Temporal Trends in Inpatient Oncology Census Before and During the COVID-19 Pandemic and Rates of Nosocomial COVID-19 Among Patients with Cancer at a Large Academic Center

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted health care systems. However, to date, the trend of hospitalizations in the oncology patient population has not been studied, and the frequency of nosocomial spread to patients with cancer is not well understood. The objectives of this study were to evaluate the impact of COVID-19 on inpatient oncology census and determine the nosocomial rate of COVID-19 in patients with cancer admitted at a large academic center.

Materials and methods: Medical records of patients with cancer diagnosed with COVID-19 and admitted were reviewed to evaluate the temporal trends in inpatient oncology census during pre-COVID-19 (January 2019 to February 2020), COVID-19 (March to May 2020), and post-COVID-19 surge (June to August 2020) in the region. In addition, nosocomial infection rates of SARS-CoV-2 were reviewed.

Results: Overall, the daily inpatient census was steady in 2019 (median, 103; range, 92-118) and until February 2020 (median, 112; range, 102-114). However, there was a major decline from March to May 2020 (median, 68; range, 57-104), with 45.4% lower admissions during April 2020. As the COVID-19 surge eased, the daily inpatient census over time returned to the pre-COVID-19 baseline (median, 103; range, 99-111). One patient (1/231, 0.004%) tested positive for SARS-CoV-2 13 days after hospitalization, and it is unclear if it was nosocomial or community spread.

Conclusion: In this study, inpatient oncology admissions decreased substantially during the COVID-19 surge but over time returned to the pre-COVID-19 baseline. With aggressive infection control measures, the rates of nosocomial transmission were exceedingly low and should provide reassurance to those seeking medical care, including inpatient admissions when medically necessary.

Implications for practice: The COVID-19 pandemic has had a major impact on the health care system, and cancer patients are a vulnerable population. This study observes a significant decline in the daily inpatient oncology census from March to May 2020 compared with the same time frame in the previous year and examines the potential reasons for this decline. In addition, nosocomial rates of COVID-19 were investigated, and rates were found to be very low. These findings suggest that aggressive infection control measures can mitigate the nosocomial infection risk among cancer patients and the inpatient setting is a safe environment, providing reassurance.

Keywords: COVID-19; Cancer; Clinical outcomes; Inpatient; Nosocomial rate.

Figure 1

Comparing the weekly inpatient census numbers of patients with cancer at Massachusetts General Hospital between 2019 and 2020. Data exhibit a steep drop in the 2020 inpatient numbers following the beginning of the COVID‐19 quarantine. Abbreviations: MGH, Massachusetts General Hospital; v, versus.

Figure 2

Displaying the number of admitted COVID‐19 positive patients with cancer at Massachusetts General Hospital. Data show a steady decline since the observed peak on April 28th, 2020. Abbreviation: MGH, Massachusetts General Hospital.

Figure 3

Comparing the weekly ambulatory infusion census numbers of patients with cancer at Massachusetts General Hospital between 2019 and 2020. Data show an overall decrease in census numbers in 2020 but also present a drop in ambulatory infusion numbers shortly following the beginning of the COVID‐19 pandemic quarantine. Abbreviations: MGH, Massachusetts General Hospital; v, versus.

Figure 4

Displaying COVID‐19 test results in relation to the patient's day of admission (x = 0) to Massachusetts General Hospital. Red dots designate a positive test result, and green dots designate a negative test result. Data indicate that admitted patients were testing positive for COVID‐19 prior to admission or on the day of admission, which implies that patients were not acquiring nosocomial COVID‐19 infections. Abbreviation: ID, identification.