My daughter, a hospital nurse, has been telling me about this for the past 6 Months. She says anywhere between 75 and 90 percent of her COVID positive patients are not there for Covid.
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My state, Massachusetts, started differentiating between patients in the hospital dying with and of COVID, as the article describes:
Doronâs work was instrumental to Massachusetts changing its hospitalization reporting a year ago to include both total hospitalizations with covid and those that received dexamethasone. In recent months, only about 30 percent of total hospitalizations with covid were primarily attributed to the virus.
Of course, we are at the same time undercounting total COVID cases due to at home antigen testing.
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Counting the rate of hospitalization due to Covid may be tricky, but counting deaths due to Covid shouldnât be as tricky (if clearly defined). If someone tested positive prior to her/his death, her/his death was at least accelerated by Covid, if not directly caused by Covid.
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I agree with you. Even if Covid wasnât the primary cause of the hospitalization, it is likely to have exacerbated any other health issues.
From the hospitalâs perspectives, there is still a significant impact on the the allocation of resources and actual patient care if some one tests positive even if it is completely unrelated to the named cause of the hospitalization.
The hospitalâs perspective is not relevant. States/counties/cities have specific guidelines/rules for reporting deaths and those rules s/b followed.
Not necessarily. My daughter has had patients with brain injuries that were going to cause imminent death. They did test positive but this truly was unrelated to their cause of death.
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Agree with the second point but not the first. On the orthopedic floor my daughter works on occasionally , patients had COVID but had no bearing on their hospitalization or their stay in terms of their own health.
We are definitely undercounting which means the spread is much greater but the percentage infected being hospitalized for COVID is much lower than the stats would indicate.
@maya54 counting hospitalizations and deaths is of course different from counting total COVID cases in the community.
In fact if hospitalizations/death were low and community cases were high, that might be reassuring in terms of severity.
Before extremely widespread home testing the hospitalization rate gave us a better view of the percentage of infected facing severe illness.
Also, my guess based on what I am hearing around me is that people have stopped testing for mild cold symptoms, even though they did so last year. Which is contributing even more to the spread of COVID and poorer data about severe illness.
And if we are just testing all people hospitalized and reporting hospitalization with COVID as being no different than âfor COVIDâ than hospitalization will absolutely rise in tandem with community rise whereas if we could only report those who needed to be hospitalized âfor Covidâ (which can be tricky in someâŠbut not alllâŠcases, we would get a better picture of severity).
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It is probably more complicated that many commentators assume.
Someone who dies in the hospital while COVID-19-positive (or having a type of long COVID that impacts risk of survival / death) could fall into various categories:
- COVID-19 was the cause of death.
- COVID-19 combined with something else caused death, but neither alone would likely have caused death.
- COVID-19 did not cause or contribute to death.
Sometimes, it could be a judgement call between 1 and 2, or 2 and 3. But how big is group 2, and how should they be counted as âdied of COVID-19â versus âdied with COVID-19â that commentators seem to have a binary choice between?
Also note that the reason for hospitalization may not necessarily be the same as reason for death. Someone may be hospitalized for something else, then get COVID-19 and die of it. Someone may be hospitalized for COVID-19, be about to be discharged as recovered, then die of something unrelated.
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How can Covid be ruled out to have not contributed to the death definitely? UK, for example, doesnât think itâs possible so its Covid death tally includes anyone who has had Covid any time in the 28 days prior to the death.
Examples where presence of COVID-19 is very unlikely to have contributed to death:
- Someone is brought to the hospital for trauma and dies of trauma during emergency surgery.
- Someone is brought to the hospital and is diagnosed with metastatic cancer and dies shortly thereafter of it.
Of course, some may be a judgement call for which there is no obviously correct answer as to whether it is COVID-19-related. For example:
- Death due to heart attack or stroke in a patient with a history of atherosclerosis, hypertension, previous heart attack, etc⊠Could be COVID-19-related due to the possibility of clotting disorders from COVID-19, but can it be said for sure that it actually is COVID-19-related?
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Not sure if it is still the case, but we are still under an emergency COVID declaration - hospitals received a higher Medicare reimbursement rate for COVID patients. So there could very likely have been a financial incentive for a patient to not only HAVE COVID, but to have been hospitalized BECAUSE of COVID, even if COVID was not the primary driver of the illness. A 20% uncharge for a covid patient is not negligible to a bottom line.
â This higher allocation of funds has been made possible under the Coronavirus Aid, Relief and Economic Security Act through a Medicare 20% add-on to its regular payment for COVID-19 patients, as verified by USA TODAY through the [American Hospital Association Special Bulletin]'(https://www.aha.org/special-bulletin/2020-03-26-senate-passes-coronavirus-aid-relief-and-economic-security-cares-act) on the topic.;
A car accident causing massive brain injury for one.
But then a patient bringing in COVID-19 also imposes extra costs on the hospital due to heightened procedures to avoid spread and the risk of giving it to staff who cannot work if they get it.
The whole âhow much of this death was due to COVIDâ discussion is so complicated. I may have shared before about my aunt, who was 83, had some dementia, got COVID, seemed to be okay for a few days, then had a stroke. Couldnât get to a hospital from her care home for 6 hours because the hospitals were so slammed (Los Angeles, December 2021). She lived for another 10 months but was minimally responsive and bedridden. Did she die of COVID? Not directly, but it sure contributed on several levels. The death certificate doesnât mention it.
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Around me car accident victims are not Covid deaths even if they had Covid and this goes back to pre-vax days. They still test for it so the emergency personnel know. Itâs one of the questions specifically asked some time ago, I think, because some other states were doing things differently. Iâm not sure if all changed since then or not.
According to my resident son and fiancee who both work in a hospital there are several deaths that are almost certainly related to Covid, yet not counted because they happen well after Covid is over. Theyâre due to the after effects or blood clots. It can be a more dangerous time period for people within 6 months or so of having had Covid - even mild cases.
My guess is they arenât counted due to the gray area @ucbalumnus points out. Some folks would have had strokes (or heart attacks, etc) anyway even if Covid werenât around, but the numbers being seen from previous Covid folks are simply a lot larger than what used to be being seen pre-Covid.
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I was not referring to the reporting by the state but the impact of Covid patients on the hospital more generally. Sorry for the confusion.
Iâm glad to hear that Covid status did not impact patient care where your daughter works. It has definitely had an impact on how my H can provide care.
@ucbalumnus described the impact better than I could.
My H also gets notified if heâs visited a patient who subsequently tests positive. It is often stressful for us worrying about his exposures. And yes he does wear an N95 mask but will often touch a patient with his bare hands as he believes in the healing power of touch. When he knowingly goes into a Covid patientâs room heâll gown up, cover his mask with a disposable surgical mask, and will wear gloves.
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