Surge in Incidence and Coronavirus Disease 2019 Hospital Risk of Death, United States, September 2020 to March 2021

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Early COVID-19 pandemic phases suggested patient outcomes were worsened by surges.
• The impact of the largest COVID-19 surge (September 2020-March 2021) on in-hospital mortality remains unexamined.
• This study investigates the relationship between community COVID-19 surges and in-hospital mortality.

Purpose of the Study:

• To determine if in-hospital mortality rates for COVID-19 patients were affected by community surges.
• To quantify the risk-adjusted odds of death during different phases of a major COVID-19 surge.

Main Methods:

• Retrospective cohort study of 416,962 adult COVID-19 patients.
• Data sourced from the Vizient Clinical Database, including US academic and community hospitals.
• Comparison of in-hospital mortality odds during surge phases versus pre-surge, adjusting for multiple variables.

Main Results:

• In-hospital death rates increased from 9% pre-surge to 12% during peak and declining surge intervals.
• Risk-adjusted odds ratios for death were elevated during all surge phases: rising (1.14), peak (1.37), and declining (1.30).
• Increased mortality was observed across most geographic regions and was more pronounced in community hospitals compared to academic centers.

Conclusions:

• Findings support public health policies for pandemic surge containment.
• Healthcare delivery systems require support during surges to mitigate adverse patient outcomes.
• Managing healthcare capacity during surges is critical for improving COVID-19 patient survival.