COVID-19 in a Mississippi Community Hospital. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Babar, Ijlal; Ekenna, Okechukwu; Clarkson, Maggie Ramsey; Boudreaux, Daralyn; Bennett, William; Roth, Randy
• Is Part Of: Southern medical journal. Volume 114:Issue 5(2021)
• Publication Date: 2021-05
• Subjects: BMI -- community health system -- comorbidities -- COVID-19 -- critical care staffing; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001245
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: Mississippi recorded the first case of coronavirus disease 2019 (COVID-19) on March 11, 2020. This report describes the initial COVID-19 experience of the single healthcare system serving Jackson County, Mississippi. The intent of this retrospective review of COVID-19 hospitalized patients was to identify any characteristics or interventions amenable to improving care management and clinical outcomes for patients within our community hospital. Methods: All hospitalized patients 18 years of age and older in our health system with positive tests for COVID-19 (severe acute respiratory syndrome-coronavirus-2 [SARS CoV-2]) by reverse transcriptase-polymerase chain reaction between March 15 and April 10, 2020 are included in this retrospective observational report. Results: During the study period, 158 patients of the 1384 tested (11.4%) were positive for COVID-19 infection. Of the 158 patients, 41 (26%) were hospitalized, with 17 (41%) admitted to the intensive care unit (ICU). The remaining 24 patients did not require ICU admission. The mean age of the 158 COVID-19-positive patients was 55 years (range 2–103). Obesity was noted in 68% of the hospitalized patients, including 13 (54%) of the non-ICU patients and 15 (88%) of the ICU patients. All 9 deceased patients were obese. Twelve of 17 patients received invasive mechanical ventilation (IMV) and 3 patients received only high-flow nasal cannula oxygen. Only 25% (3 of 12) of the IMV patients were successfully extubated during the study period. The median duration on IMV was 17 days (range 4–35). The mortality in the 158 COVID-19-positive patients was 5.7% (9 of 158). None of the 24 non-ICU patients died. The ICU mortality rate was 53% (9 of 17). Conclusions: This report describes a community hospital experience with COVID-19. Patient outcome was comparable to that reported at larger centers. Obesity was a major comorbidity and correlated with adverse outcomes. Amidst the initial wave of COVID-19 with high demand for inpatient treatment, it is reassuring that appropriate care can be provided in a community health system. Abstract : This retrospective observational review of the initial experience caring for coronavirus disease 2019 patients in a community health system in Mississippi provides insight into the characteristics and interventions amenable to improving care management and clinical outcomes for these patients during the early phase of the coronavirus 2019 pandemic. The authors incorporated the care continuum, from initial testing to presenting symptoms, demographic characteristics, pertinent comorbidities, hospitalization factors (including clinical, laboratory, and radiologic findings), severity of illness, respiratory interventions used, clinical outcomes (including discharge, mortality, and length of stay), and staffing patterns affecting care outcomes.