The unpredictable course of COVID-19

The medical community has learned much about the novel coronavirus in the past seven months, from risk factors for severe illness, treatments that could benefit hospitalized patients, and the effectiveness of masks and social distancing to prevent spread of the infection. Yet many questions remain, like why some patients with COVID-19 worsen several days after initially developing symptoms, in a pattern not characteristic of other viral illnesses.

Clinicians who work in emergency departments must decide whether patients with COVID-19 are sick enough to require hospitalization or can safely recover at home. In the case of COVID-19, clinicians need better data upon which to base guidance and reassurance to patients who are sick but stable.

Person wearing face mask and wearing a blanket coughing into fist.

For this reason, a team including Austin Kilaru, a Leonard Davis Institute (LDI) associate fellow, emergency physician, and an advanced fellow in the VA Clinical Scholars Program, studied COVID-19 patients who return to the hospital after an initial evaluation in the emergency department. The team wanted to understand how often people need hospitalization after initially appearing well enough to recover at home, as well as when they develop worsening symptoms and which patients tend to require return visits. They analyzed the outcomes of 1,419 patients with COVID-19 who were evaluated and discharged from five University of Pennsylvania Health System (UPHS) hospital emergency departments from March through May.

The results, published in Academic Emergency Medicine, have implications for systems seeking to monitor patients with COVID-19 as well as clinicians seeking evidence with which to counsel patients. Overall, nearly 5% of patients returned within 72 hours and needed admission to the hospital. For context, this rate may be five times higher than that described for all ED patients. An additional 3.5% of patients needed admission within one week. The fact that patients were hospitalized on their second visit indicates that their illness and symptoms progressed to the point where they needed a higher level of support, such as oxygen or therapeutic medications, than they could receive at home.

This story is by Austin Kilaru. Read more at Penn LDI.