Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021–August 2022
Author:
Kojima Noah1ORCID, Adams Katherine1, Self Wesley H2, Gaglani Manjusha3, McNeal Tresa4, Ghamande Shekhar4, Steingrub Jay S5, Shapiro Nathan I6, Duggal Abhijit7, Busse Laurence W8, Prekker Matthew E9, Peltan Ithan D10, Brown Samuel M10, Hager David N11, Ali Harith11, Gong Michelle N12, Mohamed Amira13, Exline Matthew C14, Khan Akram15, Wilson Jennifer G16, Qadir Nida17, Chang Steven Y17, Ginde Adit A18, Withers Cori A18, Mohr Nicholas M19, Mallow Christopher20, Martin Emily T21, Lauring Adam S2223, Johnson Nicholas J24, Casey Jonathan D25, Stubblefield William B26, Gibbs Kevin W27, Kwon Jennie H28, Baughman Adrienne26, Chappell James D29, Hart Kimberly W30, Jones Ian D26, Rhoads Jillian P31, Swan Sydney A30, Womack Kelsey N31, Zhu Yuwei30, Surie Diya32, McMorrow Meredith L32, Patel Manish M1, Tenforde Mark W1, Gaglani Manjusha, McNeal Tresa, Ghamande Shekhar, Calhoun Nicole, Murthy Kempapura, Herrick Judy, McKillop Amanda, Hoffman Eric, Zayed Martha, Smith Michael, Steingrub Jay, Kozikowski Lori-Ann, De Souza Lesley, Ouellette Scott, Shapiro Nathan I, Bolstad Michael, Coviello Brianna, Ciottone Robert, Devilla Arnaldo, Grafals Ana, Higgins Conor, Ottanelli Carlo, Redman Kimberly, Scaffidi Douglas, Weingart Alexander, Surie Diya, McMorrow Meredith, DeCuir Jennifer, Thornburg Natalie, Flannery Brendan, Lewis Nathaniel, Tenforde Mark, Adams Katherine, Patel Manish, Mehkri Omar, Mitchell Megan, Griffith Zachary, Brennan Connery, Ashok Kiran, Poynter Bryan, Duggal Abhijit, Busse Laurence, ten Lohuis Caitlin, Stanley Nicholas, Zhang Sophia, Prekker Matthew, Erickson Heidi, Frosch Anne, Hendrickson Audrey, Caspers Sean, Tordsen Walker, Kaus Olivia, Scharber Tyler, Peltan Ithan, Brown Samuel, Lumpkin Jenna, Smith Cassie, Marshall Hunter, Hager David N, Ali Harith, Rothman Richard E, Gong Michelle, Mohamed Amira, Nair Rahul, Chen Jen-Ting (Tina), Exline Matthew, Karow Sarah, Robart Emily, Maldonado Paulo Nunes, Khan Maryiam, So Preston, So Madison, Schwartz Elizabeth, Botros Mena, Khan Akram, Hough Catherine L, Jung Haeun, Martinez Jesus, Luong Andrea, Huynh Bao, Ibrahim Habiba, Villanueva-Vargas Cynthia, Villanueva-Vargas Juliana, Quadri Suha, Wilson Jennifer G, Gordon Alexandra June, Perez Cynthia, Lau Lily, Bekiroglu Ismail Hakki, Qadir Nida, Chang Steven, Frankel Trevor, Garner Omai, Chandrasekaran Sukantha, Ginde Adit, Douin David, Jensen Kelly, Huynh David, Steinwand Aimee, Withers Cori, Mohr Nicholas, Zepeski Anne, Nassar Paul, Landers Shannon, Nielsen Karin, Briggs Noble, Fairfield Cathy, Mallow Chris, Rivas Carolina, Martin Emily, Monto Arnold, Lauring Adam, McSpadden E J, Truscon Rachel, Kaniclides Anne, Thomas Lara, Bielak Ramsay, Valvano Weronika Damek, Fong Rebecca, Fitzsimmons William J, Blair Christopher, Gilbert Julie, Baker Leigh, Johnson Nicholas, Srinivasan Vasisht, Crider Christine D, Steinbock Kyle A, Paulsen Thomas C, Anderson Layla A, Self Wesley H, Talbot H Keipp, Grijalva Carlos, Jones Ian, Halasa Natasha, Chappell James, Womack Kelsey, Rhoads Jillian, Baughman Adrienne, Kampe Christy, Johnson Jakea, Hart Kim, Rice Todd, Casey Jonathan, Stubblefield William B, Zhu Yuwei, Short Laura L, Ezzell Lauren J, Whitsett Margaret E, McHenry Rendie E, Hargrave Samarian J, Blair Marcia, Luther Jennifer L, Pulido Claudia Guevara, Peterson Bryan P M, Files D Clark, Gibbs Kevin, LaRose Mary, Landreth Leigha, Hicks Madeline, Parks Lisa, Babcock Hilary, Kwon Jennie, Bongu Jahnavi, McDonald David, Cass Candice, Seiler Sondra, Park David, Hink Tiffany, Wallace Meghan, Burnham Carey-Ann, Arter Olivia G,
