Are COVID-19 patients in hospital or admitted to hospital?
April 13, 2020
James Mahon, Tom Jefferson, Carl Heneghan
It has become common for the UK government daily briefings to include one slide that shows data relating to COVID-19 patients in hospital. Three recent slides have included the following different descriptions of the presented data:
The April 1st briefing definition ‘COVID-19 hospital admissions’ can be interpreted in different ways. Does the definition include only those who tested positive, or people already in hospital for other reasons? Does it include people who had COVID-19 prior to admission and were admitted for other reasons than COVID-19? We do not know the answers to these questions.
The April 5th briefing definition ‘Hospitalisations for COVID-19’ is a different definition than that used on April 1st.
‘Hospitalisations’ implies the numbers were those admitted to hospital at the time of infection, although there is some ambiguity as to whether some (or all) were already in hospital. The word ‘for’ indicates that the patients are only in hospital due to COVID-19, it implies causality.
The April 9th briefing definition now changed to ‘People in hospital beds with COVID-19,’ and included ‘number of people in hospital with confirmed COVID-19.’ None of these mention hospitalisation or admission or infer that the numbers only relate to patients in hospital because of COVID-19.
Dominic Raab further added to the confusion by stating at the April 9th briefing: “the number of people admitted to hospital with coronavirus symptoms now stands at 16,784” [4].
This number matches the number of people in ‘Hospital Beds with confirmed COVID-19’ in the slides for that day.
The data to support the 1st, 5th and 9th of April briefings were provided by the Cabinet Office and are available in an Excel workbook after each briefing. We think the data source used, whilst not referenced, has been the same for each of the three slides, and for the statement from Mr Raab, but it is not clear [1-3].
The definition of people in hospital due to (or with) COVID-19 needs to be clear to understand the following:
- How and where COVID-19 is being spread – if a large percentage of COVID-19 cases in hospital originated in hospital then this has implications for hospital infection management strategies, as well as understanding the impact of the lockdown on community transmission
- the use of hospital data to understand the growth of the epidemic and when the peak has been reached – the total number of people in hospital at any one time with or due to COVID-19 does not aid understanding of the progression of the epidemic, as it is almost certainly a selected subpopulation. However, the number of new hospitalisations arising from community-acquired infection may be a useful indicator of changing COVID-19 prevalence rates both nationally and at a local level.
- the demand COVID-19 is placing on NHS hospital capacity – the additional demand on the NHS from COVID-19 is, in part, a function of the additional length of stay due to COVID-19 of those patients who were already in hospital at the time of their infection, coupled with the new admissions due to the virus and their length of stay.
Current unanswered questions that require clarifying include:
- The number of people in hospital for reasons other than symptoms of COVID-19 at the time of diagnosis
- The number of people admitted from nursing or residential care homes due to symptoms of COVID-19
- The number of people admitted from the community with a diagnosis of COVID-19
- The number of people discharged from hospital with a diagnosis of COVID-19
James Mahon is an economist who holds an honorary post at the Liverpool Reviews and Implementation Group (LRiG) in the Department of Health Services Research at Liverpool University and works alongside the York Health Economics Consortium (YHEC) at the University of York.
Tom Jefferson is an Epidemiologist. Disclosure statement is here
Carl Heneghan is Professor of Evidence-Based Medicine, Director of the Centre for Evidence-Based Medicine and Director of Studies for the Evidence-Based Health Care Programme. (Full bio and disclosure statement here)
References
[1]. Cabinet Office Briefing Rooms. Slides and datasets to accompany coronavirus press conference: 1 April 2020 [online] [viewed 10 April 2020]. Available from https://www.gov.uk/government/publications/slides-and-datasets-to-accompany-coronavirus-press-conference-1-april-2020
[2]. Cabinet Office Briefing Rooms. Slides and datasets to accompany coronavirus press conference: 5 April 2020 [online] [viewed 10 April 2020]. Available from https://www.gov.uk/government/publications/slides-and-datasets-to-accompany-coronavirus-press-conference-5-april-2020
[3]. Cabinet Office Briefing Rooms. Slides and datasets to accompany coronavirus press conference: 9 April 2020 [online] [viewed 10 April 2020]. Available from https://www.gov.uk/government/publications/slides-and-datasets-to-accompany-coronavirus-press-conference-9-april-2020
[4]. Dominic Raab. Foreign Secretary’s statement on coronavirus (COVID-19): 9 April 2020 [online] [viewed 10 April 2020]. Available from https://www.gov.uk/government/speeches/foreign-secretarys-statement-on-coronavirus-covid-19-9-april-2020
