COVID Uncovered (part 1)
Lessons from an undisclosed NHS Trust
In the film Love Actually some of the action takes place in an art gallery that is exhibiting 'Christmas Uncovered', being a series of larger than life B&W male nudes with bright red Santa hats covering nipples.
Yesterday I ran a post called Valentine’s Day Treat in which I presented a breakdown of 3,948 COVID admissions to the emergency department of a sizeable NHS Trust for the period Jan – Sep ’21 so we could see how the positive test results were stacking up against chief complaint and diagnoses made. This morning I am going to give this analysis a little more love, as they say, by considering significant non-respiratory morbidity; that is to say contenders for other states of ill-health severe enough to warrant admission for emergency care in their own right.
For this exercise I elected to divide diagnoses into the primary categories of cardiac, cancer, CNS, sepsis/organ failure and physical trauma. Examples within each category are cardiogenic shock, multiple myeloma, tonic-clonic epilepsy, acute renal failure syndrome and crushing injury of chest. The idea here is to consider serious conditions in addition to whether a person is also suffering from respiratory illness. A person may well be in respiratory distress and test positive for COVID but if they’ve just been crushed by a truck then we also need to take account of this!
A total of 371 such conditions meriting emergency department admission were identified and merged to form a single indicator variable. A crosstabulation of this variable with audited COVID-19 status is provided by the fascinating table below. The easiest way to get your head round this is to consider the column headed ‘no’ and consider these admissions to primarily arise from respiratory conditions. Thus, out of those 2,929 positive admissions presenting with a flu-like complaint we observe just 130 folk who were also suffering from something else entirely (4.4%). We can thus be fairly certain that 2,799 of these (95.6%) were mild COVID cases (assuming an accurate test)…
As regards severely symptomatic COVID (positive test and acute respiratory condition with or without a relevant chief complaint) we find a total of 143 such cases that decline to 129 when we exclude those suffering significant non-respiratory morbidity. These are the only symptomatic COVID cases we can be certain of in terms of admission requirement.
In the second table (positive test results only) we find a total of 3,948 COVID admissions including 227 admissions that may well have been primarily for other causes (5.7%). The greatest proportion of significant non-respiratory morbidity lies with cases being admitted with a just a positive test and other respiratory diagnosis (30.8%); an example would be an asthmatic youngster being involved in a road traffic accident…
So where does this leave us? Well, it leaves us with 129 bone fide severe COVID admissions out of a total of 3,948 positive test results over the period Jan – Sep ’21 (3.3%). In terms of all admissions those 3,948 positive folk sit amongst a total of 296,331 tested folk, this representing just 1.3% of all admissions.
Boiling this down further we arrive at 129/296,331 (0.04%) admissions that can be pinned on severe COVID and only severe COVID in terms of respiratory disease.
Another way of looking at the workload picture is to realise that the emergency department dealt with 90,434 non-COVID major morbidity admissions during which time 3,948 positive testing folk were handled one way or another (4.4%). I can guess which of these kept clinicians busy!