent with the epidemic waves in the country. There was a decline in ICU admissions, especially soon after the declaration of the COVID-19 epidemic. Conclusions: After 2021, significant excess mortality occurred at the national level despite decreasing COVID-19 case fatality rates and decreased admissions to intensive care units, which means there might be an another relevant factors on all-cause mortality aside from the direct effect of deaths from COVID-19.

Soluble IL-2R Levels Predict in-Hospital Mortality in COVID-19 Patients with Respiratory Failure (preprint)

Acute respiratory distress syndrome is the primary cause of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. Our study aims to determine the association between serum markers and mortality in COVID-19 patients with respiratory failure. This retrospective study was conducted in a tertiary care hospital in South Korea. Forty-three patients with COVID-19, who required high flow nasal cannulation or mechanical ventilation from Feb 2020-Jan 2021, were included. Demographic and laboratory data were analyzed at baseline and on Day 7 of admission. Older age was associated with mortality. Serum creatinine, troponin, procalcitonin, and soluble interleukin-2 receptor (sIL-2R) at baseline were more elevated in the non-survivor group; however, were not associated with mechanical ventilator use on Day 7 PaO 2 /FiO 2 ratio, lymphocyte and platelet counts, lactate dehydrogenase, IL-6, c-reactive protein, and sIL-2R on Day 7 were significantly associated with mortality. Delta sIL-2R (Day 7-Day 0) per standard deviation was significantly higher in the non-survivor group (adjusted hazard ratio 3.225, 95% CI 1.151-9.037, p=0.026). sIL-2R could predict mortality in COVID-19 patients with respiratory failure, not mechanical ventilator use. Its sustained elevation suggests a hyper-inflammatory state, and mirrors the severity of COVID-19 in patients with respiratory failure; therefore, warrants further attention.

Effective Use of an Advanced Isolation Unit During the COVID-19 Pandemic: A Retrospective Cohort Study (preprint)

Background: Advanced isolation and testing of patients with suspicious symptoms or community-acquired pneumonia of an unknown origin are of prime importance in the current coronavirus disease (COVID-19) pandemic. We describe herein a strategy for preventing virus transmission within hospitals through screening and advanced isolation.Methods: We retrospectively analysed patients screened and admitted to the adult advanced isolation unit at a South Korean hospital, from February to April 2020. Those requiring hospitalization were admitted to the unit. Based on the hospital’s testing capacity for severe acute respiratory syndrome coronavirus 2, we divided patients into groups to identify the relationship between test-running frequency and efficacy of the advanced isolation unit based on the decrease in de-isolation time.Findings: Of the 10,364 screened patients, 5,969 were tested for the virus, and 10 were confirmed to have COVID-19. Of the 338 patients admitted to the unit, one patient was diagnosed with COVID-19. The median de-isolation time from the unit was 2·9 hours (interquartile range: 1·0–6·6), and patients stayed in the unit for a median of 16·6 hours (interquartile range: 9·0–24·1). The group that tested six times per day had the shortest admission to de-isolation time and stay time in the unit.Interpretation: Our process minimized exposure without delaying proper treatment and prevented virus transmission within the hospital. High testing frequencies maximized the efficacy of the advanced isolated unit.Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectorsDeclaration of Interests: No conflicts of interest exist for any author. Ethics Approval Statement: The study protocol was reviewed and approved by the Institutional Review Board of Severance Hospital (IRB No. 4-2020-0374), and the need for informed consent was waived by the committeee.