Appreciated the opportunity to comment on 2 excellent cohort studies led by @jLewnard (Kaiser) and @leorahorwitzmd (NYU) in @bmj_latest that give us a much better understanding of who gets sick from #COVID19. A thread putting this work into perspective👇
bmj.com/content/369/bm…
bmj.com/content/369/bm…
2/ Take away #1: It's not just the elderly who get sick.
Most who were hospitalized for #COVID19 were *under* the age of 65:
- 53% (n=1,452) in NYU cohort
- 60% (n=1,108) in Kaiser
Most who were hospitalized for #COVID19 were *under* the age of 65:
- 53% (n=1,452) in NYU cohort
- 60% (n=1,108) in Kaiser
3/ Take away #2: Those who were hospitalized spent 1-2 weeks in hospital. A trip to the hospital is no joke.
Median length of stay (75th percentile)
- NYU cohort: 7 days (13 days)
- Kaiser cohort: 10 days (17 days)
Median length of stay (75th percentile)
- NYU cohort: 7 days (13 days)
- Kaiser cohort: 10 days (17 days)
4/ Take away #3: A high proportion of #covid19 patients admitted to the hospital developed critical illness (life-support on a ventilator, ICU care, death, or discharge to hospice):
- NYU cohort: 36% (n=990)
- Kaiser cohort: 41% (n=749)
That's a lot of ICU admissions/beds
- NYU cohort: 36% (n=990)
- Kaiser cohort: 41% (n=749)
That's a lot of ICU admissions/beds
5/ Take away #4: Similar to prior studies, there are consistent patient characteristics that are more common in those who are high risk from #covid19 (hospitalization, critical illness, or death):
- Older age
- Male
- Obesity
- History of heart failure
- Older age
- Male
- Obesity
- History of heart failure
6/ The Kaiser cohort study presents a striking visualization showing that even after adjusting for key patient characteristics, men had worse outcomes than women in every age group.
Fellas, #WearAMask. Trust me, you do not want to roll the dice. (Ladies too)
Fellas, #WearAMask. Trust me, you do not want to roll the dice. (Ladies too)
7/ Take away #5: compelling evidence is provided in the NYU study on predictors of critical illness:
- elevated inflammatory markers, in particular: elevated d-dimer, c-reactive protein, troponin
- O2 sat <92% (speaks to potential value of walk tests in ED and home monitoring)
- elevated inflammatory markers, in particular: elevated d-dimer, c-reactive protein, troponin
- O2 sat <92% (speaks to potential value of walk tests in ED and home monitoring)
8/ Take away #6: decreased transmission rates were found in the Kaiser insured population corresponding to the time when social distancing policies were enacted:
- March 1 - infected patient transmitted to 1.3-2.5 others
- April 1 - infected patient transmitted to 0.8-0.9 others
- March 1 - infected patient transmitted to 1.3-2.5 others
- April 1 - infected patient transmitted to 0.8-0.9 others
9/ Most intrigued by decreasing mortality over time in NYU cohort. Potential reasons worth looking into:
- hospital capacity strain improved
- changes in care (e.g. proning or better ventilator management)
- changes in meds (e.g. more anticoagulation, less hydroxycholoroquine?)
- hospital capacity strain improved
- changes in care (e.g. proning or better ventilator management)
- changes in meds (e.g. more anticoagulation, less hydroxycholoroquine?)
10/ To wrap up, why are these #covid19 hospitalization studies important? Because for every person that succumbs to this terrible illness, four more will fight for days in the hospital. It's not just about risk of death. See prior thread:
11/ Want to thank lead author/rising super star @georgeanesi for helping to lead the writing of this editorial and our mentor @ScottHalpernMD for polishing. George is leading really interesting work in acute care outcomes research. Great person to follow
