A Tale of Two Surges: Differences in Outcomes in the COVID-19 Pandemic in a Community Teaching Hospital in Massachusetts

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has challenged the scientific community in the prompt implementation of therapies. We report and contrast characteristics and outcomes from two COVID-19 surges in March 2020 and December 2020 in patients at MetroWest Medical Center in Framingham. Methods The study was conducted at MetroWest Medical Center. We extracted the data of 315 patients from March 17, 2020, to June 30, 2020, and 104 patients from November 19, 2020, to December 30, 2020. All patients were inpatients and had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by polymerase chain reaction (PCR). We extracted the patient's demographic information, clinical data, and given treatments. We also examined comorbidities and categorized them by the Charlson Comorbidity Index (CCI). The primary endpoints were intensive care unit (ICU) level of care, mechanical ventilation, or death. Results A total of 419 patients were studied. The median age was 76. During the first surge (S1), 150 (47%) were from nursing homes and 133 (42%) were from independent living. More than half (72) of the independent living patients had a primary language other than English. During the second surge (S2), 12% (13) were from nursing homes. The most common comorbidities were similar for both groups and included obesity, diabetes, and chronic lung disease. However, during the first surge, 33% (104) of the patients had dementia. The median Charlson Comorbidity Index score was worse in the first surge; the predicted 10-year survival was 21% versus 53%. The treatments given included remdesivir in 5% (16) in the first surge versus 60% (62) in the second surge. Dexamethasone was given only in the second surge in 69% (72) of the patients. Outcomes The reported outcomes are contrasted by the first versus the second surge. Admission to the intensive care unit was required in 83 (27%) of the patients during the first surge versus 15 (14%) of the patients during the second surge. Mechanical ventilation was required in 33 (11%) of the patients during the first surge versus 5 (11%) of the patients during the second surge. The overall mortality was 25% during the first surge (79) versus 9% (9) during the second surge. Conclusion Among patients with COVID-19 infection admitted to a community teaching hospital during the second Massachusetts surge, there was a significant improvement in clinical outcomes, particularly mortality, compared with patients admitted during the early pandemic. It is tempting to attribute the improved outcomes to the implementation of treatment with corticosteroids and more use of antiviral therapy. However, the patients admitted during the larger first surge were more likely to have a do not resuscitate (DNR) status on admission, be from a nursing home, have dementia, and have poorer predicted survival.

Keywords: covid-19; covid-19 cases; covid-19 mortality; infectious disease medicine; retrospective research.

Figure 1. Outcomes by Charlson Comorbidity Index in patients with COVID-19