1
|
Morgan G, Casalino S, Chowdhary S, Frangione E, Fung CYJ, Haller S, Lapadula E, Scott M, Wolday D, Young J, Arnoldo S, Aujla N, Bearss E, Binnie A, Bombard Y, Borgundvaag B, Briollais L, Dagher M, Devine L, Faghfoury H, Friedman SM, Gingras AC, Goneau LW, Khan Z, Mazzulli T, McLeod SL, Nomigolzar R, Noor A, Pugh TJ, Richardson D, Satnam Singh HK, Simpson J, Stern S, Strug L, Taher A, Lerner-Ellis J, Taher J. Characterizing Risk Factors for Hospitalization and Clinical Characteristics in a Cohort of COVID-19 Patients Enrolled in the GENCOV Study. Viruses 2023; 15:1764. [PMID: 37632107 PMCID: PMC10457914 DOI: 10.3390/v15081764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The GENCOV study aims to identify patient factors which affect COVID-19 severity and outcomes. Here, we aimed to evaluate patient characteristics, acute symptoms and their persistence, and associations with hospitalization. Participants were recruited at hospital sites across the Greater Toronto Area in Ontario, Canada. Patient-reported demographics, medical history, and COVID-19 symptoms and complications were collected through an intake survey. Regression analyses were performed to identify associations with outcomes including hospitalization and COVID-19 symptoms. In total, 966 responses were obtained from 1106 eligible participants (87% response rate) between November 2020 and May 2022. Increasing continuous age (aOR: 1.05 [95%CI: 1.01-1.08]) and BMI (aOR: 1.17 [95%CI: 1.10-1.24]), non-White/European ethnicity (aOR: 2.72 [95%CI: 1.22-6.05]), hypertension (aOR: 2.78 [95%CI: 1.22-6.34]), and infection by viral variants (aOR: 5.43 [95%CI: 1.45-20.34]) were identified as risk factors for hospitalization. Several symptoms including shortness of breath and fever were found to be more common among inpatients and tended to persist for longer durations following acute illness. Sex, age, ethnicity, BMI, vaccination status, viral strain, and underlying health conditions were associated with developing and having persistent symptoms. By improving our understanding of risk factors for severe COVID-19, our findings may guide COVID-19 patient management strategies by enabling more efficient clinical decision making.
Collapse
Affiliation(s)
- Gregory Morgan
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Selina Casalino
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Sunakshi Chowdhary
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Erika Frangione
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Chun Yiu Jordan Fung
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Simona Haller
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Elisa Lapadula
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Mackenzie Scott
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Dawit Wolday
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Juliet Young
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Saranya Arnoldo
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- William Osler Health System, Brampton, ON L6R 3J7, Canada
| | - Navneet Aujla
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Alexandra Binnie
- Department of Critical Care, William Osler Health System, Etobicoke, ON M9V 1R8, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON M5G 2A2, Canada
| | | | - Marc Dagher
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Luke Devine
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Hanna Faghfoury
- Fred A Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, Toronto, ON M5T 3H7, Canada
| | - Steven M. Friedman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Emergency Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lee W. Goneau
- Dynacare Medical Laboratories, Brampton, ON L6T 5V1, Canada
| | - Zeeshan Khan
- Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Microbiology, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada
| | - Shelley L. McLeod
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON M5G 2A2, Canada
| | | | - Abdul Noor
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Trevor J. Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | | | - Harpreet Kaur Satnam Singh
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Jared Simpson
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada
| | - Seth Stern
- Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
| | - Lisa Strug
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, ON M5G 1Z5, Canada
| | - Ahmed Taher
- Mackenzie Health, Richmond Hill, ON L4C 4Z3, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Jordan Lerner-Ellis
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5G 1X5, Canada
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jennifer Taher
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| |
Collapse
|
2
|
Belzile MN, Lam P, Chan AK, Andany N, Simor A, Estrada-Codecido J, Ga'al A, Kapsack A, Mahmud A, Fridman D, Lee SM, Santoro A, Vandenbergh N, Daneman N. Evaluating the impact of a virtual outpatient care program in preventing hospitalizations, emergency department visits and mortality for patients with COVID-19: a matched cohort study. Clin Microbiol Infect 2023:S1198-743X(23)00154-4. [PMID: 37059224 PMCID: PMC10091723 DOI: 10.1016/j.cmi.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES We sought to evaluate the impact of virtual care in preventing unnecessary healthcare visits for SARSCoV-2 patients. METHODS We conducted a retrospective matched cohort study, evaluating the COVID-19 Expansion to Outpatients (COVIDEO) program involving virtual assessments for all positive patients in the Sunnybrook assessment center from January 2020 to June 2021, followed by risk-stratified routine follow-up, couriering of oxygen saturation devices, and 24 hour/day direct-to-physician pager for urgent questions. We linked COVIDEO data to province-wide datasets, matching each eligible COVIDEO patient to ≤10 other Ontario SARS-CoV-2 patients on age, sex, neighborhood, and date. The primary outcome was emergency department (ED) visit, hospitalization or death within 30 days. Multivariable regression accounted for comorbidities, vaccination and pre-pandemic healthcare utilization. RESULTS Among 6,508 eligible COVIDEO patients, 4,763 (73.1%) were matched to ≥1 non-COVIDEO patient. COVIDEO care was protective against the primary composite outcome (adjusted odds ratio (aOR) 0.91, 95%CI 0.82-1.02), with a reduction in ED visits (7.8% vs 9.6%; aOR 0.79, 95%CI 0.70-0.89), but increase in hospitalizations (3.8% vs 2.7%, aOR 1.37, 95%CI 1.14-1.63) reflecting more direct-to-ward admissions (1.3% vs 0.2%, p < 0.0001). Results were similar when matched comparators were limited to patients who had not received virtual care elsewhere with a decrease in ED visits (7.8 vs. 8.6%, aOR 0.86, 95%CI 0.75-0.99) and an increase in hospitalizations (3.7 vs 2.4%, aOR 1.45, 95%CI 1.17-1.80). CONCLUSIONS An intensive remote care program can prevent unnecessary ED visits and facilitate direct-to-ward hospitalizations and thereby mitigate the impact of COVID-19 on the healthcare system.
Collapse
Affiliation(s)
- Mei-Ni Belzile
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Philip Lam
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adrienne K Chan
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Nisha Andany
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Simor
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jose Estrada-Codecido
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amal Ga'al
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abby Kapsack
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abdalla Mahmud
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel Fridman
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Samantha M Lee
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Aimee Santoro
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nancy Vandenbergh
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nick Daneman
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada.
| |
Collapse
|