The changing characteristics of COVID-19 presentations: A regional comparison of SARS-CoV-2 hospitalised patients during the first and second wave

Atkin, Catherine; Kamwa, Vicky; Reddy‐Kolanu, Vinay; Parekh, Dhruv; Evison, Felicity; Gallier, Suzy; Ball, Simon; Sapey, Elizabeth

doi:10.1101/2021.02.07.21251297

Cited by 13 publications

(17 citation statements)

References 13 publications

(13 reference statements)

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“…The mean age of hospitalized patients in our study was 59.2 ± 16.5. Mean age was lower in our study during the rst wave, which is in contrast with the ndings of Atkin et al, reporting lower mean age of patients during the second wave [10]. We believe that this may be attributed to different study populations and smaller sample sizes in our study, while both studies have included only admitted patients.…”

Section: Discussioncontrasting

confidence: 99%

“…The rate of ICU admission was 16.4% in our study, and patients did not differ in need of intensive care support. Our results are in line with the ndings of Atkin et al, reporting no difference in ICU admission during the rst and second wave [10].…”

Section: Discussionsupporting

confidence: 94%

“…However, disease severity, in-hospital mortality, and the number of patients receiving invasive mechanical ventilation in our study did not differ across the surges, and the overall in-hospital mortality rate was 17.8% during our study period. Some previous studies demonstrated a lower disease severity, need for invasive mechanical ventilation, and mortality during the second wave [10]. The rate of ICU admission was 16.4% in our study, and patients did not differ in need of intensive care support.…”

Section: Discussionsupporting

confidence: 58%

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COVID-19 in Iran: Clinical Presentations and Outcomes in Three Different Surges of COVID-19 Infection

Hadadi

Pirzadeh

Kazemian

et al. 2021

Preprint

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Background: A few studies compared the characteristics and outcomes of COVID-19 patients during the first and second surges of the disease.We aimed to describe the clinical features and outcomes of COVID-19 patients across the first, second, and third surges of the disease in Tehran, Iran.Method: We conducted aretro-respective cohort study of patients with COVID-19 admitted to Sina hospital of Tehran, Iran,during three surges of COVID-19 from February 16 to October 28, 2020.Result: Surge 1 patients were youngerwith more prevalence of hypertension.They also presented with significantly higher oxygen saturation, systolic blood pressure, andrespiratory rateon admission. Patients had higher levels of neutrophil to lymphocyte ratio, Urea, CRP, and ESR, in surge 2. The incidence of dyspnea, chest pain, and neurological manifestations followed a significant increasing trend from surge 1 to surge 3. There was no difference in severity and in-hospital mortality between the surges. However, the length of hospital stays and acute cardiac injury (ACI) was less in surge 1 and acute respiratory distress syndrome (ARDS) in surge 2 than in other surges. Conclusion: patients did not significantly differ in disease severity, ICU admission, and mortality between surges; however, length of hospital stay and ACI increased during surges, and the number of patients developing ARDS was significantly less in surge 2 compared to other peaks.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 58%

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COVID-19 in Iran: Clinical Presentations and Outcomes in Three Different Surges of COVID-19 Infection

Hadadi

Pirzadeh

Kazemian

et al. 2021

Preprint

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“…Overall, our observations showed a number differences between the two waves of the COVID-19 pandemic, which were mostly consistent with other studies of European populations. This included findings that in wave 2: COVID-19 patients were younger [ 32 , 33 ] and with fewer co-morbidities [ 33 ] and suffered lower rates of mortality [ 7 , 34 ]. This study also contributed to the hitherto very limited data on differences in hospital LOS and post-hospital mortality between the two waves.…”

