Headlines:

Sleep Disorders

A heart-healthy and “stroke-free” world through policy development

Supporting the Health Care Workforce During the COVID-19 Epidemic

Characteristics of Hospitalized Adults With COVID-19

Nygard’s Commitment to a Breast Cancer Cure Continues

Late Effects and Healthy Living: Lessons for Childhood Cancer Survivors

Eating Disorders: Anorexia and Bulimia

A Change in Lighting Helps Aging Eyesight

Women’s Hearts Need Attention

Dentists Help Patients Say Goodnight to Sleep Issues

Don’t Lose Sight of the Eye Health ?ABCs’

New Cancer Test Helps Men Reduce Unnecessary Prostate Biopsies

Aging and Changes in Physical and Mental Health

Signs and Symptoms That You May Be at Risk for Hypothyroidism

Explore the Next Generation of Immune System Support

Helping Valley People Manage The Cost of Insulin

6 Things Young Adults Should Know About Managing Their Health Care

Can Excess Exercising Worsen Health?

Get the Facts About Cataracts and Surgery

Helping Manage The Cost of Asthma And COPD Inhalers

Biomechanics In Medicine

7th Heaven Mom Advocates Prescription Drug Safety

Patients Have New Role In Health Research

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

Transforming Health Research on the High Plains

Artificial Tissue and Organs

Should scientists work to make computers displace doctors?

Diabetes and Eyes, What Your Vision is Trying to Tell You

Cancer and Male Fertility: Know Your Options

Amazing Homeopathic Medicines

How to Manage Cancer-Related Pain

Protect Your Health During Cancer Treatment

Viral Infection and Powerful Treatments

Breaking the Addiction: Wave Goodbye to Smoking

Cancer treatment and research 2021

Mental Health Patients Reap Benefits of Psychoanalysis

Back Pain: Chiropractic Care First, Medicine Second, Surgery Last

Should there be state regulation of fast food chains?

Next Generation Supplements Make Menopause Less Stressful

Add Essentials to Your Diet With Avocado Oil

Pediatric Cancer Landscape Calls for Global Outreach

Compare Your Health Care Options Online

Dietary Supplement Improves Cognition in Alzheimer’s

Effects Of Smoking, Alcohol Consumption, And Drug Abuse On Human Health

Protect Your Heart Through Your Legs

Whole New Way to Shop For Health Insurance Coming in October 2022

Autism: a disease or a variant of norm?

Diabetics Now Have More, Diverse Beverage Choices

Should Teens Be Able To Obtain Birth Control Pills?

Secure Future Health With Stem Cell Storage

Should there be state regulation of fast-food chains?

Medicare’s 5-star Special Enrollment Period for 2022 Underway

Investing in Your Future Health With American CryoStem

Company Steps Up to Keep Health Care Workers Healthy

COVID-19 Leaves Lasting Impact on Heart Health

Are You Kidding? Belly Fat Can Save My Life?

Your Weight Matters: Take the Pledge to Talk to a Healthcare Provider

Alzheimer’s disease: is it possible to battle it?

Discover the Potential Immune-System Benefits of Vitamin D

Making Headway Against Traumatic Brain Injuries

Doctors Have the Highest Mortality Rate from Covid-19

Peyton Manning Throws a Hail Mary Pass With Stem Cell Therapy

What drives healthcare cost in the US in 2021 ?

International NASH Day Draws Attention to Severe Liver Disease

Shift Workers Risk More Than Insomnia

Should there be an opt-in or opt-out donor system?

Should the state provide free health care to homeless people?

Resources to Help Family Caregivers

Are You Ready? The Health Insurance Marketplace Is Coming

Should doctors quit their jobs not to deal with COVID-19 ?

Military Veterans, Here’s What You Need to Consider About Medicare

Traveling and Constipation

Who should decide whether to place an elderly in the elderly center? A person himself, children, or health care specialist?

Sleep Apnea May Cause You to Snooze on the Job

Is the French doctor suggestions to test the vaccine in Africa is a sound strategy or an act of racism?

It’s Time to Decide: Which Health Plan Is Right for You?

Adult Stem Cell Research Is Growing Possibilities

An At-Home Study on Heart Health And AFib Detection

Stroke Survivors with Aphasia May Be Able to Recover Language Skills

How should the issue of obesity be treated?

5 Tips to Help Older Adults Stay Apart, Not Alone During COVID-19

Should people be encouraged to homeopathy first?

Doctors Have the Highest Mortality Rate from Covid-19. What are the ways to decrease it?

Medicare Open Enrollment Is Here

Childhood Cancer Can Lead to Infertility

Students’ Mental Health Must Figure in Plans to Restart Classes

Sweet Advice to Ease Coughs

Chiropractic Care Has Its Place in Pregnancy

Yale OB/GYN Offers Helpful Tips to Prep for Pregnancy

Banking on Your Health

Should the state refuse to import the products, obtained at the cost of someone’s health?

Oh, My Aching Head—Managing Headaches With Chiropractic Care

Can medical research pose a threat? If yes, what are the ways to mitigate it?

Should scientists research options for people to become immortal?

Should a doctor be able to provide medical care to a minor despite their parent’s wish?

The National Children’s Cancer Society Observes 25 Years

Study Shows Older Americans Are Coping Best During the Pandemic

Should surrogate pregnancy be used on-demand or only for health reasons?

New Campaign “Rewrites” Special Days for People Living With Chronic Migraine

End Agonizing Mouth Pain the Natural Way

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