Hospitalizations and Covid-19: Is the Current Data Reliable in 2021?

As the Delta variant works its way across communities in the  United States, a new study is calling into question how dire the situation really is with regard to COVID-19 precipitated hospitalizations. 

The study, conducted by a team of researchers from Harvard Medical School, Tufts Medical Center, and the Veterans Affairs Healthcare System, used the metric of oxygen saturation (SpO2 ) as a measure of severity of COVID-19. That’s because patients with severe cases of COVID_19 almost always have respiratory distress and therefore require oxygen support, and in severe cases, intubation and the use of a ventilator. 

Dr. Nathanael Fillmore, Associate Director for Machine Learning and Advanced Analytics, VA Boston Healthcare System
The researchers found evidence that may contradict the assumption that COVID-19 attributed hospitalizations are on the rise. Specifically, the researchers determined that the amount of severe COVID-19 cases are actually in decline compared to previous data, stating, “From 3/1/2020-1/20/2021, the proportion of hospitalized patients with moderate-to-severe disease was 64.0% (95% CI, 63.1–64.9%) and from 1/21/2021-6/30/2021, was 52.0% (95% CI, 50.9–53.2%).”

The researchers also looked at dexamethasone usage, a  corticosteroid medication that is appearing to make a “substantial contribution to the treatment of novel COVID-19.” They found that “Proportions of COVID-19 cases receiving treatment with dexamethasone also dropped in parallel with reduction in disease severity as measured by vital signs particularly in vaccinated patients.” 

These findings led the researchers to state, “Consideration should be given to updating the case definition of COVID-19 hospitalizations to better reflect cases of hospitalization caused by COVID-19 versus hospitalizations associated with detection of SARS-CoV-2.” In their Discussion section, the researchers point out that “These findings suggest that reporting definitions may need to be revised to reflect the changing nature of the pandemic, particularly in regions with high levels of vaccine uptake.” 

The implication is that many patients who are diagnosed with COVID-19 have mild or severe cases of COVID-19 and may actually be there for other reasons beyond COVID-19. As the authors of the study state:

“Other recent studies similarly found that current definitions of ‘COVID-19 hospitalizations’ combined with routine, and often mandatory, screening testing of all admissions may substantially overestimate the number of hospitalizations caused by SARS-CoV-2 infection. In a pediatric population, 41% of reported admissions associated with SARS-CoV-2 infection were for reasons other than COVID-19, rates similar to those found when the simple definition of moderate to severe disease was applied in our cohort.” 

However, there are some significant limitations to this study. The researchers themselves say:

“The VA population is not representative of the US population as a whole, having few women and no children. We did not control for patients with baseline hypoxemia or oxygen requirement (common among VA patients) or for altitude, and thus some mild cases may have been misclassified as moderate-to-severe.”

Nor has this study been peer-reviewed, which should be the next step. There have also been some severe criticisms on the website in the Comments section. One specifically asks, “I wonder why the team decided to deviate from the NIH definition of “moderate” covid (signs of respiratory infection but blood O2 at greater than 94%)? The cases they have categorized as moderate to severe would all be categorized as severe by the NIH guidelines.”

Others are more nuanced, such as “The limitations in this study are worrisome. However, I think the conclusion that Dr. Fillmore et. al. have reached is something that we have all suspected. The differentiation between being placed in the hospital due to SARS-CoV-2 and the presence of a viral load that leads to a positive test are two vastly different things.”

Lastly, one other pronouncement by the researchers bears inclusion: “vaccinated patients develop less severe disease.”

These are important findings. We need solid, reliable, accurate data to make medical and public-health policy decisions because these decisions have a great impact on our collective future. Regardless of how you feel about this study, however, many people are still being admitted to hospitals due to COVID-19 complications, and some of those are still dying from these complications. The battle is not over, folks. 

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