Non-COVID post-hospital deaths highlight pandemic consequences
While Medicare beneficiary hospitalizations for non–COVID-19 diagnoses fell sharply in March and April 2020 and stayed low through September 2021, death rates after hospitalization rose substantially—particularly for Black and Hispanic patients, finds a study yesterday in JAMA Network Open.
University of Texas and Johns Hopkins researchers analyzed claims data from 8,448,758 Medicare admissions to 4,626 US hospitals for non-COVID indications from January 2019 through September 2021. Average patient age was 73.7 years.
A multilevel logistic regression analysis showed that the death rate in the 30 days after hospitalization rose from 9.4% in 2019 to 11.5% from Apr 1, 2020, to Mar 31, 2021 (odds ratio [OR], 1.20).
The higher death rate, which held throughout the first 18 months of the pandemic, varied by race (ORs, 1.27 for Black, 1.25 for Hispanic, and 1.18 for White participants), Medicaid eligibility (OR, 1.25 for Medicaid-eligible vs 1.18 for noneligible patients), and hospital quality score (1 to 5 stars, with 1 being the worst) (OR, 1.27 for 1 star vs 1.11 for 5 stars).
Greater increases in the odds of death from the prepandemic to pandemic periods were associated with greater hospital COVID-19 prevalence. For example, when comparing deaths in October through December 2020 with those in the same period in 2019, the OR was 1.44 for hospitals in the top quartile of COVID admissions vs 1.19 for admissions to those in the lowest.
"The prolonged elevation in mortality rates after hospital admission in 2020 and 2021 for non–SARS-CoV-2 diagnoses contrasts with reports of improvement in hospital mortality during 2020 for SARS-CoV-2," the study authors wrote. "The results of this cohort study suggest that, with the continued impact of SARS-CoV-2, it is important to implement interventions to improve access to high-quality hospital care for those with non–SARS-CoV-2 diseases."
In a related commentary, Laura Myers, MD, MPH, and Vincent Liu, MD, both of Kaiser Permanente Northern California, said the findings underscore the far-reaching consequences of COVID-related strain on hospitals.
"Prior work has shown that during periods of high hospital strain, borderline patients with common illnesses like sepsis and acute respiratory failure are far less likely to be admitted to the intensive care unit compared with periods of low strain," they wrote.
Mar 9 JAMA Netw Open study and commentary
Study: Booster mRNA doses offer good protection against severe Omicron
The New England Journal of Medicine (NEJM) has published a study from Qatar showing good protection of mRNA booster vaccines against Omicron variant infection but much better protection against severe Omicron disease and the Delta variant.
Researchers compared vaccine effectiveness of standard two doses against symptomatic SARS-CoV-2 infection and COVID-19–related hospitalization and deaths from Dec 19, 2021, through Jan 26, 2022, with that of the standard series and a booster. The time period covered the Omicron surge.
A total of 2,239,193 people, all vaccinated with either the Pfizer/BioNTech or Moderna vaccine series, were included in the study. Among those who also had a Pfizer booster dose, protection against symptomatic infection caused by the Omicron variant was 49.4% (95% confidence interval [CI], 47.1% to 51.6%). The Pfizer boosters were 76.5% (95% CI, 55.9% to 87.5%) protective against hospitalizations and death.
Pfizer booster effectiveness against symptomatic infection with the Delta variant, compared with the primary series, was 86.1% (95% CI, 67.3% to 94.1%). Moderna booster effectiveness against symptomatic Omicron infection, compared with the primary series, was 47.3% (95% CI, 40.7% to 53.3%).
"Cases of severe Covid-19 were rare in both the booster and nonbooster cohorts despite the large number of infections. These findings affirm the durability of vaccine protection against hospitalization and death several months after receipt of the second dose," the authors concluded.
Mar 9 NEJM study