Headlines:

The Next Generation of Immune System Support

Virus infections and their treatment

New Lung Cancer Research Offers Patients Hope

Are Pills the Best Way to Take Medication?

Enter GOLO Fall Inspirations Giveaway for a Chance to Win

Chiropractic Care Offers Drug-Free Pain Relief for Back Pain Sufferers

Grunge, Scrunchies, and Chickenpox: One of These Things Should NOT Come Back

Brain Injuries and Their Consequences

SHOULD CLONING/GENETIC ENGINEERING RESEARCH BE ALLOWED?

Turning 65: What to Consider When Selecting a Medicare Plan

From COVID to Migraines, FDA Cleared Device Provides Non-Drug Safe Pain Relief Solution

Shoot for the Stars When It Comes to Medicare Advantage

The Treatment Of Pregnant Women And Their Differences

Four Things Seniors Need to Know About Dental Coverage

Men: Heed Warning Signs of Heart Attack

Dollar General Shoppers Get Help Choosing Pain Relievers

Next Generation Make Menopause Less Stressful

These Three Facts about Sudden Cardiac Arrest Could Help Save a Life

The Role of Paramedics in General Health Care

Be a Hero, Save a Life, Learn Hands-Only CPR

The Key to Post-Pandemic Well-Being Is Lots of Self-Care, Study Reveals

Back-to-School List Should Include an Eye Exam

New Noninvasive Face Lift Targets Sagging Skin and Muscles

Should uninsured people be provided with any medical care?

Seniors Saving Nearly $2,000 Annually with Medicare Advantage

Boost Immunity Naturally With a Simple Spray

Your Heart is in Your Mouth: Good Oral Hygiene Could Mean Healthier Hearts

More than 20 Years Helping Cancer Patients and Saving Lives

SHOULD CHILDHOOD VACCINATION BE MANDATORY?

What’s in Your Cart? How to Shop Healthy, Stay on a Budget

Building Good Trust in the Science of Vaccines

Fall Into Healthy Habits This Autumn

A Heart Month Reminder: One Young Mother’s Story of Survival

The Science of Water: What You Drink and Your Immune System

Baby Teeth Are More Important That You Might Think

Diabetics Have More, Diverse Beverage Choices

The ethical aspects of medical research on humans and animals

Peanuts Pack a Tasty Protein Punch

The Flu and You — How to Protect Yourself

COVID-19 Leaves Lasting Impact on Heart

Water Shown to Alleviate Aches and Pains Associated With Pregnancy

Help Your Child Make Healthy Eating Choices Through the School Year

Love Gets Around With Help From Chiropractic Care

5 Mistakes to Avoid When Choosing a Medicare Advantage Plan

Understanding the history of medicine and religion

Have You Heard of Gaucher Disease?

Welcome to The Future of Diagnostic Tests

Drinking More Water Can Ease Pregnancy Aches and Pains

American Heart Association Issues Call to Live Fierce

Improving Kids’ Minds Linked to Improving Their Health

Stroke Survivors with Aphasia Able to Recover Language Skills

Detox Your Body With These Health-Related Spring Cleaning Tips

How to Be A Better Medicare Patient

Antibiotics Role in Diseases Treatment, Resistance and Solution

Yale GYN Offers Helpful Tips to Prep for Pregnancy

SHOULD EUTHANASIA BE ILLEGAL?

What Is Micro-Clustered Water, and Why Is It Different

If You Have Diabetes, Know These Signs of a Stroke

Adjusting for a New Life During Pregnancy

The Natural Way To End Agonizing Mouth Pain

My Aching Head—Managing Headaches With Chiropractic Care

Allergies Could Be Causing Your Bad Breath

Medicine Cabinets Need Spring Cleaning, Too

Learn How to Keep Teeth with Braces Clean

Homoeopathy as compared to traditional forms of medicinal treatments

Managing Pain: Are You Reading Your Medicine Labels?

