In the Journals: Admitted with or for COVID-19? Why It Matters.

Although the incidence of severe COVID-19 disease and deaths has declined dramatically since SARS-CoV-2 first entered the country, two things are clear: 1) The virus will continue to circulate for years if not decades; 2) Certain groups will be most vulnerable to severe disease. To best know who would benefit from booster dosing, we need to define who exactly is being hospitalized and killed by this virus. What are their ages? Have they recently received a vaccine? Which vaccine did they receive? How many doses of vaccine have they received? When was their last dose of vaccine? What specific comorbidities do they have? What is their ethnic or socioeconomic background? Did they receive antiviral medications? Then, and only then, can we best target which populations will benefit from booster dosing.

One problem with defining who is at risk of being hospitalized is that some people who are said to have been hospitalized because of COVID-19 are admitted for another reason but happen to be infected with SARS-CoV-2 asymptomatically or with mild symptoms. Indeed, one society of epidemiologists recently recommended that all hospitals stop testing people for COVID-19 if they are asymptomatic.

To address the issue of who is being admitted for COVID-19 and who is being admitted with incidental COVID-19 infection, researchers at Massachusetts General Hospital performed a chart review of hospital admissions in Massachusetts, Pennsylvania, and Illinois (Klann JG, Strasseer ZH, Hutch MR, et al. Distinguishing Admissions Specifically for COVID-19 from Incidental SARS-CoV-2 Admissions: National Retrospective Electronic Health Record Study. J Med Internet Res. 2022, May 18;24(5):e337931) From a retrospective electronic-health-record-based cohort in four U.S. healthcare systems, a random sample of 1,123 SARS-CoV-2 PCR-positive patients hospitalized between March 2020 and August 2021 was manually chart-reviewed and classified as admitted with COVID-19 (incidental) or for COVID-19. Investigators found that about 26% of patients classified as being admitted for COVID-19 had incidental infections, although depending on the time of the year, incidental admissions ranged from 0% to 70%.

This study underlines the importance of accurate public health reporting as we make decisions about vaccines moving forward.