Original Article

COVID-19 in a Mississippi Community Hospital

Authors: Ijlal Babar, MD, Okechukwu Ekenna, MD, Maggie Ramsey Clarkson, MSN, Daralyn Boudreaux, MSN, William Bennett, MD, Randy Roth, MD

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.
Posted in: Infectious Disease42

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Images

Table 1. Demographic characteristics, exposures, and presenting symptoms of COVID-19-positive cases (N = 158), March 15–April 10, 2020

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Table 2. Hospitalized patients by site of care (non-ICU or ICU) and death, stratified by BMI level

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Table 3. Clinical characteristics and outcomes of hospitalized COVID-19 patients

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Table 4. Respiratory parameters and adjunct therapy in ICU patients

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References

1. Bhatraju P, Ghassemieh B, Nichols M, et al. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med 2020;382:2012–2022.
 
2. Mississippi Department of Health. COVID-19 update. https://msdh.ms.gov/msdhsite/_static/14,0,420.html. Accessed March 8, 2021.
 
3. Price-Haywood E, Burtin J, Fort D, et al. Hospitalization and mortality among black patients and white patients with covid-19. N Engl J Med 2020;382:2534–2543.
 
4. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–1720.
 
5. Short V. Report on the burden of chronic diseases in Mississippi, 2014. MSDH, Office of Health Data and Research. https://msdh.ms.gov/msdhsite/_static/resources/4775.pdf.
 
6. Zhi G, Xin W, Ying W, et al. “Obesity paradox” in acute respiratory distress syndrome: a systemic review and meta-analysis. PLoS ONE 2016;11:e0163677.
 
7. Zhou Y, Jim X, Lv Y, et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med 2017;43:1648–1659.
 
8. Fleishon HB, Itri JN, Boland GW, et al. Academic medical centers and community hospitals integration: trends and strategies. J Am Coll Radiol 2017;14:45–51.
 
9. Pronovost PJ, Angus DC, Dorman T, et al. Physician staffing patterns and clinical outcomes in critically ill patients: a systemic review. JAMA 2002;288:2151–2162.
 
10. Pronovost PJ, Jenckes MW, Dorman T, et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 1999;281:1310–1317.