Where people go wrong with 'incidental' COVID-19 hospitalizations

The current state of the COVID-19 pandemic in the U.S. in many ways differs from earlier surges, with breakthrough infections now a norm and not the exception. 

With that has come a rise in what health experts call incidental COVID-19 hospitalizations, referring to patients who are primarily admitted for other ailments and test positive as part of routine screening. New York and Massachusetts have recently shifted their reporting on COVID-19 hospitalizations, asking hospitals to distinguish between those who are admitted primarily because of the virus and incidental cases. About 42 percent of COVID-19 positive patients across New York hospitals as of Jan. 8 did not have COVID-19 included as reason for admission, according to state data

And while some may dismiss all incidental COVID-19 hospitalizations as a mere coincidence that surfaces when patients seek care for other ailments, and thus inconsequential relative to the 'real' COVID-19 hospitalization tally, health providers say that line of thinking is too simplistic. 

First, COVID-19 is a multisystem infection with variable presentation that can complicate care and worsen existing conditions, whether it's the primary reason for hospital admission or not. In a series of Jan. 4 tweets, Ashish Jha, MD, dean of the Brown University School of Public Health in Providence, R.I., broke down a scenario involving an 86-year-old patient with kidney disease. 

"This 86 year-old had COVID a week ago with two days of fevers, sore throat," Dr. Jha wrote. "Two days of fever caused him to become dehydrated, go into acute kidney failure. His COVID is 'better' but he's in the hospital with kidney failure. Was he admitted for COVID? No. With COVID? Yes." 

Additionally, all COVID-19-positive patients are isolated, and isolation rooms "are not plentiful," Dr. Jha said. Treating patients who incidentally tested positive for the virus can place the same demands on the system as a patient who was admitted primarily for the virus. For example, entering the room of any infected patient commands the same supply of personal protective equipment, he said. 

Across NewYork-Presbyterian hospitals, there are approximately 1,200 COVID-19-positive patients, Rahul Sharma, MD, emergency physician-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center in New York City, said during a Jan. 10 news conference. About 50 percent of patients were primarily admitted for treatment of their virus symptoms, such as difficulty breathing and pneumonia. The other half include patients primarily hospitalized for heart attack, stroke, abdominal pain and other infections who incidentally test positive. 

While the conversation on primary versus incidental COVID-19 hospitalizations is important to shed light on the overall state of the pandemic and disease severity, the distinction only goes so far, especially in the context of hospital capacity and labor shortages. For example, NewYork-Presbyterian is not challenged by COVID-19 alone, Dr. Sharma said: Its emergency departments are seeing prepandemic volumes — as opposed to the surge in 2020, when volume fell nearly 50 percent — and current staffing shortages are much more pronounced than earlier surges. 


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