key: cord-0773277-hxipuwzl
authors: Geno Tai, Don Bambino; Wilson, Walter R.
title: Outcomes of COVID-19 With the Mayo Clinic Model of Care and Research
date: 2021-02-08
journal: Mayo Clin Proc
DOI: 10.1016/j.mayocp.2021.02.004
sha: 8c39e01c33a047cf4b00097fc71d78c092f1ae97
doc_id: 773277
cord_uid: hxipuwzl

nan

To the Editor: We read with interest the article published by our colleagues about the coronavirus 2019 (COVID-19) treatment outcomes at Mayo Clinic. 1 We commend them for the excellent work, and for showing that superior outcomes are possible with a care model that is multidisciplinary, collaborative, agile, compassionate, and socially responsible. The authors reported that from March 1, 2020 and July 31, 2020, overall mortality for patients afflicted with COVID-19 managed at Mayo Clinic was 1.1%. The mortality for hospitalized patients was 7.1%, while mortality for those that required ICU care was 11.9%. This was lower than in most studies reported in literature and government data. 1 Several points bear emphasis. While we agree that the mortality rates are lower numerically, there are some aspects that we want to point out. Hospitalization and mortality rates can easily be confounded by comorbidities, race, ethnicity, and social determinants of health.

The variables mentioned have important implications on COVID-19 outcomes. 2 In a study referenced, Black patients represented 37.3% of the study population compared with only 9.3% in this study. 3 It is important to know the proportion of patients in this study that experienced homelessness or patients without health insurance. It is possible that the rates in this study were different from other studies because the populations were very different from each other.

Secondly, best practice supportive care (and dexamethasone) is vitally important for treating patients afflicted by COVID-19 given that novel therapeutics have failed to show mortality benefit. 4 It was correctly pointed out that the Mayo Clinic hospitals were not impacted J o u r n a l P r e -p r o o f by an overwhelming surge of hospitalizations during the study period. One key piece is the staffing ratio of doctors and allied health professionals to patients. Chronic understaffing of nurses has been reported even before the pandemic, particularly in New York where nurses routinely take care of up to nine patients per shift. 5 The exact numbers were not reported in this study but we suspect that our institution may have fared better than some other institutions during the pandemic.

Third, the article highlighted the importance of a multidisciplinary physician team that contributed to these outcomes. The most important factor is the exceptional teamwork of our physicians, nurses, nursing assistants, pharmacists, phlebotomists, respiratory therapists, radiology technologists, physical therapists, emergency medical technicians, medical laboratory scientists, and other allied health staff including environmental services staff, clinical assistants, language interpreters, information technologists, and other support staff. We would like to highlight this fact, and for readers to take into account their invaluable contribution to the outcomes reported in this study. 

Outcomes of COVID-19 with the Mayo Clinic model of care and research

COVID-19 Racial and Ethnic Health Disparities

Association of Race With Mortality Among Patients Hospitalized With Coronavirus Disease 2019 (COVID-19) at 92 US Hospitals

COVID-19 Guideline, Part 1: Treatment and Management

Chronic hospital nurse understaffing meets COVID-19: an observational study