Clinical characteristics of the first and second COVID-19 waves in the Bronx, New York: A retrospective cohort study

Abstract

Background There is limited clinical patient data comparing the first and second waves of the coronavirus disease 2019 (COVID-19) in the United States and the effects of a COVID-19 resurgence on different age, racial and ethnic groups. We compared the first and second COVID-19 waves in the Bronx, New York, among a racially and ethnically diverse population. Methods Patients in this retrospective cohort study were included if they had a laboratory-confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab specimen detected between March 11, 2020, and January 21, 2021. Main outcome measures were critical care, in-hospital acquired disease and death. Patient demographics, comorbidities, vitals, and laboratory values were also collected. Findings A total of 122,983 individuals were tested for SARS-CoV-2 infection, of which 12,659 tested positive. The second wave was characterized by a younger demographic, fewer comorbidities, less extreme laboratory values at presentation, and lower risk of adverse outcomes, including in-hospital mortality (adj. OR = 0·23, 99·5% CI = 0·17 to 0·30), hospitalization (adj. OR = 0·65, 99·5% CI = 0·58 to 0·74), invasive mechanical ventilation (adj. OR = 0·70, 99·5% CI = 0·56 to 0·89), acute kidney injury (adj. OR = 0·62, 99·5% CI = 0·54 to 0·71), and length of stay (adj. OR = 0·71, 99·5% CI = 0·60 to 0·85), with Black and Hispanic patients demonstrating most improvement in clinical outcomes. Interpretation The second COVID-19 wave in the Bronx exhibits improved clinical outcomes compared to the first wave across all age, racial, and ethnic groups, with minority groups showing more improvement, which is encouraging news in the battle against health disparities.

Improvements throughout the Three Waves of COVID-19 Pandemic: Results from 4 Million Inhabitants of North-West Italy

“…The decrease in the median age of affected patients over time was described in France, Spain, and the USA [ 11 , 15 , 17 ] in contrast to Germany [ 29 ]. Nevertheless, over time we observed a similar need for hospitalization in people aged over 70 and a higher rates of comorbid conditions in admitted patients compared with outpatients, both associated with a poor prognosis [ 11 , 12 , 13 , 15 , 17 , 26 ].…”

“…To the best of our knowledge, despite the worldwide spread of the disease, only a few studies have thoroughly compared the disease severity and the demographic and clinical characteristics of infected patients in subsequent waves [ 11 , 12 , 13 ]: these studies are monocentric [ 11 , 14 , 15 ] or on a regional [ 9 , 10 , 15 , 16 , 17 ] or national level [ 12 , 13 , 18 ] or concern specific populations [ 19 ].…”

Outcomes of Hospitalized Patients With COVID-19 With Acute Kidney Injury and Acute Cardiac Injury

“…All patients in this study were seen in The Montefiore Health System (MHS) and tested for SARS-CoV-2 infection using real-time polymerase chain reaction test (RT-PCR) on a nasopharyngeal swab between January 1, 2020, and January 29, 2021. The Montefiore Health System is one of the largest healthcare systems in New York City with 15 hospitals located in the Bronx, the lower Hudson Valley, and Westchester County serving a large, low-income, and racially and ethnically diverse population that was hit hard by COVID-19 early in the pandemic ( 13 , 26 ).…”

“…Health data were searched and extracted as described previously ( 13 , 27 ). In short, de-identified data were made available for research by the Montefiore Einstein Center for Health Data Innovations after standardization to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) version 6.…”

“…Black and Hispanic patients have been disproportionately affected by COVID-19 and have increased mortality. This may be due to a higher prevalence of cardiovascular risk factors in this population or socioeconomic factors such as crowding, food insecurity and poverty (12)(13)(14)(15).…”