Affiliation:
1. Influenza Division, Centers for Disease Control and Prevention , Atlanta , Georgia , USA 2. Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee , USA 3. Department of Pediatrics, Baylor Scott & White Health and Texas A&M University College of Medicine , Temple and Dallas, Texas , USA 4. Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine , Temple, Texas , USA 5. Department of Medicine, Baystate Medical Center , Springfield, Massachusetts , USA 6. Department of Emergency Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA 7. Department of Medicine, Cleveland Clinic , Cleveland, Ohio , USA 8. Department of Medicine, Emory University , Atlanta, Georgia , USA 9. Department of Emergency Medicine and Medicine, Hennepin County Medical Center , Minneapolis, Minnesota , USA 10. Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah , Salt Lake City, Utah , USA 11. Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA 12. Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine , Bronx, New York , USA 13. Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine , Bronx, New York , USA 14. Department of Medicine, The Ohio State University , Columbus, Ohio , USA 15. Department of Medicine, Oregon Health and Sciences University , Portland, Oregon , USA 16. Department of Emergency Medicine, Stanford University School of Medicine , Stanford, California , USA 17. Department of Medicine, University of California-Los Angeles , Los Angeles, California , USA 18. Department of Emergency Medicine, University of Colorado School of Medicine , Aurora, Colorado , USA 19. Department of Emergency Medicine, University of Iowa , Iowa City, Iowa , USA 20. Department of Medicine, University of Miami , Miami, Florida , USA 21. School of Public Health, University of Michigan , Ann Arbor, Michigan , USA 22. Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan , USA 23. Department of Microbiology and Immunology, University of Michigan , Ann Arbor, Michigan , USA 24. Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington , USA 25. Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee , USA 26. Department of Emergency Medicine, Vanderbilt University Medical Center , Nashville, Tennessee , USA 27. Department of Medicine, Wake Forest School of Medicine , Winston-Salem, North Carolina , USA 28. Department of Medicine, Washington University , St. Louis, Missouri , USA 29. Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee , USA 30. Department of Biostatistics, Vanderbilt University Medical Center , Nashville, Tennessee , USA 31. Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee , USA 32. Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
Abstract
Abstract
Introduction
Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies.
Methods
Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed.
Results
Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47–72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar–Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun–Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9–122.0) to 11.5 mg/L (2.7–42.8) and 3.1 mcg/mL (0.8–640.0) to 1.0 mcg/mL (0.5–2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period.
Conclusions
Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.
Funder
US Centers Disease Control and Prevention National Center for Advancing Translational Sciences National Institutes of Health
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
Cited by
21 articles.
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