Related Experiment Video
Updated: Sep 6, 2025
Author Spotlight: Advancements in Multiplex Detection of Respiratory Viruses
Published on: November 10, 2023
The impact of key secular trends during the first three waves the COVID-19 pandemic
Brian J Lichtenstein1, Tyler Smith2, Besa Smith3
1Sharp HealthCare, San Diego, CA, USA.
Insights
Patient age and disease severity are key to COVID-19 survival. While ICU occupancy impacts survivorship during surges, patient-level factors remain the primary predictors of outcomes.
Area of Science:
- Epidemiology
- Critical Care Medicine
- Infectious Diseases
Background:
- COVID-19 survival is influenced by patient demographics, comorbidities, and disease severity.
- Healthcare system strain, such as intensive care unit (ICU) occupancy, may impact patient outcomes during pandemic surges.
- Understanding the interplay between patient-specific and hospital-level factors is crucial for managing COVID-19.
Purpose of the Study:
- To assess the impact of patient and hospital risk factors on COVID-19 survivorship during surges.
- To characterize COVID-19 severity distribution across different pandemic waves.
- To evaluate the effect of ICU capacity on patient survival.
Main Methods:
- Retrospective cohort study including 6,851 adult patients admitted with COVID-19.
- Data collected from four acute care hospitals within a San Diego healthcare network (March 2020 - June 2021).
- Analysis focused on patient survivorship and length of stay, considering patient-level and hospital-level factors.
Main Results:
- Mortality predictors included disease severity (WHO Clinical Progression Score), age, gender, BMI, marital status, language, Elixhauser score, and specific laboratory values (d-dimer, ferritin, LDH).
- Survivorship during surges showed an inverse correlation with ICU occupancy when adjusted for patient age alone.
- This correlation between ICU occupancy and survivorship was not significant when patient-level factors were fully accounted for.
Conclusions:
- Patient age, comorbidity burden, and disease severity are primary determinants of COVID-19 survival.
- High ICU occupancy during surges may pose additional risks, especially under maximal healthcare system stress.
- Further exploration of the dynamic interaction between patient and hospital factors is warranted.
Importance:
Patient age, comorbidity burden, and disease severity at presentation are the major factors associated with surviving COVID-19. Hospital-level factors including ICU occupancy may confer additional risk to individual patients, particularly at times of maximal stress on healthcare systems. The interaction of patient- and hospital-level factors over time during pandemic disease remains an area of active exploration.
Objective:
To determine the impact of patient and hospital risk factors during episodic surges, characterize severity distribution between waves, and evaluate patient-level impact of ICU capacity on COVID-19 survivorship.
Design:
Retrospective cohort study.
Setting:
Four acute care hospitals within an integrated healthcare network in San Diego, California.
Participants:
All patients (18+ y.o.) admitted with a positive PCR test for SARS-CoV-2 or ICD-10 code for COVID-19 from March 1, 2020 through June 30, 2021.
Main Outcome(S) And Measure(S):
Patient survivorship and length of stay.
Results:
Six thousand eight hundred fifty-one patients were evaluated in this large cohort series. Patient level factors associated with mortality included: severity at admission (WHO Clinical Progression Score [WCPS]), age, gender, BMI, marital status, language preference, Elixhauser score, elevated laboratory (d-dimer, ferritin, LDH) or lower absolute lymphocyte count. When adjusting for patient age alone, survivorship during surges was also inversely associated with ICU occupancy, though this correlation was not present when adjusted for patient-level factors.
Conclusions And Relevance:
Patient age, comorbidity burden, and severity at the time of presentation are the major factors associated with surviving COVID-19. Hospital-level factors including ICU occupancy may confer additional risk to individual patients, particularly at times of maximal stress on healthcare systems.
Related Concept Videos
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:30Current Trends in Nursing II
01:30Types of Impact
The coefficient of restitution is a metric for understanding the dynamics of impacts. It quantifies the ratio of relative velocity...
01:28Current Trends in Nursing I
01:18Factors Affecting Illness
For instance, risk factors are connected to illness,...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...