Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study
Tóm tắt
To understand the epidemiology and burden of severe coronavirus disease 2019 (covid-19) during the first epidemic wave on the west coast of the United States.
Prospective cohort study.
Kaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state.
1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9 596 321 healthcare plan enrollees. Analyses of hospital length of stay and clinical outcomes included 1328 people admitted by 9 April 2020 (534 in northern California, 711 in southern California, and 83 in Washington).
Cumulative incidence of first acute hospital admission for confirmed covid-19, and subsequent probabilities of admission to an intensive care unit (ICU) and mortality, as well as duration of hospital stay and ICU stay. The effective reproduction number (
As of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100 000 cohort members in northern California, 23.3 per 100 000 in southern California, and 14.7 per 100 000 in Washington. Accounting for censoring of incomplete hospital stays among those admitted by 9 April 2020, the estimated median duration of stay among survivors was 9.3 days (with 95% staying 0.8 to 32.9 days) and among non-survivors was 12.7 days (1.6 to 37.7 days). The censoring adjusted probability of ICU admission for male patients was 48.5% (95% confidence interval 41.8% to 56.3%) and for female patients was 32.0% (26.6% to 38.4%). For patients requiring critical care, the median duration of ICU stay was 10.6 days (with 95% staying 1.3 to 30.8 days). The censoring adjusted case fatality ratio was 23.5% (95% confidence interval 19.6% to 28.2%) among male inpatients and 14.9% (11.8% to 18.6%) among female inpatients; mortality risk increased with age for both male and female patients. Reductions in
Among residents of California and Washington state enrolled in Kaiser Permanente healthcare plans who were admitted to hospital with covid-19, the probabilities of ICU admission, of long hospital stay, and of mortality were identified to be high. Incidence rates of new hospital admissions have stabilized or declined in conjunction with implementation of social distancing interventions.
Từ khóa
Tài liệu tham khảo
World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 102. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Accessed May 1, 2020.
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19) cases in US. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Accessed May 1, 2020.
Gordon NP. Similarity of the adult Kaiser Permanente membership in Northern California to the insured and general population in Northern California: Statistics from the 2011 California Health Interview Survey. https://divisionofresearch.kaiserpermanente.org/projects/memberhealthsurvey/SiteCollectionDocuments/chis_non_kp_2011.pdf. Accessed May 1, 2020.
Kaiser Permanente Geographically Enriched Member Sociodemographics Datamart (GEMS). Accessed April 30, 2020.
Ryan CL Bauman K . Educational attainment in the United States: 2015. Curr Popul Rep [Spec Censuses] 2016.
Kaiser Permanente Emergency Management. COVID-19 intensive care unit, medical surgical and medical surgical telemetry unit surge playbook. 2020. https://permanente.org/wp-content/uploads/2020/03/KP-NCAL-COVID-MST-Playbook_March-30.pdf. Accessed May 1, 2020.
Centers for Disease Control and Prevention. Interim Guidance: Discontinuation of transmission-based precautions and disposition of patients with COVID-19 in healthcare settings. 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html. Accessed May 1, 2020.
Fuller T, Baker M, Hubler S, et al. A coronavirus death in early February was ‘probably the tip of an iceberg’. New York Times. 2020. https://www.nytimes.com/2020/04/22/us/santa-clara-county-coronavirus-death.html. Accessed May 1, 2020.
Center for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine. Temporal variation in transmission during the COVID-19 outbreak: National and subnational estimates for the United States of America. 2020. https://epiforecasts.io/covid/. Accessed May 1, 2020.