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- Some hospitals have started tracking patients who enter the hospital because of COVID-19 separately from people who show up for another medical reason and test positive on screening.
- In New York, 57 percent of coronavirus-positive patients were admitted “for COVID,” while the rest were admitted “with COVID.”
- All coronavirus-positive patients in the hospital pose a risk to healthcare workers and other patients, even if the patient showed up at the hospital for a non-COVID reason.
With the rapid spread of the Omicron variant, many people admitted to the hospital for non-COVID reasons are now testing positive for coronavirus as part of routine screening.
To address this, New York and Massachusetts have started tracking these incidental COVID-19 hospitalizations, as they’re called, separately from patients admitted due to COVID-19 or its complications.
As of Jan. 7, 57 percent of coronavirus-positive patients in New York were admitted “for COVID,” while the rest were admitted “with COVID” (incidental cases).
Healthcare systems in other areas also break down hospitalization data into these two categories.
In Ontario, Canada, 54 percent of coronavirus-positive patients in the hospitals were admitted for COVID-19. However, “for COVID” patients make up 83 percent of ICU patients in the province.
This distinction is intended to better capture the pandemic’s burden on healthcare systems and society.
“Tracking these two types of patients helps us prioritize who can benefit from [certain] treatments in some cases,” said Dr. Tammy Lundstrom, an infectious disease specialist and chief medical officer at Trinity Health. “It will also help us to better understand the true severity of illness and death due to COVID infection.”
Experts caution that because of the need for strict infection-control measures, both groups of patients further strain hospitals at a time when COVID-19 hospitalizations in the United States are at a record high.
COVID-positive patients further strain hospitals
All coronavirus-positive patients in the hospital pose a risk to healthcare workers and other patients, even if the patient showed up at the hospital for a non-COVID reason.
“There are many patients for whom [coronavirus] infection can exacerbate their underlying condition — those with diabetes, cancer, underlying heart or lung disease, for example,” said Lundstrom.
In Ontario, at least 800 people have died from COVID-19 in a hospital outbreak in the province, including people who may have contracted the virus in the hospital, reports the Toronto Star. This report is from September of last year, before the highly contagious Omicron appeared.
In addition, COVID-positive patients may not be able to access mental health care, dialysis, or other services outside the hospital until they are can no longer transmit the virus. These treatment delays can worsen their health.
To help prevent the transmission of the virus in the hospital, both “for COVID” and “with COVID” patients are isolated, said Lundstrom. Staff also need to wear personal protective equipment whenever they are around these patients.
Staff taking care of patients with COVID-19 are also not available to treat patients who do not have the coronavirus.
This can increase hospital staffing issues, said Lundstrom, but “we need to make sure we operate in a way that provides the best possible care without exposing other patients to infection.”
Healthcare systems are under considerable stress due to a surge in COVID-19 patients.
For example, in the United Kingdom, many areas are seeing a sharp rise in both “for COVID” and “with COVID” hospitalizations.
Many hospitals are already understaffed due to workers leaving the profession or isolating themselves at home because they have the coronavirus themselves.
‘For COVID’ and ‘with COVID’ not always clear
While counting the number of patients in the hospital or ICU is straightforward, it is not always easy to determine whether a person is in the hospital “with” or “for” COVID.
Specific COVID-positive hospitalizations are clearly incidental — a person in a car accident or a child who breaks an arm falling off a swing.
However, because the coronavirus can affect multiple organs, including the heart, lungs, kidneys, skin, and brain, as well as cause blood clotting, COVID-19 can show up in many ways.
In a Jan. 4 Twitter thread, Dr. Ashish Jha, dean of the Brown University School of Public Health, gave the example of an 86-year-old man with kidney disease who had COVID-19 with fever and a sore throat.
“Two days of fevers caused him to become dehydrated [and] go into acute kidney failure,” Jha wrote. “His COVID is ‘better’ but he’s in the hospital with kidney failure. Was he admitted for COVID? No. With COVID? Yes.”
While some doctors might classify this patient as an incidental COVID-19 patient, others could argue that the man wouldn’t have had kidney failure if it weren’t for the coronavirus infection.
“Many patients present for a work-up of unusual symptoms, including those related to diarrhea/enteritis or blood clotting/vascular symptoms,” Dr. Howard Forman, a professor in the Yale School of Medicine, wrote on Twitter.
“These [cases] are being called ‘incidental,’ and we just do not know what contribution COVID is making, but it is likely significant,” Forman wrote.
“Some patients are admitted with typical stroke or myocardial infarction [heart attack], and these are almost always called ‘incidental,’ and they may well be,” he continued. “But we have strong evidence to support higher risk for these disorders in patients testing positive for COVID.”
Clarity needed on how to track COVID-19 hospitalizations
Another question is what happens when a coronavirus-positive patient admitted for another medical condition develops COVID-19 or complications from their infection while in the hospital?
Do they get moved from one category to the other? Or should there be a third category for these patients?
Because of the need for clarity, some doctors have called for the Centers for Disease Control and Prevention (CDC) to develop a standard definition of incidental COVID-19 hospitalizations, similar to the agency’s guidelines for other types of health data.
This could help make data released by state and local health departments more accurate and meaningful.
It might also reduce some of the polarization that’s already happening around incidental COVID-19 hospitalizations — with some people using these cases as “evidence” that Omicron is “mild.”
Even though most vaccinated people — and especially those vaccinated and boosted — are well-protected against severe illness caused by Omicron, the unvaccinated are still at risk.
During the current surge, unvaccinated people have a higher risk of hospitalization and death due to COVID-19 than the vaccinated.
“We encourage everyone who is eligible to get vaccinated and boosted, as this is the absolute best way to prevent hospitalization and severe illness,” said Lundstrom. “Masking and physical distancing also add layered protection on top of vaccine boosting.”