#Surges in hospital caseload tied to higher COVID-19 mortality

(HealthDay)—Hospitalized COVID-19 patients cared for in hospitals with the greatest surges in caseload have twofold greater mortality risk than patients in hospitals not experiencing surges, according to a study published online July 6 in the Annals of Internal Medicine.

Sameer S. Kadri, M.D., from the National Institutes of Health Clinical Center in Bethesda, Maryland, and colleagues evaluated the association between hospitals’ severity-weighted COVID-19 caseload and COVID-19 mortality risk. The analysis included adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020.

The researchers found that of the 144,116 inpatients with COVID-19 at 558 U.S. hospitals, 54.2 percent were admitted to hospitals in the top surge index decile and, overall, 17.6 percent of patients died. Crude COVID-19 mortality decreased over time across all surge index strata, but the risk for death increased in the 50 to 75, 75 to 90, 90 to 95, 95 to 99, and >99 percentiles (odds ratios, 1.11, 1.24, 1.42, 1.59, and 2.00, respectively) compared with nonsurging (hospital-months. The association between surge index and mortality was visible across ward, intensive care unit, and intubated patients. Despite greater corticosteroid use and more judicious intubation during later and higher-surging months, the surge-mortality relationship was stronger in June to August than in March to May. It is estimated that nearly one in four COVID-19 deaths (23.2 percent) were potentially attributable to hospitals strained by surging caseload.

“Many COVID-19 deaths may be preventable through prudent public health and health care organizational interventions that minimize the effect of surges,” the authors write. “Bolstering preventive measures and supporting surging hospitals will save many lives.”

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