Clinical Trends Among U.S. Adults Hospitalized with COVID-19, March-December 2020

Garg, MD; MPH, S.; Patel, MPH; K., Pham; MPH, H.; Daily Kirley, MPH; P., Kawasaki; MPH, B.; Yousey-Hindes, MPH; K., Anderson; MD, E. J.; Weigel, MSW; A., Ryan; MS, P. A.; Reeg, MPH; L., Como-Sabetti; MPH, K.; Shrum Davis, MPH; S., Muse; MPH, A.; Bennett, MD; MS, N. M.; Billing, MPH; L., Sutton; MD, MPH; M., Talbot; MD, H. K.; Hill, MPH; M., Wortham; MD, J.; Kim, MD; L., Havers; MD, MHS; F., COVID-NET Surveillance Team

Background: The COVID-19 pandemic has caused substantial morbidity and mortality. Objectives: To describe monthly demographic and clinical trends among adults hospitalized with COVID-19 Design: Pooled cross-sectional Setting: 99 counties within 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) Patients: U.S. adults (aged [≥]18 years) hospitalized with laboratory-confirmed COVID-19 during March 1-December 31, 2020 Measurements: Monthly trends in weighted percentages of interventions and outcomes including length of stay (LOS), intensive care unit admissions (ICU), invasive mechanical ventilation (IMV), vasopressor use and in-hospital death (death). Monthly hospitalization, ICU and death rates per 100,000 population. Results: Among 116,743 hospitalized adults, median age was 62 years. Among 18,508 sampled adults, median LOS decreased from 6.4 (March) to 4.6 days (December). Remdesivir and systemic corticosteroid use increased from 2% and 19% (March) to 54% and 74% (December), respectively. Frequency of ICU decreased from 38% (March) to 21% (December). IMV (28% to 9%), vasopressors (23% to 9%) and deaths (14% to 9%) decreased from March to October; however, percentages of these interventions and outcomes leveled out or increased in November and December. Percentage of deaths significantly decreased over time for non-Hispanic White patients (p-value <0.01) but not non-Hispanic Black or Hispanic patients. Rates of hospitalization (105.3 per 100,000), ICU (20.2) and death (11.7) were highest during December. Limitations: COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country. Conclusions: After initial improvement during April-October 2020, trends in interventions and outcomes worsened during November-December, corresponding with the 3rd peak of the U.S. pandemic. These data provide a longitudinal assessment of trends in COVID-19-associated outcomes prior to widespread COVID-19 vaccine implementation.