Risk factors predict who will be hospitalized for COVID-19

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Hospitals may not know how many COVID-19 patients they will treat during the next month’s pandemic wave in Minnesota, but they are starting to have a better idea of ​​who will end up in bed.

Although COVID-19 remains a random or understandable aspect – and why it causes no symptoms in some people, but sends others gasping in hospitals – the latest state and federal data show some clear risk factors.

Hypertension and obesity – the same plagues that fuel diabetes and heart disease in Minnesota in the past two decades – have each been identified in at least half of all COVID-19 inpatients, according to COVID-NET , a federal tracking site that receives hospitalization data from Minnesota and a dozen other states.

Labored breathing and low blood oxygen levels are what usually prompts doctors to admit COVID-19 patients, but these patients rarely have any other health problems, said specialist Dr. Aaron Rutzick from Hennepin Healthcare which treats COVID-19 patients and assesses their needs. for hospital care.

The connection can be as simple as an infection that makes a patient sicker, he added. “Your body just has other medical conditions that it works on. Then you throw this other element at it. “

The state reported 16,372 laboratory-confirmed COVID-19 cases and 731 deaths on Monday, which marked the end of a statewide 51-day residence order. The number of patients requiring hospital care on Monday was 488, including 229 requiring intensive care.

While the number of hospital patients in the state has remained virtually unchanged over the past week, health officials expect more transmission of the disease after the end of the home stay order and a consequent increase in cases.

Modeling from the University of Minnesota and public health researchers has suggested that almost two months of reduced contact under the home stay order has made a difference. Face-to-face contact and opportunities for disease transmission have been reduced by 55%, although initial forecasts suggest a greater reduction by 80%.

Nevertheless, modeling a scenario similar to Minnesota’s current strategy predicted a peak in just over a month of 3,397 patients requiring intensive care beds with ventilators, which are required for COVID-19 cases who cause severe respiratory symptoms and difficulty breathing. The state’s preparation website lists a total capacity of 3,696 fans in Minnesota – but 858 on deferred order.

State health officials have said they will be monitoring hospital admissions closely and that the best way to maintain bed capacity is to continue to take steps to reduce the spread of the virus.

The final state direction is to avoid gatherings outside immediate households of 10 or more people, to wear cloth masks or bandanas when possible, and to maintain a social distance of 6 feet or more of the others.

Although there are no separate recommendations for people with underlying health conditions, they should be especially aware of these safety measures recommended by the state health commissioner and their high risks hospitalization, said Kris Ehresmann, state director of infectious disease.

“These are all things that need to be taken into account because people hear the social distance commissioner’s exhortation, to wear masks, to do all the things we have advised,” said Ehresmann. “A large part of our population falls into the risk category. “

Statewide, 2,128 COVID-19 patients were hospitalized. To date, the state has examined 1,104 COVID-19 patients, primarily those in the metropolitan area of ​​the seven twin cities whose overall hospital results are part of the federal COVID-NET program.

The median body mass index for these patients was 30, the lower threshold for obesity. About 48% suffered from diabetes or other metabolic diseases; 39% had asthma or other lung diseases; and 33% had hypertension – the technical term for high blood pressure.

Cardiovascular problems have been discovered in 43% of hospital patients and are of particular concern for COVID-19, which tends to cause blood clots that can cause stroke or other problems.

Doctors have become aggressive enough to admit and prescribe blood thinners for many patients with COVID-19 to combat these risks of clots, said Dr. Andrew Olson of M Health Fairview.

There are still many unknowns about COVID-19 and why it strikes similar patients in different ways, he added: “Why some people with … hypertension don’t end up in the hospital and others do ? I don’t think we know it yet. ”

Admissions vary by breed; blacks make up 23% of hospital admissions, but only 6% of the population of Minnesota. While rates of chronic disease are higher in this minority group in Minnesota, Olson said there are likely social and economic disparities that predispose black people in Minnesota to worsen COVID-19.

Deaths from COVID-19 were more common in the elderly. The median age of death is 83 years compared to the median age of hospitalization, which is only 61 years.

Of the reviewed COVID-19 cases with hospitalizations terminated, 85% were discharged alive and 15% died. The mortality rate was much higher, at 53%, when examining the results of 152 patients who were intubated due to respiratory failure and placed on ventilators or heart-lung bypass machines.

Sometimes patients with COVID-19 who have other conditions are admitted because they already have worse respiratory symptoms when they seek medical care, said Dr. Chris Kapsner, medical director of emergency care at Abbott Northwestern Hospital in Minneapolis.

Other times, doctors are simply trying to predict which patients are more likely to hit the “brick wall” that seems to come with COVID-19 when their health breaks down, he added. “We are committed to predicting the future, and so if you have high blood pressure, heart disease, you are 55 and a man, your prognosis is worse than a 50 year old woman with no health problems.”

Hospital resources have improved in the past three weeks, particularly in terms of personal protective equipment which reduces the threat of virus infection to doctors, nurses and other caregivers.

On Monday morning, the state’s pandemic response page lists a stock of 1.2 million N95 masks that are installed and offer more protection than standard surgical masks – as well as 2.6 million scheduled for delivery. Three weeks ago, the site listed only 478,000 masks of this type, including 1.6 million awaiting delivery.

Kapsner said that decision-making on who to place in a hospital today may change in a month when the space in the bed tightens and the masks and fans shrink.

COVID-19 patient outcome studies will help guide decisions at this time. Allina Health is developing a COVID-19 home care strategy for patients who can avoid hospitalization with appropriate home monitoring and treatment.

“Let’s say the hospitals are full, there is no room,” he said. “What we could admit today, we will send tomorrow. “

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