Editor’s Note: Search for the latest COVID-19 news and guidance on Medscape Coronavirus Resource Center.
Late last month, Vice President Mike Pence Sent a letter To the administrators of 6,000 hospitals across the country requesting a yes.
He asked them to fill out a form daily with data about the patients they were treating with COVID-19, get the disease caused by the new coronavirus, and submit it to the Centers for Disease Control.
“This data helps us better understand disease patterns and develop policies for the prevention and management of health problems associated with COVID-19,” writes Pence.
Currently, COVID-19 is approaching the top of some parts of the country, so the number of hospitals submitting the requested information is unknown. The CDC only states that it has not released the data publicly and will release it shortly.
The response of the US healthcare system to coronaviruses has revealed many blind spots. Helps make informed decisions about the inability to quickly create widely deployable tests, the lack of personal protective equipment for first-line doctors and nurses, and the lack of basic hospitalization data.
“We are in the fog because there is little reliable data,” said Dr. Ashish Jha, head of the Harvard Global Health Institute. I ’ve been studying the capabilities of the hospital.
Having real-time data on hospitalizations nationwide does two things. First, it provides a window into the spread of the coronavirus, about a week ago, because infected patients take time to get sick enough to be hospitalized. Second, federal and state officials can identify hotspots that require more equipment and staff and shift resources from one area to another.
Dr. Peter Hotes, co-director and dean of the Vaccine Development Center at Texas Children’s Hospital, said: Of the National School of Tropical Medicine at Baylor College of Medicine in Houston. “It sounds like part of [United States], It is happening because the test could not be sped up.
“The reason we are testing is to get ahead of it.”
According to the COVID tracking project, as of Wednesday, most states had released some information about patients hospitalized for COVID-19. Operate website It summarizes key indicators of a country’s response to the virus. But the two states with the highest numbers of cases (Michigan and Texas) did not do so every day. The information is inconsistent among those releasing data. Some report information about current hospitalizations that provide a window on whether the hospital can handle the load, while others report information about cumulative hospitalizations that give a sense of ongoing disease.
What we know about COVID-19 rates
According to experts, what we are learning is that COVID-19 seems to hit parts of the United States, especially New York, as well as Wuhan in China. According to Chinese data, about one in five patients hospitalized for COVID-19 died. Early data in the United States suggested that hospitalized infected people were far less likely to die, but more data were reported, which was intolerable. Part of the reason is that patients with severe COVID-19 often spend days on intensive care before dying.
As of Wednesday night, 80,204 A case of COVID-19 was identified in New York City. Of these, 20,474, or nearly 26%, required hospitalization at some point. A total of 4,260 people died, and more than 5% of those who tested positive.
It is difficult to draw comparisons because other cities and regions do not report data in the same way. For example, in California, 2,714 patients with COVID-19 were hospitalized as of Wednesday, of which 1,154 were in the ICU, more than 42%. Another 3,078 people suspected of having COVID-19 were hospitalized, of which 522 received intensive care.
Some state data contain many unknowns. For example, Massachusetts Out of 16,790 COVID-19 patients, 1,583 required hospitalizationAs of Wednesday. Another 4,717 did not. However, the state said it was investigating a majority of the case, 10,490.
The lack of available data is $ 35 billion investment In an electronic medical record 10 years ago, Jha et al. The transition from paper records to digital records should have made healthcare systems more agile and able to provide information more quickly.
“If it doesn’t happen, it’s a massive failure of the system,” he said.
In Harris County, Texas, including Houston, testing did not keep up with the ward reality. NBC News coverage Last week, as of March 30, fewer than 950 confirmed cases of coronavirus in areas around Houston. “But on the same day, 996 people were hospitalized in the area with confirmed or suspected cases of COVID-19.”
University of Minnesota Team Carlson School of Management We have begun collecting inpatient information directly from the state health department. On Tuesday’s post Journal Health AffairsThe team noted that the percentage of the adult population hospitalized varies widely from state to state.
According to the report, the average hospitalization rate was 11.5 per 100,000 adults in states that released data on currently hospitalized people. In Louisiana, the incidence was much higher, at 49.5 per 100,000 adults.
The report also states that among the 14 states reporting daily data for at least the past 10 days, the average doubling time for cumulative hospitalization is 4.21 days. The doubling time in Massachusetts was 2.79 days, while in Georgia it was 6.08 days. Faster doubling times can mean more community transmission, so healthcare system alerts need to be higher.
“This may reflect, in part, differences in the timing of the pandemic reaching different states, but may reflect learning differences because of the state-wide strategies. Yes, “the authors said.
As part of that, the CDC on Friday has launched a release Weekly snapshot of hospitalization, Based on data from hospitals serving about 10% of the US population. The hospitalization rates for COVID-19 in the first few weeks were similar to those seen at the beginning of each year’s influenza season. However, given that the impact of COVID-19 has been felt most seriously since the cut-off period of the posted data, hospitalization rates appear to have increased thereafter.
so Data briefs released on WednesdayThe CDC provided additional information on hospitalizations identified by COVID-19 in 14 states from March 1-30, based on sites surveyed in each state. Per capita rates are highest in Connecticut, Michigan, and New York, and much lower in Oregon, Colorado, and Ohio, indicating that the virus affects different parts of the country differently. (Looking at raw cases alone does not adjust for differences in state population.) Elderly hospitalization rates were high, and most of the hospitalized elderly had underlying medical conditions.
Regarding the initiative announced by Pence, CDC stated that it is collecting daily hospital data through the National Healthcare Safety Network. A spokeswoman said, “The purpose of the new module is to provide a better understanding of what is happening in U.S. hospitals once it is up and running. We hope to get publicized soon. “
Ongoing blind spots
Even for coarser forms of data, such as mortality data, US systems have not proven to be particularly agile. At the peak of the opioid epidemic several years ago, Dr. Christopher JL Murray took months, sometimes over a year, to gather accurate information about locations and causes of death, and valuable time to respond to hotspots Wasted. Director of Institute for Health Metrics and Evaluation At the University of Washington, its COVID-19 model notified the White House response.
“Hospital data is less sophisticated than death data,” Murray said. “A nationwide daily report, hospital admissions, and ICU admissions will be a great boost to understanding where the next big wave is coming and where we are really making progress.”
This gap in data has caused problems with efforts to model illness tolls. “We’re starting to see this pattern of death reports falling on Sundays, which come in on Monday, and they will catch up,” Murray said. “This is a huge blow to our model.”
State health authorities and hospital systems are not waiting for the right data to increase the number of hospital beds, ICU beds, and ventilators available for treating COVID-19 patients.
For example, in Indiana, as of March 1, the hospital had 1,132 ICU beds. Dr. Christina Boxin of the Indiana Health Commission stated in this week’s briefing. It increased to 2,188 by April 1 and 2,964 by April 4. “Our hospital has done an incredible job of turning every room possible into an ICU room,” she said.
It is a good thing that has happened. As of Sunday, approximately 58% of the currently available ICU beds are occupied in the United States, exceeding the total available on March 1st. About 924 of the 1,721 occupied ICU beds were used by COVID-19 patients.
Dr. Nilavsher, a senior researcher at Stanford University and a former health commissioner in New York, said the healthcare system needed to learn from this crisis and get accurate real-time data on hospitalization in preparation for the next crisis. Was. Part of that.
“We don’t have the early warning system needed for this epidemic outbreak,” Shah said. “I think everyone understands. This epidemic has made it clear enough that 21st century disease requires the creation of a 21st century system. I do. “