key: cord-0988415-d6xoys7g
authors: Pawlowski, C.; Venkatakrishnan, A.; OHoro, J. C.; Badley, A. D.; Halamka, J.; Soundararajan, V.
title: COVID-associated pediatric hospitalization and ICU admission trends across a multi-state health system and the broader US population
date: 2021-04-05
journal: nan
DOI: 10.1101/2021.04.02.21254593
sha: dde6f513eeb7b6a6a23c88f5321dc446a3c34b66
doc_id: 988415
cord_uid: d6xoys7g

Public health concerns are emerging based on reports of new SARS-CoV-2 variant strains purportedly triggering a rise in COVID-associated hospitalizations and ICU admissions, particularly in younger patients and the pediatric population. However, analyzing health records of COVID patients from the electronic health records (EHRs) of a multi-state US healthcare system, we find that there is actually a significant drop in COVID-associated hospitalization rates and ICU admission rates in March 2021 compared to February 2021. We further triangulate these EHR-derived insights with the official US government epidemiological data sets to show that during this same time period, there is no apparent nation-wide spike in pediatric hospitalizations. Our study motivates the need to develop a real-time system that integrates various COVID hospitalization and ICU monitoring efforts from the EHR databases of various health systems together with national epidemiological data sets. By infusing SARS-CoV-2 genomic sequencing data to flag potentially new or emergent viral strains, as well as county-level COVID vaccine rollout rates and shifts in SARS-CoV-2 PCR positivity rates into such a real-time monitoring system, public health policies and media reporting can be more effectively informed through the rigor of holistic biomedical data sciences.

Media reports this week are suggesting a potential spike up in COVID-19 genetic variants-associated intensive care unit (ICU) admissions for younger patients from the continents of North America 1-3 , South America 4,5 , and Europe 6, 7 . Here, we conducted an observational study on the health records of 60,539 patients (March 1-28, 2021) and 60,256 patients (February 1-28, 2021) from the multi-state Mayo Clinic health system for whom the SARS-CoV-2 PCR test results were also available. We then juxtaposed these results on to the national epidemiological data from the US government as of March 29, 2021 (https://healthdata.gov/). 8 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted April 5, 2021 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted April 5, 2021. ; https://doi.org/10.1101/2021.04.02.21254593 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted April 5, 2021. ; https://doi.org/10.1101/2021.04.02.21254593 doi: medRxiv preprint

This is a retrospective study of individuals who underwent polymerase chain reaction (PCR) testing for suspected SARS-CoV-2 infection at the Mayo Clinic and hospitals affiliated with the Mayo Clinic Health System. This study was reviewed by the Mayo Clinic Institutional Review Board (IRB) and determined to be exempt from the requirement for IRB approval (45 CFR 46.104d, category 4). Subjects were excluded if they did not have a research authorization on file.

Analysis of the health records from Mayo Clinic health system for patients where the SARS-CoV-2 PCR test results were also available as of March 29, 2021 shows a significant drop in the ICU admission rates during March (1.45%; 87 of 6017 COVIDpos patients) compared to February (1.99%; 121 of 6078 COVIDpos patients) with a Rate Ratio of 0.78 (p-value = 0.0002; Figure 1a ). In this study population, there is a slight shift in the peak of ICU admissions towards the younger population in March relative to February (Figure 1b) . While this trend is not statistically significant at this time, this particular shift requires further monitoring over the coming weeks.

Restricting the study population to younger COVIDpos patients (age < 55), we observe a drop in the number of ICU admissions in March compared to February (not statistically significant; Figure 2a) . Consistent with the drop in the ICU admission rate, we also see a statistically significant drop in the hospitalization rate in March 2021 (10.97%; 660 of 6017 COVIDpos patients) compared to February 2021 (13.64%; 829 of 6078 COVIDpos patients) with a rate ratio of 0.8 (p-value: 2.34e-12; Figure 2b ). Focusing the study population to the younger COVIDpos patients (age < 55), we observe a drop in the number of hospitalizations in March compared to February (not statistically significant; Figure 2c ).

Independently, the national data from the US government (https://healthdata.gov/) 8 also shows a steady drop over recent months in hospitalized pediatric patients with confirmed or suspected COVID-19 (Figure 3a) . We observe similar trends in the top-10 states by population as well (Figure 3b) .

This preliminary analysis shows that there is a decreasing trend in ICU admissions and hospitalization of COVID-19 patients across a large multi-state health system as of March 2021. Furthermore, there is no apparent nation-wide spike in pediatric hospitalizations in March compared to February 2021. Decreased hospitalizations and . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted April 5, 2021. ; https://doi.org/10.1101/2021.04.02.21254593 doi: medRxiv preprint ICU admission rates may be reflective of advances in early diagnosis and intervention. As the proportion of circulating viruses shift towards more variants, these results may change. Overall, amidst recent concerns about emergent SARS-CoV-2 strains, there is an imminent need to develop a real-time system that integrates various national surveillance efforts in order to guide public health policies.

After publication, the data will be made available to others upon reasonable requests to the corresponding author (venky@nference.net). A proposal with a detailed description of study objectives and the statistical analysis plan will be needed for evaluation of the reasonability of requests.

ADB is a consultant for Abbvie, is on scientific advisory boards for Nference and Zentalis, and is founder and President of Splissen therapeutics. One or more of the investigators associated with this project and Mayo Clinic have a Financial Conflict of Interest in technology used in the research and that the investigator(s) and Mayo Clinic may stand to gain financially from the successful outcome of the research. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with Mayo Clinic Conflict of Interest policies. The authors from nference have financial interests in the company.

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted April 5, 2021. 

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