Sanford Health's analysis of the around 44,000 COVID-19 patients it has treated revealed some patterns that have helped the health system get ahead of the virus.
Many of the patients who have a harder time fending off COVID-19 also battle underlying chronic conditions, the Sioux Falls, S.D.-based system found. While that has been corroborated by other providers and researchers, new data from FAIR Health show which comorbidities present the most risk to COVID-19 patients. The findings could help risk-stratify patients—particularly as COVID-19 cases are on the rise—and prioritize interventions and vaccination distribution, providers said.
"It is tremendously important to say this is the stratification of patients that we need to take a hard look at to try to keep them out of the hospital, or if they are in the hospital, optimize treatment as soon as possible," said David Pearce, president of research and innovation at Sanford, who lauded FAIR's research and noted that it matched up with Sanford's.
When a high-risk individual is COVID-19 positive and does not require acute care, Sanford sets them up with a blood oxygen level kit to monitor their status at home. Once those levels hit a certain threshold, they should see their doctor, hopefully heading off complications that would require hospitalization, Pearce said.
"Prevention and education are key," he said.
Developmental disorders present the most risk across all age groups, according to FAIR Health's analysis of more than 467,000 private insurance claims from April through August. Those who had disorders involving speech and language, scholastic skills, central auditory processing, among others, were three times more likely to die from COVID-19 than patients who had the virus but not developmental disorders.
COVID-19 patients with lung cancer were a little less than three times as likely to die compared to COVID-19 patients who didn't have lung cancer. The mortality odds ratio was 2.75 for COVID-19 patients with intellectual disabilities, 2.48 for those with spina bifida or other nervous system anomalies, and 2.2 for patients with leukemia and lymphomas.
Multiple comorbidities significantly increased mortality rates. Among those who succumbed to COVID-19, 83% had an underlying condition, FAIR Health found.
"Stratifying comorbidities will give us a public health roadmap," said Robin Gelburd, president of FAIR Health. "The provider community and other community outlets and social service agencies can memorialize prioritization based on the most vulnerable, which would presumably translate into policies that allow certain individuals to advance to the front of the line."
Providers and public health experts can drill down into why certain populations may not be adhering to recommended practices, and make a concerted outreach with education, assistance and optimal treatment plans, she said. Administrators can coordinate services near high-risk populations, for instance.
"As cases are spiking up again, hopefully the healthcare community and public health officials can learn in real time how to best work with different populations," Gelburd said.
Males were somewhat less likely to be diagnosed with COVID-19, but much more likely to die from the virus, FAIR Health data show. About 60% of COVID-19 deaths were among males. Of all the patients diagnosed with COVID-19, 0.59% died.
While patients 69 or older accounted for only 4.82% of COVID-19 diagnoses, that demographic accounted for 42.43% of total deaths.
Those findings aligned with researchers at Santa Clara Valley Medical Center, which developed its own risk assessment tool. If COVID-19 patients are male, over the age of 60, have a body-mass index of at least 30 and have comorbidities, they are more likely to get sick. Lower scores of less than two of those criteria were associated with a mortality rate of zero, according to SCVMC's analysis from March until August.
"As we head into the challenging winter months, there will be additional strain on resources as the pandemic continues and non-COVID related illness require hospitalization," said Dr. Sanjay Kurani, medical director of inpatient medicine at the medical center in San Jose, Calif., who said the paper was "very well done."
The medical center is examining what risk factors are driving racial disparities in COVID-related morbidity and mortality.
"Some of these risk factors could be modifiable," Kurani said.
While COVID-19 patients with underlying medical conditions have a harder time fending off the virus, much is still unknown. Patients who experience even mild symptoms can experience neurological, cardiovascular or other long-term issues, researchers said.
"Sometimes those with mild symptoms have the most persistent issues, which is worrisome," Gelburd said.
