The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study.
Infect Control Hosp Epidemiol
; : 1-24, 2022 Jan 11.
Article
in English
| MEDLINE | ID: covidwho-1815395
ABSTRACT
BACKGROUND:
COVID-19 hospitalization definitions do not include a disease severity assessment. Thus, we sought to identify a simple and objective mechanism for identifying hospitalized severe cases and to measure the impact of vaccination on trends.METHODS:
All admissions to a Veterans Affairs (VA) hospital, where routine screening is recommended, between 3/1/2020-11/22/2021 with SARS-CoV-2 were included. Moderate-to-severe COVID-19 was defined as any oxygen supplementation or any SpO2 <94% between one day before and two weeks after the positive SARS-CoV-2 test. Admissions with moderate-to-severe disease were divided by the total number of admissions, and the proportion of admissions with moderate-to-severe COVID-19 was modelled using a penalized spline in a Poisson regression and stratified by vaccination status. Dexamethasone receipt and its correlation with moderate-to-severe cases was also assessed.RESULTS:
Among 67,025 admissions with SARS-CoV-2, the proportion with hypoxemia or supplemental oxygen fell from 64% prior to vaccine availability to 56% by November 2021, driven in part by lower rates in vaccinated patients (vaccinated, 52% versus unvaccinated, 58%). The proportion of cases of moderate-to-severe disease identified using SpO2 levels and oxygen supplementation was highly correlated with dexamethasone receipt (correlation coefficient, 0.95), and increased after 7/1/2021, concurrent with delta variant predominance.CONCLUSIONS:
A simple and objective definition of COVID-19 hospitalizations using SpO2 levels and oxygen supplementation can be used to track pandemic severity. This metric could be used to identify risk factors for severe breakthrough infections, to guide clinical treatment algorithms, and to detect trends in changes in vaccine effectiveness over time and against new variants.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Vaccines
/
Variants
Language:
English
Journal:
Infect Control Hosp Epidemiol
Journal subject:
Communicable Diseases
/
Nursing
/
Epidemiology
/
Hospitals
Year:
2022
Document Type:
Article
Affiliation country:
Ice.2022.13
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