Studies look at hospital at home, experimental therapy, mortality and readmissions in COVID-19

A virtual hospital and a trial of inhaled interferon-beta both reported success, studies compared COVID-19 and other critically ill patients, and mortality and readmission risks were quantified in recent pandemic research.

Patients requiring hospital-level care for COVID-19 were successfully treated at home with a virtual hospital model, according to a study published by Annals of Internal Medicine on Nov. 11. The analysis of 1,477 patients included 1,293 treated in the virtual observation unit, of whom only 3% ended up requiring hospitalization. The other 184 patients were treated in the virtual acute care unit (some receiving IV fluids, antibiotics, or oxygen), and 13% of that group required admission. The authors noted that their program was planned and launched within two weeks. (The Nov. 25 ACP Hospitalist Weekly will include more details on this model.)

Positive results were also reported in a manufacturer-sponsored phase 2 trial of inhaled nebulized interferon beta-1a, published by The Lancet Respiratory Medicine on Nov. 12. The 48 hospitalized patients who were randomized to the treatment had double the odds of clinical improvement by day 15 or 16 compared to 50 patients given placebo. There were three deaths in the placebo group and none in the treatment group. The results provide “a strong rationale for further trials,” the authors said.

Mortality rates and other outcomes of COVID-19 hospitalization were quantified by several new studies. A retrospective comparison of 65 ICU patients with COVID-19 and 74 with influenza published by Annals of the American Thoracic Society on Nov. 13 found similar rates of mechanical ventilation but slower improvement (including time to weaning) in those with COVID-19, as well as significantly higher inpatient mortality (40% vs. 19%). Another comparison, published as a research letter by JAMA Internal Medicine on Nov. 16, used postmortem findings from 26 patients with COVID-19 and eight with other critical illnesses to identify diaphragm myopathy that might explain difficulty weaning, persistent dyspnea, and fatigue in COVID-19.

In an analysis of 126,137 COVID-19 patients hospitalized in March to July and included in the Premier Healthcare Database, the inpatient mortality rate was 15.5%. Of 106,543 patients who were discharged, 9% were readmitted (1.6% more than once), with a median interval from discharge to readmission of eight days, according to results published by MMWR on Nov. 9. Risk factors for readmission included age 65 years or older, presence of certain chronic conditions, hospitalization within three months preceding the COVID-19 hospitalization, and discharge to a skilled nursing facility or with home health care.

Higher mortality and readmission rates were found in an analysis of 1,648 patients hospitalized with COVID-19 in Michigan in March through June, published as a letter in Annals of Internal Medicine on Nov. 11. Overall, 75.8% survived to discharge, but by 60 days after discharge, an additional 84 patients had died, bringing the overall mortality rate to 29.2% (63.5% in the 405 ICU patients). The 60-day readmission rate was 15.1%. Of 488 patients surveyed at 60 days, 265 had seen a primary care physician within two weeks of discharge. They reported a variety of ongoing issues, including cardiopulmonary symptoms, psychological problems, and financial impacts. “These data confirm that the toll of COVID-19 extends well beyond hospitalization, a finding consistent with long-term sequelae from sepsis and other severe respiratory viral illnesses,” the study authors said. “Collectively, these findings suggest that better models to support COVID-19 survivors are necessary.”