Characteristics, Clinical Course, and Outcomes of Veterans Admitted With Covid-19 in Detroit, Michigan

Abstract

Background The deaths due to coronavirus disease (Covid-19) in Michigan have been disproportionately centered in the city of Detroit. We sought to characterize hospitalized veterans with Covid-19 infection in Detroit, MI and compare them to inpatients previously reported. Methods A retrospective observational study of 79 veterans admitted to a veteran's hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, through April 6, 2020. Each patient had at least 30 days of follow-up. Results The median age of 79 enrolled patients was 69.0 years (interquartile range, 57.0–75.0 years) and 74 (94%) were men. Twenty-four (30%) had a recent emergency department visit. Respiratory symptoms were present in 67 (85%). Gastrointestinal symptoms were common (49 [62%]), including diarrhea (27 [34%]) and loss of appetite (31 [39%]). Only 30 (38%) patients had fever on admission. Comorbidities included hypertension (73 [92%]), diabetes (48 [61%]), obesity (42 [53%]), chronic obstructive pulmonary disease (30 [38%]), coronary disease (28 [35%]), and obstructive sleep apnea (25 [32%]). Nine patients were admitted to the intensive care unit, and 18 (26%) of 70 required intensive care unit transfer. Twenty-Four (30%) were intubated; of which 3 were extubated and 20 (83%) died. Of the 57 (72%) patients discharged alive, 22 (39%) required supplemental oxygen and 8 (14%) were readmitted within 30 days. Conclusions Detroit veterans were primarily older African American men with more comorbidities than inpatients previously described. Gastrointestinal symptoms were twice as common as fever. Rates of mortality and readmission were higher than those previously reported in populations with shorter follow up.

In the SARS-CoV-2 Pandora Pandemic: Can the Stance of Premorbid Intestinal Innate Immune System as Measured by Fecal Adnab-9 Binding of p87:Blood Ferritin, Yielding the FERAD Ratio, Predict COVID-19 Susceptibility and Survival in a Prospective Population Database?

“…Detroit veterans had experienced two waves of COVID-19 illness. More in-depth information with a comparison to the earlier first wave in early March 2020 had been published [17] as a descriptive paper, and the results matched the data in Table 2. It was important to compare patients from the 2020 wave to our combined COVID-19 patient cohort (group 1) to find significant differences that could have resulted from the benefits of medical and nursing care that had improved with increased experience, and this was, indeed, the case.…”

“…The demographics and the duration of admission/disease are also shown in Tables 1 and 2. [17]. Our patients were older with a mean 72 versus 69 years; despite the differences, the mortality was higher, 18.5 versus 25.3%, respectively, but this was at a point in time when treatment modalities were at a preliminary juncture with higher comorbidities/inflammatory markers.…”

“…It was important to compare patients from the 2020 wave to our combined COVID-19 patient cohort (group 1) to find significant differences that could have resulted from the benefits of medical and nursing care that had improved with increased experience, and this was, indeed, the case. Therefore, we validated our sample with the initial published sample [17].…”

Predictors of Death, Survival, Need for Intubation, and Need for Oxygen Support Among Admitted COVID-19 Patients of the Veterans Affairs Greater Los Angeles Healthcare System

“…Most studies have focused on general trends in population disease severity, racial disparities in testing and hospitalization, and predictors of hospitalization. 7–13 While several studies have investigated risk factors for severe COVID-19 among Veterans, multivariate survival analysis has not been conducted to explore factors contributing to shorter survival length. 14–20…”