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Association Between Caseload Surge and COVID-19 Survival in 558 U.S. Hospitals, March to August 2020

Sameer S Kadri1, Junfeng Sun1, Alexander Lawandi1

  • 1National Institutes of Health Clinical Center, Bethesda, Maryland (S.S.K., J.S., A.L., M.K., C.Y., S.M., J.K., R.L.D., C.Y.D., S.W.).

Annals of Internal Medicine
|July 5, 2021
PubMed

Insights

Hospital surges in COVID-19 cases increased patient mortality risk, even as treatments improved. Supporting hospitals during surges is crucial for saving lives and overcoming challenges posed by high caseloads.

Area of Science:

  • Public Health
  • Epidemiology
  • Healthcare Management

Background:

  • Several U.S. hospitals experienced surges in COVID-19 patient numbers.
  • The impact of these surges on COVID-19 survival rates, independent of other factors, was not well understood.

Purpose of the Study:

  • To investigate the association between a hospital's severity-weighted COVID-19 caseload and patient mortality risk.
  • To identify factors that modify this relationship.

Main Methods:

  • A retrospective cohort study analyzed data from 558 U.S. hospitals between March and August 2020.
  • Hospitals were stratified by a surge index, a measure of COVID-19 caseload relative to bed capacity.
  • Hierarchical modeling assessed the effect of the surge index on in-hospital mortality risk.

Main Results:

  • Higher surge index percentiles were associated with increased odds of COVID-19 mortality.
  • The relationship between surge index and mortality was stronger during later months (June-August) despite treatment advancements.
  • An estimated 23.2% of COVID-19 deaths were potentially linked to hospitals experiencing caseload surges.

Conclusions:

  • Hospital COVID-19 caseload surges negatively impacted patient survival, potentially offsetting gains from improved treatments.
  • Strengthening preventive measures and providing support to hospitals facing surges are vital for reducing mortality.
Abstract

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