Self-care on Your Schedule with Mental Wellness App

Chiropractic Care Comes To The Workplace

Awards Honor Mental Health Professionals

A Dose of Knowledge About Medicine Safety This Cold Season

Tips to Stay Healthy this Flu Season

Possible Ways of Medicine Development in the Future

Health Trend to Watch in 2018 – Personalized Medicine

Medicare at Home or in the Doctor’s Office — Seniors Have Options

Easy Tips for Taking Care of Your Heart

One Man’s Quest to Treat Chronic Bronchitis, a Type of COPD

Learn the Benefits of Chiropractic

Medical instruments history and evolution

Avoid Body Drought To Prevent Dehydration

Military Veterans, Here’s What You Need To Know About Medicare

Should marijuana/drugs be legalized?

How Chiropractic Care Can Help Fight Presenteeism At Work

It’s Not Too Late to Improve Your Health

Building a Bridge From Hospital to Home Health Care

Chronic Diseases and Treatment

Bringing Chiropractic Care to the Little Leagues

Know the Benefits of Safe Ear Cleaning

Tips to Help Seniors Conquer Stress

Virtual Colonoscopy Is Becoming a Reality for More People

Three Tips to Help You Prepare for Retirement

Trouble Sleeping? Help to Diagnose Insomnia

Three Tips to Beat Indigestion

New Drug May Help Control the Spread of Cancer

Lifesaving Wearable Saves Single Father from Heart Attack

The Eyes Have It — Corrective Lens Marks Vision Breakthrough

Genetic Engineering and Cloning

Gallup Poll Finds More Americans Are Choosing Chiropractic Care

Women Face Unique Risks for High Blood Pressure and Stroke

Get Fit from Home with Resistance Bands, Videos and App

Women and Strokes: Facts, Signs, Symptoms

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Characteristics of Hospitalized Adults With COVID-19

Date

 

Coronavirus disease 2019 (COVID-19) has resulted in increased hospital and intensive care unit (ICU) use. In the United States, few reports have characterized patients treated outside of the ICU.1 Northern California was an early epicenter of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community transmission in the United States. We report hospitalization and ICU admissions from Kaiser Permanente Northern California (KPNC), a regional integrated health care system serving 4.4 million members, constituting 30% of the area’s insured population.

Methods

We performed a retrospective cohort study of adults (≥18 years) with nasal/throat swabs positive for SARS-CoV-2 by polymerase chain reaction hospitalized between March 1, 2020, and March 31, 2020, at 21 KPNC hospitals. Tests were approved by infectious disease physicians based on public health and local guidelines. Patients were triaged according to clinician judgment. No patients were lost to follow-up.

We characterized patients by demographics, comorbid disease,2 severity of illness,2 ICU use, laboratory/chest film data, and highest level of respiratory support. Patients were treated according to national guidelines for pneumonia and acute respiratory distress syndrome. We report numbers (percentages) for binary/categorical variables and medians (interquartile ranges) for continuous variables. As of April 9, 2020, 14.8% of the cohort was still hospitalized. In-hospital mortality estimates were calculated for patients with discharge dispositions as of April 9, 2020.

The KPNC institutional review board approved the project with a waiver of informed consent.

Results

Of 16 201 tests in adults, results from 1299 patients (8.0%) were positive for SARS-CoV-2. Of these patients, 377 (29.0%) were treated as inpatients and 113 (8.7%) were treated in the ICU.

The median age was 61.0 years (interquartile range, 50.0-73.0 years); 56.2% were men (Table). The most common comorbidity was hypertension (n = 164, 43.5%). Of 166 patients who underwent testing for influenza A/B or respiratory syncytial virus (44.0% of the cohort), none tested positive. Bilateral infiltrates on chest film were seen in 63.4% (n = 239). Overall, 34 patients (9.0%) received a prednisone-equivalent dosage of 20 mg/d or more.

Most patients were treated on the general ward or intermediate care unit (n = 264 [70.0%]); of whom 54.9% received supplemental oxygen through nasal cannula/face mask. A total of 113 inpatients (30.0%) required ICU admission and 110 (29.2%) received invasive mechanical ventilation.

