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Late last month, Vice President Mike Pence sending a letter to the administrators of 6,000 state hospitals asking for help.
He asked them to fill out forms every day with data on patients they had treated with COVID-19, a disease caused by the new corona virus, and submit it to the Centers for Disease Control and Prevention.
“These data will help us better understand disease patterns and develop policies for the prevention and control of health problems associated with COVID-19,” Pence wrote.
Now, as COVID-19 approaches the peak in several parts of the country, it is unclear how many hospitals have sent the requested information. For its part, the CDC has not released data publicly, only saying that it plans to do it soon.
The response of the US health care system to coronavirus has exposed many blind spots: the inability to quickly make tests widely used, the lack of personal protective equipment for frontline doctors and nurses, and the lack of basic data about hospitalization. to help make decisions based on information.
“We are in a fog because we have very little reliable data,” Dr. Ashish Jha, director of the Harvard Global Health Institute, who have studied hospital capacity.
Having real-time data about hospitalization across the country will do two things. First, it will provide a window into the spread of the corona virus, even though it is one week or older because the time needed for infected patients is sick enough to be hospitalized. Second, this will allow federal and state officials to identify hot spots that require more equipment and staffing and to divert resources from one area to another.
“You want to avoid what is happening in Italy and Spain, where you first find out that you have a COVID epidemic when the ICU is filling up,” Dr. Peter Hotez, co-director of the Vaccine Development Center at Texas Children’s Hospital and Dean. from the National School of Tropical Medicine at Baylor College of Medicine in Houston. “Sounds like in some parts [United States], it happens because testing never increases rapidly.
“The main reason you do the testing is to overcome it.”
On Wednesday, most states released some information about patients being hospitalized for COVID-19, according to the COVID Tracking Project, which running a website which calculates the main metrics of the national response to viruses. But two states with a high number of cases – Michigan and Texas – don’t do it every day. Among those who released data, the information was inconsistent. Some report information on hospitalization now, which offers a window into whether the hospital can handle the burden, while others report information on cumulative hospitalization, which provides an overview of victims of ongoing disease.
What We Know About COVID-19 Toll
What we are learning, experts say, is that COVID-19 seems to affect some parts of the United States, especially New York, in the same way as in Wuhan, China. Data from China shows that around one in five patients hospitalized with COVID-19 dies. Preliminary data in the United States shows that far fewer infected people who are hospitalized will die, but that does not survive because more data is reported. Partly because patients seriously ill with COVID-19 often spend days in intensive care before dying.
Until Wednesday night, 80,204 people have confirmed COVID-19 cases in New York City. Of those, 20,474, or nearly 26%, require hospitalization at some point. All told, 4,260 died, more than 5% of those who tested positive.
Other cities and regions have not reported the data in the same way, so it is difficult to make comparisons. In California, for example, 2,714 patients with COVID-19 were hospitalized on Wednesday, where 1,154 were in the ICU, more than 42%. Another 3,078 people suspected of having COVID-19 were also hospitalized, and 522 of them were hospitalized.
Data on several countries includes many unknowns. Massachusetts, for example, reports that 1,583 of the 16,790 COVID-19 patients required hospitalization, on Wednesday. Others 4,717 no. But the state registered the majority of cases, 10,490, under investigation.
The lack of available data raises questions about the federal government $ 35 billion investment in an electronic health record a decade ago, Jha and others said. The shift from paper to digital records should enable health care systems to be more agile and provide information more quickly.
“If that does not happen, it is a major system failure,” he said.
In Harris County, Texas, which includes Houston, testing does not match reality on hospital wards. NBC News reports last week that on March 30, the area around Houston had reported fewer than 950 confirmed cases of the corona virus. “But on the same day, there were 996 people hospitalized in the region with confirmed or suspected COVID-19 cases.”
A team at the University of Minnesota Carlson School of Management has determined to collect inpatient information directly from the state health department. In Tuesday’s post at Journal of Health Affairs, the team notes that there is wide variation between states in the percentage of the adult population that is hospitalized.
