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. 2023 Aug 22;77(4):547-557.
doi: 10.1093/cid/ciad276.

Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021-August 2022

Collaborators, Affiliations

Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021-August 2022

Noah Kojima et al. Clin Infect Dis. .

Abstract

Introduction: Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies.

Methods: Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed.

Results: Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period.

Conclusions: Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.

Keywords: COVID-19; SARS-CoV-2; death; hospitalization; severe disease.

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Conflict of interest statement

Potential conflicts of interest. J. C. reports grants from the National Institutes of Health (NIH) and Department of Defense (DoD), outside the submitted work. J. C. reports receiving grants from the NIH, DoD, outside the submitted work. A. D, reports grants from the NIH and National Heart, Lung, and Blood Institute (NHLBI) for the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) platform and Prevention and Early Treatment of Acute Lung Injury (PETAL) network respectively, as well as consulting fees for Alung Technologies, outside the submitted work. S. C. reports receiving consulting fees from PureTech Health and Kiniksa Pharmaceuticals and participating as a Data and Safety Monitoring Board (DSMB) member for a neuromodulation study at University of California, Los Angeles, outside the submitted work. M. E. reports grants from NIH and Regeneron, personal funds for speaking at the ASPEN conference for Abbott Labs, and payment for testimony from Medical Legal Expert Witness, outside the submitted work. M. G. reports receiving grants from CDC, CDC-Abt Associates, CDC-Westat, and Janssen, and served as co-chair of the Infectious Diseases and Immunization Committee for the Texas Pediatric Society, outside the submitted work. K. G. reports grants from NIH and DoD, outside the submitted work. A. G. reports receiving grants from NIH, DoD, AbbVie, and Faron Pharmaceuticals, outside the submitted work. M. N. G. reports grants from NHLBI, CDC, Agency for Healthcare Research and Quality (AHRQ), speaking at medicine grand rounds at New York Medical College, travel support for the American Thoracic Society (ATS) executive meeting and serving as ATS Chair Critical Care Assembly, DSMB membership fees from Regeneron, and participating on the scientific advisory panel for Endpoint, outside the submitted work. D. H. reports receiving grants from NHLBI, outside the submitted work. A. K. reports receiving grants from United Therapeutics, Johnson & Johnson, 4D Medical, Eli Lily, Dompe Pharmaceuticals, and GlaxoSmithKline; and serves on the guidelines committee for Chest, outside the submitted work. J. K. reports a grant from NIH, outside the submitted work A. L. reports receiving grants from CDC, National Institute of Allergy and Infectious Diseases (NIAID), and Burroughs Wellcome Fund, Michigan Department of Health and Human Services, Flu Lab, and consulting fees from Sanofi and Roche for consulting on oseltamivir and baloxavir respectively, outside the submitted work. E. M. reports grants from Flu Lab, Merck, and NIH outside the submitted work. T. N. reports receiving a grant from CDC, receiving a one-time payment for participating as a virtual webinar panelist for Clinical Updates in Heart Failure, and being a Practice Management Committee member for Society of Hospital Medicine, outside the submitted work. I. D, P. reports grants from NIH/NHLBI, Janssen Pharmaceuticals and institutional support from Regeneron, outside the submitted work. J. S. reports a grant from NHLBI, outside the submitted work. W. B. S, reports grants from NIH/NHLBI, outside the submitted work. J. W. reports a grant from NIH/NHLBI, payment for the American College of Emergency Physicians speaker honorarium and participating on the American Board of Internal Medicine Critical Care Exam Committee, outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
(A) Age group of hospitalized adults with acute COVID-19 by week and predominant SARS-CoV-2 variant period—IVY Network, United States, 11 March 2021–31 August 2022. (B) Number of categories of underlying medical conditions among hospitalized adults with acute COVID-19 by week and by predominant SARS-CoV-2 variant period. Categories of medical conditions included autoimmune, cardiovascular, endocrine, gastrointestinal, hematologic, kidney, neurologic, and pulmonary diseases. (C) Vaccination status of hospitalized adults with acute COVID-19 by week and by predominant SARS-CoV-2 variant period. (D) Highest level of supplemental oxygen received among hospitalized adults with acute COVID-19 by week and predominant SARS-CoV-2 variant period. (E) Patient status (dead, still hospitalized, or discharged from the hospital) 28 days following hospital admission among hospitalized adults with acute COVID-19 by week and predominant SARS-CoV-2 variant period. Abbreviations: COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; HFNC, high flow nasal cannula; IMV. invasive mechanical ventilation; NIPPV, non-invasive positive pressure ventilation; O2, oxygen; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 1.
Figure 1.
(A) Age group of hospitalized adults with acute COVID-19 by week and predominant SARS-CoV-2 variant period—IVY Network, United States, 11 March 2021–31 August 2022. (B) Number of categories of underlying medical conditions among hospitalized adults with acute COVID-19 by week and by predominant SARS-CoV-2 variant period. Categories of medical conditions included autoimmune, cardiovascular, endocrine, gastrointestinal, hematologic, kidney, neurologic, and pulmonary diseases. (C) Vaccination status of hospitalized adults with acute COVID-19 by week and by predominant SARS-CoV-2 variant period. (D) Highest level of supplemental oxygen received among hospitalized adults with acute COVID-19 by week and predominant SARS-CoV-2 variant period. (E) Patient status (dead, still hospitalized, or discharged from the hospital) 28 days following hospital admission among hospitalized adults with acute COVID-19 by week and predominant SARS-CoV-2 variant period. Abbreviations: COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; HFNC, high flow nasal cannula; IMV. invasive mechanical ventilation; NIPPV, non-invasive positive pressure ventilation; O2, oxygen; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Comment in

References

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