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There is something funny happening with COVID hospitalizations
Proportion of COVID pts getting hospitalized falling
A lot
Just recently
My theory?
As hospitals fill up, bar for admission rising
A patient who might have been admitted 4 weeks ago may get sent home now
Thread
Proportion of COVID pts getting hospitalized falling
A lot
Just recently
My theory?
As hospitals fill up, bar for admission rising
A patient who might have been admitted 4 weeks ago may get sent home now
Thread
So what do I mean "proportion of COVID pts hospitalized falling"?
For months, you could reliably predict new hospitalizations
How?
By taking cases 7 days prior, multiplying by 3.5%
That is
3.5% (1 in 29) of those diagnosed today will be hospitalized about 7 days later
2/10
For months, you could reliably predict new hospitalizations
How?
By taking cases 7 days prior, multiplying by 3.5%
That is
3.5% (1 in 29) of those diagnosed today will be hospitalized about 7 days later
2/10
LOTS of caveats to this formula
Not all states report new hospitalizations (formula takes that into account)
Could build a 10 day lag formula (3.7% hospitalized by 10 days)
All data I report are 7-day moving avgs from @COVID19Tracking
3/10
Not all states report new hospitalizations (formula takes that into account)
Could build a 10 day lag formula (3.7% hospitalized by 10 days)
All data I report are 7-day moving avgs from @COVID19Tracking
3/10
So let's look at data
On October 15, there are 53K new cases
On Oct 22, you’d expect 1844 hospitalizations (53K*0.035).
What was it actually? 1855
So far so good
4/10
On October 15, there are 53K new cases
On Oct 22, you’d expect 1844 hospitalizations (53K*0.035).
What was it actually? 1855
So far so good
4/10
On Nov 1, there are 80K new cases.
On Nov 8, you’d expect 2804 new hospitalizations (80K*0.035)
What was it actually? 2604. A little less. But fine
On Nov 15, there are 146K new cases.
On Nov 22, expect 5111 new hospitalizations (146K*0.035)
But there are only 3670
5/10
On Nov 8, you’d expect 2804 new hospitalizations (80K*0.035)
What was it actually? 2604. A little less. But fine
On Nov 15, there are 146K new cases.
On Nov 22, expect 5111 new hospitalizations (146K*0.035)
But there are only 3670
5/10
I’m ignoring data from last week b/c Thanksgiving messiness though this effect gets much more dramatic
But here’s the fact:
Over much of September and October, you could look at cases today and predict that 3.5% of that number gets hospitalized 7 days later
6/10
But here’s the fact:
Over much of September and October, you could look at cases today and predict that 3.5% of that number gets hospitalized 7 days later
6/10
But in November, that number starts falling
Initially to 3.2% by Nov 8
By Nov 15, drops to 3.0%
By Nov 22, drops to 2.5%
And by Nov 29, down to 2.1%
So what’s going on? What does this mean?
7/12
Initially to 3.2% by Nov 8
By Nov 15, drops to 3.0%
By Nov 22, drops to 2.5%
And by Nov 29, down to 2.1%
So what’s going on? What does this mean?
7/12
May be more testing means we're picking up more cases?
No
% test + is rising from 5.1% (Oct 1) to 12.1% (Nov 15)
So number of cases being missed is climbing
Proportion of pts being admitted from identified cases should be RISING
That 3.5%? Should go up. Instead, its falling
No
% test + is rising from 5.1% (Oct 1) to 12.1% (Nov 15)
So number of cases being missed is climbing
Proportion of pts being admitted from identified cases should be RISING
That 3.5%? Should go up. Instead, its falling
So what’s happening?
What you’d expect – doctors’ threshold for admission is likely going up
In early Oct, with plenty of beds, a COVID patient who is clinically borderline likely gets admitted to ensure they do OK
By Nov 15, beds in short supply, that person likely goes home
What you’d expect – doctors’ threshold for admission is likely going up
In early Oct, with plenty of beds, a COVID patient who is clinically borderline likely gets admitted to ensure they do OK
By Nov 15, beds in short supply, that person likely goes home
Of course, critically ill patients always get admitted
But over time, marginal admissions start disappearing
And as hospitals get fuller, what is defined as “marginal” keeps changing
Until you only admit the sickest folks
10/12
But over time, marginal admissions start disappearing
And as hospitals get fuller, what is defined as “marginal” keeps changing
Until you only admit the sickest folks
10/12
And that’s what appears to be happening
Here's the bottom line:
1 in 3 people who would have been admitted on October 1 aren’t being admitted by November 22
That’s a big change!
And given big rise in test positivity – its likely much higher
11/15
Here's the bottom line:
1 in 3 people who would have been admitted on October 1 aren’t being admitted by November 22
That’s a big change!
And given big rise in test positivity – its likely much higher
11/15
Best guess? we're admitting half the COVID pts we would have admitted October 1
Is this a problem?
If those people don’t need hospitalization, is this bad?
Well, on Oct 1, we would have said that they need hospitalization
So “need” is fluid
But here's the other key issue
Is this a problem?
If those people don’t need hospitalization, is this bad?
Well, on Oct 1, we would have said that they need hospitalization
So “need” is fluid
But here's the other key issue
The evidence suggests that many of these pts now being sent home will likely do worse at home
Some may be OK -- but others will come back sicker or even die at home
And one more thing
When hospitals fill up, threshold for admission for everything goes up
Some may be OK -- but others will come back sicker or even die at home
And one more thing
When hospitals fill up, threshold for admission for everything goes up
Everything -- COVID and non-COVID is affected
So borderline admission for heart failure? Person now goes home
Pt with infected leg where you’d prefer IV antibiotics in hospital? They go home with oral antibiotics
This is what is happening in hospitals across America right now
So borderline admission for heart failure? Person now goes home
Pt with infected leg where you’d prefer IV antibiotics in hospital? They go home with oral antibiotics
This is what is happening in hospitals across America right now
This is not Doctors being cruel
Its that with fewer and fewer beds, bar for hospitalizing anyone is rising
And likely means more people are suffering, getting worse, or even dying at home
All because our hospitals are really full
15/17
Its that with fewer and fewer beds, bar for hospitalizing anyone is rising
And likely means more people are suffering, getting worse, or even dying at home
All because our hospitals are really full
15/17
So what's the bottom line?
We can see in data that we are likely admitting far fewer COVID patients than we would have just 2 months ago
Likely due to very full hospitals
Because political leaders have politicized mask wearing, social distancing
Its a travesty
16/17
We can see in data that we are likely admitting far fewer COVID patients than we would have just 2 months ago
Likely due to very full hospitals
Because political leaders have politicized mask wearing, social distancing
Its a travesty
16/17
So remember:
Hospitalizations are not static thing
When hospitals get full, by definition you can’t hospitalize all the folks you'd like to hospitalize
And many who would benefit from hospitalization suffer
Because only the very sickest get a bed
Everyone else goes home
Fin
Hospitalizations are not static thing
When hospitals get full, by definition you can’t hospitalize all the folks you'd like to hospitalize
And many who would benefit from hospitalization suffer
Because only the very sickest get a bed
Everyone else goes home
Fin