Patients aged 60 to 69 years represented the most common age group both hospitalized (n = 93 [24.6%]) and admitted to the ICU (n = 31 [27.4%]) (Figure). However, adults of all ages were admitted, and the proportion of younger and middle-aged adults (≤59 years) who were hospitalized (n = 172 [45.6%]) was similar to the proportion of older adults (≥60 years) who were hospitalized (n = 205 [54.4%]).

Of 321 patients with discharge dispositions, 50 (15.6%) died in the hospital. Of 253 patients treated on the ward with discharge dispositions, 16 (6.3%) died. Of 68 patients treated in the ICU with discharge dispositions, 34 (50.0%) died.

Discussion

Estimates of patients with positive SARS-CoV-2 test results who were (1) admitted to a KPNC hospital (29.0%) and (2) treated in an ICU (8.7%) are broadly similar to those from the US Centers for Disease Control and Prevention (21%-31% and 5%-12%, respectively) and contain less missing data.3 The KPNC estimate of ICU admissions using positive tests as denominator (8.7%) is lower than Italy (12%)4 but higher than China (5%).5 Given the differences in care among countries, it is important to report data from the United States. The KPNC mortality estimate is preliminary but reasonably consistent with the early Seattle, Washington, experience.1

Unlike previous studies, adults across age groups, not just elderly individuals, required inpatient care, with persons aged 60 to 69 years most commonly hospitalized. These findings underscore the importance of public health interventions that prevent transmission for the entire public to mitigate hospital surges.

The major limitation of this study is that these data represent an early phase of SARS-CoV-2 transmission in California. Several key factors were changing over this period, including implementation of physical distancing measures and testing speed, which could affect future results.

Section Editor: Jody W. Zylke, MD, Deputy Editor.

Back to top

Article Information

Corresponding Author: Laura C. Myers, MD, MPH, Kaiser Permanente Northern California Division of Research and Systems Research Initiative, 2000 Broadway, Oakland, CA 94612 (laura.c.myers@kp.org).

Accepted for Publication: April 20, 2020.

Published Online: April 24, 2020. doi:10.1001/jama.2020.7202

Author Contributions: Drs Myers and Liu had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Escobar, Liu.

Drafting of the manuscript: Myers, Escobar, Liu.

Critical revision of the manuscript for important intellectual content: Parodi, Escobar, Liu.

Statistical analysis: Myers.

Obtained funding: Escobar, Liu.

Administrative, technical, or material support: Parodi, Escobar, Liu.

Supervision: Parodi, Escobar.

Conflict of Interest Disclosures: Dr Liu reported receiving a grant from the National Institutes of Health (R35GM128672) during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by The Permanente Medical Group Inc and Kaiser Foundation Hospitals Inc.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

1.

Arentz  M, Yim  E, Klaff  L,  et al.  Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state.   JAMA. Published online March 19, 2020. doi:10.1001/jama.2020.4326
ArticlePubMedGoogle Scholar

2.

Escobar  GJ, Gardner  MN, Greene  JD, Draper  D, Kipnis  P.  Risk-adjusting hospital mortality using a comprehensive electronic record in an integrated health care delivery system.   Med Care. 2013;51(5):446-453. doi:10.1097/MLR.0b013e3182881c8ePubMedGoogle ScholarCrossref

3.

Centers for Disease Control and Prevention. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12-March 16, 2020. Morbidity and Mortality Weekly Report. Updated March 27, 2020. Accessed March 27, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

4.

Grasselli  G, Zangrillo  A, Zanella  A,  et al; COVID-19 Lombardy ICU Network.  Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy.   JAMA. Published online April 6, 2020. doi:10.1001/jama.2020.5394
ArticlePubMedGoogle Scholar

5.

Guan  WJ, Ni  ZY, Hu  Y,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. Published online February 28, 2020. doi:10.1056/NEJMoa2002032PubMedGoogle Scholar
Facebook
Twitter
Reddit
LinkedIn
Email

More
articles

Join DBN Today!

Let DBN help guide you to success!

Doctors Business Network offers everything new and existing health care providers need to establish and build a successful career! Sign up with DBN today and let us help you succeed!

DBN Blog