- • Many patients require intensive care during admission and/or substantial follow-up care
- • Vulnerable populations are disproportionately represented among patients with the infection
Data from the first COVID-19 patients treated at three large Massachusetts hospitals reveal important trends, including disproportionate representation of vulnerable populations, high rates of disease-related complications, and the need for post-discharge, post-acute care and monitoring.
“Our medium follow-up revealed that many of these patients are very sick even after leaving the hospital,” says senior author Jason H. Wasfy, MPhil, assistant professor at Harvard Medical School and Director of Quality and Outcomes Research at the Massachusetts General Hospital Heart Center. This study was published today in EClinicalMedicine. LINK
For the study, the group created a detailed registry based on physician review of 247 patient charts for demographics, baseline characteristics, symptoms, home medications, laboratory data, electrocardiogram (EKG) data, imaging, and treatment.
Patients were included if they were admitted from March 7th through the 30th, 2020, with confirmed SARS-CoV-2 infection, to one of three Mass General Brigham (formerly Partners HealthCare) system’s hospitals -- MGH, Brigham and Women’s Hospital, and Newton-Wellesley Hospital.
These represent three of the largest hospitals in New England’s largest integrated health care system. MGH and Brigham and Women’s are both academic medical centers, and Newton-Wellesley is a community hospital.
“I’m glad we got that mix because we need data from across different kinds of settings,” Wasfy says.
Most of the study patients were initially treated with hydroxychloroquine (72%) and statins (76%, with 34% of those newly initiated), a practice that has since changed. “We don’t use either of those treatments at our institutions anymore, which highlights the dynamic nature of COVID-19 patient care,” says study lead author Cian P. McCarthy, MD, cardiology fellow, Division of Cardiology, MGH.
Another trend that stood out was the ethnic and socio-economic mix: 30% of patients were Hispanic, 21% were enrolled in Medicaid, and 12% were dual-enrolled Medicare/Medicaid.
“This strongly suggests that there are some built in disadvantages that fall on these populations’ shoulders,” says Wasfy. “They may have more family members living in one home, have greater difficulty accessing care, or other circumstances making them more likely to become infected and sick.”
The study patients also showed a surprising range of symptoms and outcomes. Just over 100 patients (42%) required intensive care during their stay. At the end of the data collection period, 213 patients (86.2%) were discharged alive, 2 patients (0.8%) were still in the hospital, and 32 patients (13%) had died. Among those discharged alive, 70 (32.9%) were discharged to a post-acute facility, 31 (14.6%) newly required supplemental oxygen, 19 (8.9%) newly required tube feeding, and 34 (16%) required new prescriptions for antipsychotics, benzodiazepines, methadone, or opioids.
About 10% of the study patients were readmitted when followed for an average of 80 days after discharge. “Our data demonstrates that the road to recovery extends far beyond the hospital and we must ensure we are supporting our patients physical and emotional needs after discharge,” says McCarthy.