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COVID-19 Insights & Analytics Issue 8
Impact of each wave on ICU Admissions and LOS

Jan 27, 2021

Overview

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The COVID-19 Insights & Analytics newsletter is designed to provide you with a summary to quantify national trends that may help in COVID-19 response planning. The included data, analytics and dashboards are generated utilizing BD HealthSight™ Infection Advisor Analytics and are derived from electronic patient data from 338 participating U.S. hospitals initiated on March 1, 2020 through December 22, 2020 unless otherwise indicated.

Introduction

The U.S. is currently experiencing its 3rd COVID wave and data suggests it is the largest to date, affecting hospitalization resources and ICU bed availability depending on the local geographic prevalence1. In this issue we look at COVID+ ICU/hospitalizations and length of stay (LOS) as a nation compared to prior COVID waves.

Executive Summary

  • Despite increases in COVID+ testing rates and COVID+ inpatient population in the 3rd wave of the pandemic, the % of patients requiring care in the ICU has not increased. (A limitation our data set is that it does not include temporary ICU beds)
  • Additionally, the upward trend in COVID+ inpatients has not driven a significant increase in LOS in this database.

Figure 1: % of patients COVID+ compared to % of patients requiring ICU care

Figure 1 examines at the 7-day rolling average for each day of the % of admitted patients that test positive for COVID and the % of all patients admitted that are currently being cared for in the ICU.

Figure 1 Commentary

  • In our database, the % of patients admitted that tested positive for COVID hit a high of 8% in wave one before retreating to 3%. During the 2nd wave the %COVID+ reached 8% again, before retreating to ~3%. In the 3rd wave (to date), COVID+ admits has reached 14% of the inpatient population.
  • The % of inpatients being cared for in an ICU was ~12% prior to the pandemic. This grew to a ~15% during the 1st wave. The 2nd wave & the 3rd wave (to date) the % in the ICU has been ~13%. This is notable in the 3rd wave due to the higher % of admitted patients being COVID+.
  • The lower relative impact on % in ICU in the 2nd & 3rd wave may be due to advancements2 in therapeutics and care regimens in addition to a relatively younger average age3 (less acute) of COVID+ populations in the 2nd & 3rd waves.
  • This finding is in contrast to some local reports of ICUs being overwhelmed4, which could be caused by a number of factors including: regional differences in patient acuity, differences in policies for patient movement or isolation, or the instances of hospitals utilizing temporary IUC beds.
  • Note that if hospitals create temporary ICU beds, they would not be counted as an ICU bed in our data set.

Figure 2: % Change vs. Year Ago for Admissions compared to % Change vs. Year Ago for LOS

Figure 2 examines the 7-day rolling average for inpatient admission and LOS % change vs. the same date a year ago.

Figure 2 Commentary

Observations per graph:

  • The % change vs. year ago for inpatient admissions was dramatic in the 1st wave dropping 37%. This was driven by state level restrictions on elective surgery and the general population avoiding care in the early months of the pandemic.
  • Inpatient Admissions % Change vs year ago has varied between -15% to -5% since recovering after the 1st wave and through the 2nd and 3rd waves. General population avoiding care appears to be greater than the increase in admissions driven by COVID+ patients seeking care.
  • The % change vs. year ago in LOS grew 10% in wave 1. Since the 1st wave the aggregated national impact has been more muted and has averaged +1.0% since June 2020 through December 2020.
  • The significant increase in LOS in the 1st wave may be driven from the longer LOS of COVID+ patients in the 1st wave vs 2nd & 3rd, due to improved treatment protocols and less acute COVID+ patients since the 1st wave.
  • Additionally, during the 1st wave restrictions, the acuity of the patients still seeking care was likely higher than pre-pandemic. Turnaround time for SARS-CoV-2 diagnostics results were also longer and less available during the beginning of the pandemic. Finally, despite higher number of infections, there are reports that mortality in COVID+ patients has dropped later in the pandemic5. (% of COVID+ patients that expire has reduced even while the total number of deaths are on the rise due to the rise of total COVID+ population.)

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