Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: an observational cohort
File(s)
Published version
OA Location
Author(s)
ISARIC Clinical Characterisation Group
Hall, Matthew D
Baruch, Joaquín
Carson, Gail
Citarella, Barbara Wanjiru
Type
Journal Article
Abstract
Background: There is potentially considerable variation in the nature and duration of the care provided to hospitalised patients during an infectious disease epidemic or pandemic. Improvements in care and clinician confidence may shorten the time spent as an inpatient, or the need for admission to an intensive care unit (ICU) or high density unit (HDU). On the other hand, limited resources at times of high demand may lead to rationing. Nevertheless, these variables may be used as static proxies for disease severity, as outcome measures for trials, and to inform planning and logistics. Methods: We investigate these time trends in an extremely large international cohort of 142,540 patients hospitalised with COVID-19. Investigated are: time from symptom onset to hospital admission, probability of ICU/HDU admission, time from hospital admission to ICU/HDU admission, hospital case fatality ratio (hCFR) and total length of hospital stay. Results: Time from onset to admission showed a rapid decline during the first months of the pandemic followed by peaks during August/September and December 2020. ICU/HDU admission was more frequent from June to August. The hCFR was lowest from June to August. Raw numbers for overall hospital stay showed little variation, but there is clear decline in time to discharge for ICU/HDU survivors. Conclusions: Our results establish that variables of these kinds have limitations when used as outcome measures in a rapidly-evolving situation. Funding: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z] and the Bill and Melinda Gates Foundation [OPP1209135]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Date Issued
2021-11-23
Date Acceptance
2021-11-18
Citation
eLife, 2021, 10, pp.1-30
ISSN
2050-084X
Publisher
eLife Sciences Publications Ltd
Start Page
1
End Page
30
Journal / Book Title
eLife
Volume
10
Copyright Statement
© 2021 ISARIC Clinical
Characterisation Group et al.
This article is distributed under
the terms of the Creative
Commons Attribution License,
which permits unrestricted use
and redistribution provided that
the original author and source
are credited.
Characterisation Group et al.
This article is distributed under
the terms of the Creative
Commons Attribution License,
which permits unrestricted use
and redistribution provided that
the original author and source
are credited.
License URL
Sponsor
Medical Research Council (MRC)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/34812731
PII: 70970
Grant Number
MR/R015600/1
Subjects
epidemiology
global health
human
medicine
viruses
Publication Status
Published
Coverage Spatial
England
Article Number
ARTN e70970
Date Publish Online
2021-11-23