Clinical Trends Among US Adults Hospitalized With COVID-19, March to December 2020 A Cross-Sectional Study

• Authors: Shikha Garg, Centers for Disease Control and Prevention, Atlanta; Kadam Patel, Centers for Disease Control and Prevention and General Dynamics Information Technology; Huong Pham, Centers for Disease Control and Prevention, Atlanta; Michael Whitaker, Centers for Disease Control and Prevention, Atlanta; Alissa O'Halloran, Centers for Disease Control and Prevention, Atlanta; Jennifer Milucky, Centers for Disease Control and Prevention, Atlanta; Onika Anglin, Centers for Disease Control and Prevention and General Dynamics Information Technology, Atlanta; Pam D Kirley, California Emerging Infections Program; Arthur Reingold, California Emerging Infections Program; Breanna Kawasaki, Colorado Department of Public Health and Environment, Denver; Rachel Herlihy, Colorado Department of Public Health and Environment, Denver; Kimberly Yousey-Hindes, Yale School of Public Health; Amber Maslar, Yale School of Public Health; Evan Anderson, Emory University; Kyle P Openo, Georgia Department of Health, Atlanta; Andrew Weigel, Iowa Department of Public Health, Des Moines; Kenzie Teno, Iowa Department of Public Health; Patricia A Ryan, Maryland Department of Health, Baltimore; Maya L Monroe, Maryland Department of Health, Baltimore; Libby Reeg, Michigan Department of Health and Human Services; Sue Kim, Michigan Department of Health and Human Services; Kathryn Como-Sabetti, Minnesota Department of Health, St. Paul; Erica Bye, Minnesota Department of Health, St. Paul; Sarah Shrum Davis, New Mexico Department of Health, Santa Fe; Nancy Eisenberg, New Mexico Department of Health, Santa Fe; Alison Muse, New York State Department of Health; Grant Barney, New York State Department of Health; Nancy M Bennett, University of Rochester; Christina B Felsen, University of Rochester; Laurie Billing, Ohio Department of Health, Columbus; Jess Shiltz, Ohio Department of Health, Columbus; Melissa Sutton, Oregon Health Authority, Portland; Nasreen Abdullah, Oregon Health Authority, Portland; Keipp H Talbot, Vanderbilt University; William Schaffner, Vanderbilt University; Mary Hill, Salt Lake County Health Department; Ryan Chatelain, Salt Lake County Health Department; Jonathan Wortham, Emory University; Christopher Taylor, Centers for Disease Control and Prevention, Atlanta; Aron Hall, Centers for Disease Control and Prevention, Atlanta, GA; Alicia M Fry, Centers for Disease Control and Prevention, Atlanta; Lindsay Kim, Centers for Disease Control and Prevention, Atlanta; Fiona Havers, Emory University
• Journal Title: ANNALS OF INTERNAL MEDICINE
• Volume: Volume 174, Number 10
• Publisher: AMER COLL PHYSICIANS | 2021-10-01, Pages 1409-+
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7326/M21-1991
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; NEW-YORK-CITY; UNITED-STATES; OUTCOMES; RATES

Abstract

Background: The COVID-19 pandemic has caused substantial morbidity and mortality. Objective: To describe monthly clinical trends among adults hospitalized with COVID-19. Design: Pooled cross-sectional study. Setting: 99 counties in 14 states participating in the Coronavirus Disease 2019–Associated Hospitalization Surveillance Network (COVID-NET). Patients: U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020. Measurements: Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients. Results: Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December. Limitation: COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. Conclusion: Rates of COVID-19–associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines.