5,800+ patient deaths tied to hospital overcrowding during COVID-19 surges, study suggests


COVID-19 case surges at the most-strained hospitals in spring and summer 2020 may have led to nearly 6,000 inpatient deaths, according to research published July 6 in the Annals of Internal Medicine.

Using a national database, researchers from the National Institutes of Health Clinical Center  evaluated whether there was a link between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk. The study included 144,116 adult COVID-19 inpatients at 558 U.S. hospitals who were admitted from March to August 2020. A total of 35,883 (24.9 percent) of patients were admitted to an intensive care unit, 19,583 (13.6 percent) required ventilation, and 25,344 (17.6 percent) died. Death rates decreased over time across all surge index levels. 

Of the total number of patients, 78,144 (54.2 percent) were admitted to hospitals in the top surge index decile, with hospital overcrowding potentially linked to 5,868 (23.2 percent) of inpatient COVID-19 deaths, findings showed. 

Researchers considered hospitals without surges as those under the 50th surge index percentile. The risk-adjusted odds ratio for COVID-19 death for hospitals in the 50th to 75th percentile was 1.11, compared to those not experiencing surges. As the percentiles rose, so did the adjusted risk, reaching 2.00 for hospitals in the top percentile. 

Overall, the association was stronger in June to August compared to March to May. In April, the Northeast saw the highest number of hospitals overwhelmed with COVID-19 surges, and in July, many hospitals in the South and West experienced overcrowding. 

"Despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remained detrimental to survival and potentially eroded benefits gained from emerging treatments," researchers said. "Bolstering preventive measures and supporting surging hospitals will save many lives." 

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