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COVID-19: Hospitalization Risk Factors, Medicare Data

Older age, black race, and diabetes mellitus are associated with increased risk of hospitalization for COVID-19, according to a study in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Data for the study were gathered from 220 hospitalized and 311 nonhospitalized adult patients from six acute-care hospitals and outpatients clinics in metropolitan Atlanta. Researchers note racial and ethnic minorities have an increased risk for severe complications from COVID-19 because of the higher prevalence of underlying conditions, such as diabetes and cardiovascular disease. Social determinants of health also might contribute to this disparity; black workers are more likely than others to have front-line or essential jobs. Other factors that increased hospitalization risk included lack of insurance, male sex, smoking, and obesity.

Measures to prevent infection with SARS-CoV-2, such as wearing face coverings and social distancing, should be emphasized for those with higher hospitalization risks, and barriers to these preventive measures should be mitigated.

CMS Releases Preliminary COVID-19 Medicare Data

In its first data snapshot, CMS breaks down COVID-19 cases and hospitalizations for Medicare beneficiaries by state, race and ethnicity, age, gender, dual eligibility for Medicare and Medicaid, and urban and rural locations. This data will be updated monthly.

CMS outlines its methodology using data sourced from Medicare fee-for-service claims, Medicare Advantage encounters, and Medicare enrollment. COVID-19 cases are identified using ICD-10 diagnosis codes B97.29 (Jan. 1 through March 31) and U07.1 (April 1 and later).

The data show that the COVID-19 hospitalization rate is highest in New York and New Jersey. Higher rates also are found among black and Hispanic beneficiaries, and among beneficiaries ages 85 or older. Dual-eligible beneficiaries also have a higher rate of COVID-19 hospitalizations.

CMS also released an FAQ with information on factors impacting the data, such as the delay between when a service occurs and when the claim or encounter for that service is available in the CMS database (i.e., claims lag).

GAO Report Highlights National Disaster Medical System Deficiencies

A new report from the Government Accountability Office highlights deficient training for responders enrolled in the National Disaster Medical System (NDMS). The NDMS is a coalition of medical providers, including doctors and nurses, who assist with the federal medical and public health response to public health emergencies, including the COVID-19 pandemic.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 included a provision for this review of the Department of Health and Human Services’ (HHS’) provider surge capacity. GAO concluded that HHS did not follow effective strategic workforce planning principles when identifying an enrollment target of 6,290 responders. The agency had 3,667 NDMS responders in December 2019. Specifically, the agency did not consider the skills and capacity needed to respond to:

  • a nationwide event or multiple concurrent events;
  • the needs of at-risk individuals; and
  • the availability of other medical responders.

For example, responders take web-based training before deployment, and in-person training sessions are optional. HHS officials agree that in-person training is more beneficial, but also more costly. GAO also states the agency does not have an adequate system in place to evaluate effectiveness of the training. GAO recommends the HHS assistant secretary of preparedness and response:

  • align its NDMS responder workforce target with its strategic plan goals;
  • ensure the workforce target accounts for critical skills and competencies;
  • create strategies to fill gaps to achieve the revised target;
  • use GAO-identified practices to evaluate both web-based and in-person responder training; and
  • prioritize in-person training.

FDA Revokes Emergency Use Authorization for Chloroquine Phosphate, Hydroxychloroquine Sulfate

The Food and Drug Administration (FDA) in a June 15 letter revoked its emergency use authorization (EUA) for oral formulations of chloroquine phosphate (CQ) and hydroxychloroquine sulfate (HCQ). This letter comes in response to the Biomedical Advanced Research and Development Authority’s request to revoke the EUA based on clinical test results that show the drug might not be effective in treating COVID-19.

FDA now believes the suggested dosing regimens for these drugs are unlikely to produce an antiviral effect, and notes earlier reports of decreased viral shedding with these drugs have not been consistently replicated. Recent data from a large, randomized clinical trial showed no evidence of benefit of HCQ treatment in hospitalized patients with COVID-19 for mortality or for other outcomes, including length of stay or need for mechanical ventilation.

FDA released FAQs with more information about the revocation.

Visit the America’s Essential Hospitals coronavirus resource page for more information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Emily Schweich is a senior communications associate for America's Essential Hospitals.

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