In the state that released data about those currently hospitalized, the average rate of hospitalization was 11.5 admissions per 100,000 adults, the report said. In Louisiana, this figure is much higher, 49.5 per 100,000 adults.
The report also noted that the average doubling time for cumulative hospitalization was 4.21 days among the 14 states that reported data every day for at least the past 10 days. The doubling time in Massachusetts is 2.79 days while in Georgia it is 6.08 days. A faster doubling time can mean that there is more transmission from the community, and therefore, the health care system must be in a higher alert state.
“Although this could partly reflect differences in the time the pandemic reached different countries, it could also reflect differences in strategies across countries and thus provide learning opportunities” to understand what regions have done to maintain their low levels, the authors write.
For its part, the CDC on Friday began to release a inpatient weekly snapshot, based on data from hospitals that service about 10% of the U.S. population. This shows that the level of hospitalization for COVID-19 in the first few weeks is similar to what is seen at the beginning of the annual flu season. But given that the impact of COVID-19 has been felt most acutely since the cutoff period for the posted data, it seems that certain inpatient rates have risen since then.
In a Brief data released Wednesday, The CDC provides additional information about inpatients confirmed by COVID-19 in 14 states from March 1 to 30, based on the sites it studies in each state. Per capita rates are highest in Connecticut, Michigan and New York and much lower in Oregon, Colorado and Ohio, suggesting the virus has affected different parts of the country differently. (Seeing the number of raw cases alone does not adjust for differences in state populations.) Older adults have higher rates of hospitalization, and most people who are hospitalized have an underlying health condition.
As for the initiative announced by Pence, the CDC said it was collecting daily hospital data through the National Health Safety Network. “The purpose of this new module – once and up – is to help provide a better picture of what happened inside the U.S. hospital during this outbreak. We hope to make this public soon,” said a spokesman.
On-going Blind Spot
Even when it comes to rougher data forms, such as mortality data, the U.S. system it hasn’t been proven to be very agile. During the height of the opioid epidemic a few years ago, it took months and sometimes more than a year to gather accurate information about the location and cause of death, wasting valuable time putting responses in hotspots, said Dr. Christopher JL Murray, director Institute of Health Metrics and Evaluation at the University of Washington, whose COVID-19 model has informed the White House’s response.
“When it comes to hospital data, it’s even less refined” than death data, Murray said. “If we have national daily reporting, hospitalization and ICU hospitalization, it will be a big push to understand where the next big wave is coming or where we are really seeing progress.”
This gap in data causes problems with efforts to model the number of victims of the disease. “We are starting to see this pattern where death reporting falls on Sunday entering Monday and then they catch up,” Murray said. “This is wreaking havoc on our model.”
State health officials and the hospital system are not waiting for good data to increase the number of hospital beds, ICU beds and ventilators available to treat COVID-19 patients.
In Indiana, for example, the hospital had 1,132 ICU beds on March 1, Indiana Health Commissioner, Dr. Kristina Boxin said at this week’s briefing. On April 1, it increased to 2,188 and on April 4 2,964. “Our hospital has done an extraordinary job to change every room that might become an ICU room,” he said.
That’s the good thing that happened. On Sundays, around 58% of ICU beds are currently available in all occupied states – more than the total available on March 1. Some 924 of the 1,721 ICU beds occupied were taken by COVID-19 patients.
Nirav Shah, a senior scholar at Stanford University and a former New York state health commissioner, said the health care system needs to learn from this crisis to be better prepared for the next crisis, and to have accurate and real-time data about hospital care. is a part of it.
“We don’t have an early warning system that we need for this epidemic to go on and on,” Shah said. “I think everyone understands and this epidemic has made it very clear that we need to make a system that originates in the 21st century for 21st century disease, that we cannot rely on technology from the 80s and 90s which is the power our current survey system. “