First 10 days after COVID patients leave hospital carry high risk, study says

Joint study carried out by University of Michigan, VA Ann Arbor Healthcare System

MEXICO CITY, MEXICO - DECEMBER 19: Doctor walks through the COVID-19 area in front of a wheelchair at the hospital of the National Institute of Respiratory Diseases Ismael Cosío Villegas on December 19, 2020 in Mexico City, Mexico. Claudia Sheinbaum, Mayor of Mexico City, announced on December 18 that the city will increase its restrictions to halt the spread of Covid-19 virus. All non-essential activities will be restricted from December 13 to January 10 while 78% of the hospital beds available to treat the disease are now occupied. Mexico City registers more than 270,000 confirmed cases and over 15,000 deceases. (Photo by Alfredo Martinez/Getty Images) (Alfredo Martinez, 2020 Alfredo Martinez)

ANN ARBOR – A growing number of studies have shown that in the first months after being discharged from the hospital, COVID-19 patients faced a high risk of returning for treatment, ongoing health problems and death.

However, the first 10 days can be especially dangerous, according to a new study by a team from the University of Michigan and VA Ann Arbor Healthcare System.

They found that COVID patients were 40% to 60% more likely to end up back in the hospital or dying in the first week and a half out of the hospital compared with heart failure and pneumonia patients who were treated at the same hospitals during the same period of time.

In the first two months, researchers found that 9% of patients who survived their initial COVID hospitalization had died and that nearly 20% were sent back to the hospital after experiencing a setback. This is in addition to the 18.5% of patients who had died of COVID while hospitalized.

The overall risk of readmission or death for COVID patients was lower than that for patients with the other two conditions after 60 days.

For the study, the research team compared outcomes for nearly 2,200 veterans with COVID-19 who survived their hospitalization at 132 VA hospitals in the spring and early summer with outcomes for nearly 1,800 patients who survived a pneumonia-related stay that was not related to COVID-19, and 3,500 patients who were hospitalized with heart failure and survived during the same time period.

According to epidemiologist at Michigan Medicine and the study’s first author, John P. Donnelly, the study suggests heightened vigilance in the first two weeks after discharge as hundreds of thousands of Americans remain hospitalized with severe COVID-19 cases.

“By comparing COVID-19 patients’ long-term outcomes with those of other seriously ill patients, we see a pattern of even greater-than-usual risk right in the first one to two weeks, which can be a risky period for anyone,” Donnelly said in a statement.

“Now, the question is what to do about it,” he continued. “How can we design better discharge plans for these patients? How can we tailor our communication and post-hospital care to their needs? And how can we help their caregivers prepare and cope?”

Donnelly worked with critical care physicians from Michigan Medicine and VAAHS on the study, including Hallie Prescott and Theodore Iwashyna.

Prescott is a senior author of a similar paper that recently showed a slow recovery of hospitalized COVID-19 patients in Michigan in the early months of the pandemic.

“Unfortunately, this is yet more evidence that COVID-19 is not ‘one and done,’” Iwashyna said in a statement. “For many patients, COVID-19 seems to set off cascades of problems that are every bit as serious as those we see in other diseases. But too little of our healthcare response -- and too little research -- is designed to help these patients as they continue for days, weeks, even months to recover from COVID-19.”

Iwashyna added that similar patterns are likely happening in the private sector, but the VA provided early data for analysis.

Half of the patients in the study were Black and 95% of the patients were male -- both high risk groups. Within the veteran group studied, the only significant factor in outcomes was age -- roughly half of them in their 70s and 80s died from COVID within 60 days of being discharged from the hospital.

Of the 2,179 COVID patients studied, 354 veterans were readmitted. The most common reasons for readmission were COVID-19 -- responsible for 30% of the rehospitalizations and sepsis, occurring in 8.5% of cases. Of the veterans who were readmitted, more than 22% spent time in an intensive care unit.

Donnelly and his colleagues hope to continue to compare outcomes from VA and non-VA hospitals amid COVID-19 patients and those with other serious conditions.

About the Author:

Meredith has worked for WDIV since August 2017 and was voted one of Washtenaw County's best journalists in 2019 by eCurrent's readers. She covers the community of Ann Arbor and has a Master's degree in International Broadcast Journalism from City University London, UK.