Sixty-Day Outcomes Among Patients Hospitalized With COVID-19

Chopra V, Flanders SA, O'Malley M, Malani AN, Prescott HC.  Ann Intern Med. 2020 Nov 11. Epub ahead of print. [CrossRef] [PubMed]

Although characteristics and in-hospital outcomes for persons with coronavirus disease 2019 (COVID-19) have been well described, less is known about the longer-term outcomes of hospitalized patients. This observational cohort study looked at patients hospitalized with COVID-19 (discharged between 16 March and 1 July 2020) at 38 hospitals participating in the MI-COVID19 initiative. Of 1648 patients with COVID-19 admitted to 38 hospitals, 398 (24.2%) died during hospitalization and 1250 (75.8%) survived. Of 1250 patients discharged alive, 975 (78.0%) went home whereas 158 (12.6%) were discharged to a skilled nursing or rehabilitation facility. By 60 days after discharge, an additional 84 patients (6.7% of hospital survivors and 10.4% of intensive care unit [ICU]-treated hospital survivors) had died, bringing the overall mortality rate for the cohort to 29.2%, and 63.5% for the 405 patients who received treatment in an ICU. Within 60 days of discharge, 189 patients (15.1% of hospital survivors) were rehospitalized. Cardiopulmonary symptoms (such as cough and dyspnea) were reported by 159 patients, including 92 with new or worsening symptoms and 65 with persistent loss of taste or smell. Fifty-eight patients reported new or worsening difficulty completing activities of daily living. Among 195 patients who were employed before hospitalization, 117 had returned to work whereas 78 could not because of ongoing health issues or job loss. Of the 117 patients who returned to work, 30 reported reduced hours or modified duties due to health reasons. Although postdischarge chart review was completed for all patients, telephone contact occurred in fewer than half. Despite these limitations, our study indicates that adverse events after COVID-19 hospitalization are common.

Association of Peer Comparison Emails with Electronic Health Record Documentation of Cancer Stage by Oncologists

Sinaiko AD, Barnett ML, Gaye M, Soriano M, Mulvey T, Hochberg E. JAMA Netw Open. 2020 Oct 1;3(10):e2015935. [CrossRef] [PubMed]

In a randomized pilot study of 56 oncologists at the Massachusetts General Hospital, the authors sent emails with peer comparison data on the proportion of an oncologist’s patients with cancer stage documentation in the machine-readable structured fields in electronic health records (EHRs). Sending these emails were associated with increased documentation of patients’ stage in the EHR by 9.0 percentage points, a relative increase of 69%. The association was observed among oncologists’ new, but not established, patients. The findings suggest interventions using peer comparisons could change physician performance on the EHR among oncologists.

Modeling COVID-19 scenarios for the United States

IHME COVID-19 Forecasting Team. Nat Med. 2020 Oct 23. Epub ahead of print. [CrossRef] [PubMed]

We use COVID-19 case and mortality data from 1 February 2020 to 21 September 2020 and a deterministic SEIR (susceptible, exposed, infectious and recovered) compartmental framework to model possible trajectories of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the effects of non-pharmaceutical interventions in the United States at the state level from 22 September 2020 through 28 February 2021. Using this SEIR model, and projections of critical driving covariates (pneumonia seasonality, mobility, testing rates and mask use per capita), we assessed scenarios of social distancing mandates and levels of mask use. Projections of current non-pharmaceutical intervention strategies by state-with social distancing mandates reinstated when a threshold of 8 deaths per million population is exceeded (reference scenario)-suggest that, cumulatively, 511,373 (469,578-578,347) lives could be lost to COVID-19 across the United States by 28 February 2021. We find that achieving universal mask use (95% mask use in public) could be sufficient to ameliorate the worst effects of epidemic resurgences in many states. Universal mask use could save an additional 129,574 (85,284-170,867) lives from September 22, 2020 through the end of February 2021, or an additional 95,814 (60,731-133,077) lives assuming a lesser adoption of mask wearing (85%), when compared to the reference scenario.

Modeling COVID-19 scenarios for the United States

IHME COVID-19 Forecasting Team. Nat Med. 2020 Oct 23. Epub ahead of print. [CrossRef] [PubMed]

We use COVID-19 case and mortality data from 1 February 2020 to 21 September 2020 and a deterministic SEIR (susceptible, exposed, infectious and recovered) compartmental framework to model possible trajectories of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the effects of non-pharmaceutical interventions in the United States at the state level from 22 September 2020 through 28 February 2021. Using this SEIR model, and projections of critical driving covariates (pneumonia seasonality, mobility, testing rates and mask use per capita), we assessed scenarios of social distancing mandates and levels of mask use. Projections of current non-pharmaceutical intervention strategies by state-with social distancing mandates reinstated when a threshold of 8 deaths per million population is exceeded (reference scenario)-suggest that, cumulatively, 511,373 (469,578-578,347) lives could be lost to COVID-19 across the United States by 28 February 2021. We find that achieving universal mask use (95% mask use in public) could be sufficient to ameliorate the worst effects of epidemic resurgences in many states. Universal mask use could save an additional 129,574 (85,284-170,867) lives from September 22, 2020 through the end of February 2021, or an additional 95,814 (60,731-133,077) lives assuming a lesser adoption of mask wearing (85%), when compared to the reference scenario.

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

CODA Collaborative, Flum DR, Davidson GH, Monsell SE, et al. N Engl J Med. 2020 Oct 5. Epub ahead of print. [CrossRef] [PubMed]

Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis. The authors conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days. In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], -0.001 to 0.03). Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The authors conclude that for the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.