News: COVID-19 caseload surges linked to doubled mortality at hardest-hit hospitals

COVID-19-related inpatient deaths doubled at hospitals hit hard by surging caseloads during the pandemic, a new National Institutes of Health (NIH) study shows.

In a retrospective cohort study published in Annals of Internal Medicine, NIH researchers examined the records on 144,116 hospitalized patients cared for in 558 hospitals to see how COVID-19 surges affected patient outcomes, HealthLeaders reported

The researchers devised a "unique surge index" that measured the strain on hospitals each month from COVID-19 in relation to bed capacity and found that clusters of high-surge index hospitals experienced two-fold greater mortality than in hospitals not experiencing surges. The metric showed that nearly one in every four deaths and almost 6,000 total deaths may have been attributable to hospital strain due to COVID-19.

“These system perturbations have significant consequences for those who provide clinical care," corresponding author Vineet Chopra, MD, a hospitalist at Michigan Medicine, wrote in an accompanying editorial. "First of all, providers are marshaled to deal with an adversary they know little about. They are then asked to do so in unfamiliar areas of the building, with people they may never have worked with before. On top of this, new processes for critical clinical decisions, such as when to test for COVID-19, how to treat, when to intubate, or how to manage cardiac arrests, are introduced.”

Chopra wrote that the findings offer several lessons:

1. Clusters of high-surge index hospitals not only existed but varied across geography and time.
2. The effect of therapeutics in the form of decreasing ICU admissions and mechanical ventilation rates.
3. How detrimental COVID-19 surges were to clinical outcomes (after risk adjustment, patients cared for in the highest surge strata experienced two-fold greater mortality than in hospitals not experiencing surges).

The findings come as healthcare providers grapple with the burgeoning global threat of a surging COVID-19 Delta variant. The authors suggest that many COVID-related deaths could be prevented with smart, coordinated regional public health strategies and health system interventions, HealthLeaders reported. Chopra said an emphasis on bolstering staff is also critical because burnout and stress related to the pandemic are prompting many clinicians to leave the field.

Editor’s note: This article was originally published by HealthLeaders. Additional ACDIS coverage of COVID-19 can be found here.