Ninh T. Nguyen, MD Chief of Gastrointestinal Division, Surgery UCI

COVID-19: Staggering Mortality and Medical Costs Interview with:

Ninh T. Nguyen, MD Chief of Gastrointestinal Division, Surgery UCI

Dr. Nguyen

Ninh T. Nguyen, MD
Chief of Gastrointestinal Division, Surgery
UCI What is the background for this study? What are the main findings 

Response: There are limited national data on hospitalized patients in the US. To our knowledge, the current publication provides data on the largest cohort of COVID-19 patients hospitalized at US academic centers. What are the main findings? 

Response: It is Important to note that more than 1/2 of the hospitalized patients are >60 years of age and there is a higher proportion of male (52.5%).

We found an overall high in-hospital mortality of 13.6% (1 death per 7-8 hospitalized patients) since the start of the pandemic. However, it is higher when you take into account that a proportion of patient were discharged to home hospice or hospice care. Most other studies only report the in-hospital or 30-day death rate and do not take into account that a proportion of patient are being sent to home for hospice care and that number were not accounted for in the death rate. If you add in these patients who are sent home for hospice care then the death rate is even more staggering at 16.6% (1 death in every 6 hospitalized patient).

Mortality in our study is highly associated with increasing age with highest mortality for the oldest age group of >80 years where by 1 in 4 died during the hospitalization. This is not a new finding which has been reported previously but the current study confirmed the finding based on the large number of patients in this study. For context of the high death rate associated with COVID, the mortality associated for hospitalized influenza’ infection (flu) is around 3-4%, mortality for open heart surgery is around 2-3%, and mortality for major esophageal resection for cancer is around 3%.

There is a high rate of ICU admission with almost 1/3 of patients requiring admission to the ICU. There is a much higher death rate observed for patients who are admitted to the ICU. There is also long length of hospital stay and long ICU stay. Looking at the survival graph in the paper, you can see that some patients even stayed for months in the hospital. However, on a bright note, the mortality decreased tremendously over the initial 6 months of the pandemic which reflect the improvement of the healthcare system and better understanding in the management of this disease with new treatment strategies (the use of high flow nasal canula, awake prone positioning), establishment of clinical pathway in management of this disease, new treatment medications (anticoagulation, Remdesivir, Convalescent plasma, steroids, etc..), and improvement in ICU care (less intubation). Unlike other disease, a high proportion of covid-19 patients also required additional recovery at skilled nursing facility or rehabilitation facility at discharge from the hospital.

Lastly, the paper reported a high median cost for hospitalization. We reported the median cost however if you examine the average (mean) cost, it would be more than doubled that number as many patients have a very lengthy hospitalization. Even using a conservative calculation based on the median cost and extrapolate it to the estimated number of COVID-19 hospitalization to date, the price tag for US healthcare system is estimated to be upward of 50 billion to date, not accounting for additional posthospitalization medical care and rehabilitation, long-term medical care, loss of earning, and loss of life. What should readers take away from your report? 

Response: Our study demonstrated that covid-19 is a deadly disease that afflict everyone but particularly to older individuals. It is a debilitating disease as many required a lengthy hospital stay and a lengthy recovery process even after discharge from the hospitalization. Lasty, this is a costly disease as it has a huge impact on the financial of the US healthcare system. What recommendations do you have for future research as a result of this work?

Response: Future research should continue to examine on novel management strategies and therapies to improve the outcome of COVID-19 patients requiring hospitalization. 

No disclosures


Nguyen NT, Chinn J, Nahmias J, et al. Outcomes and Mortality Among Adults Hospitalized With COVID-19 at US Medical Centers. JAMA Netw Open. 2021;4(3):e210417. doi:10.1001/jamanetworkopen.2021.0417

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Last Updated on March 5, 2021 by Marie Benz MD FAAD