COVID-19 community care in Israel—a nationwide cohort study from a large health maintenance organization

Abstract

Background Among the many medical challenges presented by the COVID-19 pandemic, management of the majority of patients in community outpatient settings is crucial. The aim of this study was to describe the characteristics and outcomes among confirmed COVID-19 cases who were managed at three settings: two outpatient settings and one inpatient. Methods A retrospective database cohort study was conducted in a large Israeli Health Maintenance Organization. All COVID-19 cases diagnosed between 28 February 2020 and 20 July 2020 were included. Cases in the community settings were managed through a nationwide remote monitoring center, using preliminary telehealth triage and 24/7 virtual care. Outcome parameters included hospital admission, disease severity, need for respiratory support and mortality. Results About 5448 cases, aged range 0–97 years, were enrolled; 88.7% were initially managed as outpatient either at home or in designated hotels, 3.1 and 2.1% of them, respectively, later required hospitalization. The main reason for hospitalization was dyspnea; 12 were diagnosed with severe disease; 56 patients (1.3%) died, five (0.1%) of whom were initially allocated to the outpatient settings. Conclusions Care for appropriately selected COVID-19 patients in the community provides a safe and effective option. This can contribute to reducing the hospitalization burden, with no evidence of increased morbidity or mortality.

Long covid outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study

“…The criteria for hospital admission of patients with covid-19 in Israel were consistent throughout the study period, in accordance with guidelines set by the Ministry of Health. 37 To distinguish between new outcomes and existing ones, we further excluded patients who had the considered outcome before the PCR test (index date). However, the exclusion criteria were different for different outcome types: for outcomes reflecting a chronic state (for example, asthma, diabetes), we excluded patients with any occurrence of that outcome in the past; for outcomes reflecting a temporary state (for example, cough, weakness) we excluded patients with occurrence of that outcome in the previous year.…”

“…We excluded from the study all patients who were admitted to hospital with covid-19 during the 30 days after infection, aiming to investigate long covid in patients with mild disease. The criteria for hospital admission of patients with covid-19 in Israel were consistent throughout the study period, in accordance with guidelines set by the Ministry of Health 37. To distinguish between new outcomes and existing ones, we further excluded patients who had the considered outcome before the PCR test (index date).…”

The effect of the COVID-19 pandemic on primary care physicians in Israel, with comparison to an international cohort: a cross-sectional study

“…In Israel, most patients with SARS-CoV-2 infection or symptomatic COVID-19 were treated in the community, either by centralized remote COVID-19 managed care programs (by physicians and nurses) or by the patient's personal primary care physician (PCP) (each physician treating his/her own patients) [2]. The same process happened in primary care throughout nations [3][4][5].…”

Immediate side effects of Comirnaty COVID-19 vaccine: A nationwide survey of vaccinated people in Israel, December 2020 to March 2021

“…Interestingly, there was no association between several comorbidities and reporting side effects. Considering that older age and certain underlying medical conditions are major risk factors for severe illness from COVID-19 [ 21 , 22 ], it is particularly important in this group of patients to underline that side effects are mild and therefore not an indication to avoid vaccination. Interestingly, we found that the fact of being pregnant at vaccination reduced the reporting ratio of all symptoms when compared with randomly matched controls.…”