Author: Joseph A Lewnard; Vincent X Liu; Michael L Jackson; Mark A Schmidt; Britta L Jewell; Jean P Flores; Chris Jentz; Graham R Northrup; Ayesha Mahmud; Arthur L Reingold; Maya Petersen; Nicholas P Jewell; Scott Young; Jim Bellows
Title: Incidence, clinical outcomes, and transmission dynamics of hospitalized 2019 coronavirus disease among 9,596,321 individuals residing in California and Washington, United States: a prospective cohort study Document date: 2020_4_16
ID: f8yixsds_39
Snippet: Our study has limitations. For this sample of 1277 hospitalized patients, we did not conduct a detailed review of medical records. As such, we do not address presenting characteristics of hospitalized patients and their association with demographic characteristics, length of hospital stay, or clinical outcome. Limited availability of laboratory testing in early phases of the US outbreak may have hindered ascertainment of sporadic cases in January.....
Document: Our study has limitations. For this sample of 1277 hospitalized patients, we did not conduct a detailed review of medical records. As such, we do not address presenting characteristics of hospitalized patients and their association with demographic characteristics, length of hospital stay, or clinical outcome. Limited availability of laboratory testing in early phases of the US outbreak may have hindered ascertainment of sporadic cases in January and early February, 2020; because all persons under investigation for COVID-19 may not have received testing, our estimates of disease incidence should be interpreted as lower bounds. Near real-time hospitalization data may be missing for a modest subset of cases admitted to hospitals not owned by Kaiser Permanente, which would result in lagged reporting. In estimating transmission dynamics and cumulative infections, we relied on data from other settings to infer COVID-19 natural history parameters including the proportion of symptomatic infections requiring hospitalization, the serial interval, and the time from infection to hospitalization. Increases in the proportion of cases ascertained at later phases of the outbreak would be expected to increase RE estimates over time, contrary to the trend we observed. Last, our estimation of RE required an assumption that the KPNC, KPSC, and KPWA cohorts transmit among each other (or among epidemiologically similar individuals residing in the same areas). Within these regions, individuals receiving healthcare from KP health plans may be wealthier than those without commercial insurance. Economic security and employment type may impact individuals' ability to comply with stay-at-home orders, 29 meaning our estimates of transmission dynamics may not describe circumstances for other populations, including socioeconomically vulnerable groups. Despite this limitation, our use of data on hospitalized cases in a prospectively-followed cohort, receiving care within a unified healthcare delivery system, overcomes inconsistencies affecting RE estimates from syndromic surveillance of milder COVID-19 cases across care providers and jurisdictions. 30
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