COVID-19 management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases centre: a detailed descriptive analysis

Abstract

Background: Recent large national and international cohorts describe the baseline characteristics and outcome of hospitalised patients with COVID-19, however there is little granularity to these reports. We aimed to provide a detailed description of a UK COVID-19 cohort, focusing on clinical decisions and patient journeys. Methods: We retrospectively analysed the management and 28-day outcomes of 316 consecutive adult patients with SARS-CoV-2 PCR-confirmed COVID-19 admitted to a large NHS Foundation Trust with a tertiary High Consequence Infectious Diseases centre in the North of England. Findings: Most patients were elderly (median age 75) with multiple comorbidities. One quarter were admitted from residential or nursing care. Symptoms were consistent with COVID-19, with cough, fever and/or breathlessness in 90.5% of patients. Two thirds of patients had severe disease on admission. Mortality was 81/291 (27.8%). Most deaths were anticipated; decisions to initiate respiratory support were individualised after consideration of patient wishes, premorbid frailty and comorbidities, with specialist palliative care input where appropriate. 22/291 (7.6%) patients were intubated and 11/22 (50%) survived beyond discharge. Multiple logistic regression identified age as the most significant risk factor for death (OR 1.09 [95% CI 1.06 - 1.12] per year increase, p < 0.001). Interpretation: These findings provide important clinical context to outcome data. Deaths were anticipated, occurring in patients with advance decisions on ceilings of treatment. Age was the most significant risk factor for death, confirming that demographic factors in the population are a major influence on hospital mortality rates. Funding: Funding was not required.

COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

“…Baker et al found that 40.7% of 60 nursing or residential home residents with lab-confirmed COVID-19 who were admitted to a teaching hospital in Newcastle (UK) died within a 28-day period. 23 Compared to non-care home residents, the unadjusted odds ratio for death was 6.19 (95% CI 3.32-11.8).…”

“…CFRs for 11 studies of all people at long-term care institutions facing outbreaks (including COVID-19 positive and negative residents and staff) are summarised in Table 5, 10,22,26,29,30,36,39,41,48,51,63 while CFRs for seven studies of COVID-19 positive populations are described further down. 23,25,32,38,60,67,68 For most studies included in Table 5, the source population for the identification of people with COVID-19 were all or close to all (>90%) residents or staff at long-term care institutions where an outbreak occurred. The CFR among long-term care users for these studies ranged from 0% to 33.7%, with differences in follow-up time between one and 12 weeks.…”

“…56 Not included in Table 5 are CFRs reported by seven studies for which the source population consisted exclusively of people who contracted COVID-19. 23,25,32,38,60,67,68 Due to the absence of systematic testing, these studies tended to only include symptomatic people in the denominator, resulting in higher CFRs compared to studies based on systematic testing, as described below.…”

“…49 Evidence on outcomes in long-term care residents compared to others Seven of the included studies compared outcomes in people who contracted COVID-19 between long-term care users and others. These studies generally found that long-term care users had worse outcomes, including higher 28-day-mortality (unadjusted odds ratio for death of nursing home or residential home residents admitted to hospital compared to non-residents: 6.19, 95% CI 3.32-11.8), 23 30-day-mortality (25.3%, 95% CI 24.2-26.4%, among nursing home residents who contracted COVID-19 and were registered in a primary care database compared to 4.0%, 95% CI 3.9-4.2%, among all other people with COVID-19 in the database), 38 and overall mortality (incidence rate ratio for COVID-19 mortality comparing Ontario long-term care residents to community-living adults 70 years and older: 13.1, 95% CI 9.9-17.3), 27 as well as increased risk of complicated disease (odds ratio for deteriorating disease, admission to ICU, or death, comparing nursing home residents to non-residents over 65 years of age: 2.48, 95% CI 1.29-4.65). 43 Bhatraju et al report that, among 24 patients admitted to the intensive care units of nine hospitals in the Seattle area (US), six (25%) were residents of skilled nursing facilities.…”

Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis

“…The characteristics of the shortlisted studies are summarized in Table 1. Among shortlisted studies, 23 studies were from China , nine studies were from Italy [64][65][66][67][68][69][70][71][72], ten studies were from the United States [83][84][85][86][87][88][89][90][91][92], four studies were from South Korea [75][76][77][78], three studies were from France [60][61][62], two studies were from Spain [79,80], one study each was from Belgium [35], Denmark [59], Hong Kong [63], Kuwait [73], Singapore [74], Turkey [81], and the United Kingdom [82]; and one study included data from 38 countries [93]. There were 24 studies that included hypertensive patients exclusively (100%) [36, 38, 39, 43-45, 47, 48, 50-52, 54, 56, 58, 66, 71, 72, 75, 78, 81, 87-89, 91].…”