Section: Discussionmentioning

confidence: 99%

Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic

et al. 2021

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In this study of patients admitted with COVID-19, we examined differences between the two waves in patient characteristics and outcomes. Data were collected from the first COVID-19 admission to the end of study (01/03/2020–31/03/2021). Data were adjusted for age and sex and presented as odds ratios (OR) with 95% confidence intervals (CI). Among 12,471 admissions, 1452 (11.6%) patients were diagnosed with COVID-19. On admission, the mean (± SD) age of patients with other causes was 68.3 years (± 19.8) and those with COVID-19 in wave 1 was 69.4 years (± 18.0) and wave 2 was 66.2 years (± 18.4). Corresponding ages at discharge were 67.5 years (± 19.7), 63.9 years (± 18.0) and 62.4 years (± 18.0). The highest proportion of total admissions was among the oldest group (≥ 80 years) in wave 1 (35.0%). When compared with patients admitted with other causes, those admitted with COVID-19 in wave 1 and in wave 2 were more frequent in the 40–59 year band: 20.8, 24.6 and 30.0%; consisted of more male patients: 47.5, 57.6 and 58.8%; and a high LACE (Length of stay, Acuity of admission, Comorbidity and Emergency department visits) index (score ≥ 10): 39.4, 61.3 and 50.3%. Compared to wave-2 patients, those admitted in wave 1 had greater risk of death in hospital: OR = 1.58 (1.18–2.12) and within 30 days of discharge: OR = 2.91 (1.40–6.04). Survivors of COVID-19 in wave 1 stayed longer in hospital (median = 6.5 days; interquartile range = 2.9–12.0) as compared to survivors from wave 2 (4.5 days; interquartile range = 1.9–8.7). Patient characteristics differed significantly between the two waves of COVID-19 pandemic. There was an improvement in outcomes in wave 2, including shorter length of stay in hospital and reduction of mortality.

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“…Birmingham is one of the most ethnically diverse cities in the UK with a high burden of COVID-19 cases and COVID-19 associated mortality in all the UK COVID-19 waves(6, 7). This study was conducted to understand the potential impact of a CVW, by assessing the outcomes and clinical pathways of those presenting to hospital who both met and did not meet the criteria for potentially being included in a CVW, and assessing the time needed to deliver such a system in a hospital trust with a high burden of COVID-19 presentations.…”

Section: Introductionmentioning

confidence: 99%

Evaluating discharges and readmissions using a COVID Virtual Ward model: a retrospective data study assessing patient outcomes and the likely staffing commitment

Gallier

Atkin

Reddy‐Kolanu

et al. 2021

Preprint

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Background: COVID-19 has placed a catastrophic burden on acute hospitals. In an attempt to reduce admissions and enable safe early discharge, a COVID virtual ward (CVW) care pathway has been supported by NHS England. This includes discharging people who meet objective criteria based on acuity scores and oxygen saturations, with pulse oximeters and daily phone calls for up to 14 days. Observational studies have reported the safety of this system, but without describing the outcomes from usual care. Methods: A retrospective study using routinely collected health data from all adults with a confirmed positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) swab result between 1st June 2020 and 31st Jan 2021 who attended the Emergency Department or Acute Medical Unit at QEHB, which does not have a CVW service. Criteria for CVW were applied using data from the first 24 hours of presentation to hospital and subsequent health outcomes were included for 28 days, including re-presentation, re-admission, ITU escalation and death. Results were compared to reported studies based in secondary care. Results: During the study period, 26,127 patients presented to QEHB hospital. 2301 had a positive SARS-CoV-2 swab. Of these, 1730 (75.2%) did not meet the criteria for the CVW and 571 (24.8%) did. Of the 571, 325 (56.9%) were discharged home within 24 hours and 246 (43.1%) were admitted for 24 hours or longer. Those admitted were older, with increased co-morbidities, 80.9% required hospital-supported acute therapies after the first 24 hours and 10.6% died. Of the 325 discharged, 44 were readmitted (13.5%), 30 (9.2%) with COVID-related symptoms, 5 (1.5%) required ITU and 1 patient (0.3%) died. These results were comparable to published studies with a CVW service. Discussion: In the current study, discharging patients without a CVW did not confer a greater risk of re-presentation, re-admission, ITU escalation or death. The majority of patients who remained in hospital despite meeting the CVW criteria did so for the provision of treatments or acute assessments. It remains uncertain whether a CVW delivers improvements in hard outcomes, and further research is needed.

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The changing characteristics of COVID-19 presentations: A regional comparison of SARS-CoV-2 hospitalised patients during the first and second wave

Cited by 13 publications

References 13 publications

COVID-19 in Iran: Clinical Presentations and Outcomes in Three Different Surges of COVID-19 Infection

COVID-19 in Iran: Clinical Presentations and Outcomes in Three Different Surges of COVID-19 Infection

Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic

Evaluating discharges and readmissions using a COVID Virtual Ward model: a retrospective data study assessing patient outcomes and the likely staffing commitment

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