Clinical Trends Among U.S. Adults Hospitalized with COVID-19, March-December 2020

  1. Shikha Garg
  2. Kadam Patel
  3. Huong Pham
  4. Pam D. Kirley
  5. Breanna Kawasaki
  6. Kimberly Yousey-Hindes
  7. Evan J. Anderson
  8. Andrew Weigel
  9. Patricia A. Ryan
  10. Libby Reeg
  11. Kathryn Como-Sabetti
  12. Sarah Shrum Davis
  13. Alison Muse
  14. Nancy M. Bennett
  15. Laurie Billing
  16. Melissa Sutton
  17. H. Keipp Talbot
  18. Mary Hill
  19. Jonathan Wortham
  20. Lindsay Kim
  21. Fiona Havers
  22. COVID-NET Surveillance Team
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Abstract

Background

The COVID-19 pandemic has caused substantial morbidity and mortality.

Objectives

To describe monthly demographic and clinical trends among adults hospitalized with COVID-19.

Design

Pooled cross-sectional.

Setting

99 counties within 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET).

Patients

U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during March 1-December 31, 2020.

Measurements

Monthly trends in weighted percentages of interventions and outcomes including length of stay (LOS), intensive care unit admissions (ICU), invasive mechanical ventilation (IMV), vasopressor use and in-hospital death (death). Monthly hospitalization, ICU and death rates per 100,000 population.

Results

Among 116,743 hospitalized adults, median age was 62 years. Among 18,508 sampled adults, median LOS decreased from 6.4 (March) to 4.6 days (December). Remdesivir and systemic corticosteroid use increased from 1.7% and 18.9% (March) to 53.8% and 74.2% (December), respectively. Frequency of ICU decreased from 37.8% (March) to 20.5% (December). IMV (27.8% to 8.7%), vasopressors (22.7% to 8.8%) and deaths (13.9% to 8.7%) decreased from March to October; however, percentages of these interventions and outcomes remained stable or increased in November and December. Percentage of deaths significantly decreased over time for non-Hispanic White patients (p-value <0.01) but not non-Hispanic Black or Hispanic patients. Rates of hospitalization (105.3 per 100,000), ICU (20.2) and death (11.7) were highest during December.

Limitations

COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country.

Conclusions

After initial improvement during April-October 2020, trends in interventions and outcomes worsened during November-December, corresponding with the 3 rd peak of the U.S. pandemic. These data provide a longitudinal assessment of trends in COVID-19-associated outcomes prior to widespread COVID-19 vaccine implementation.

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