Addressing Post-COVID Challenges: The Urgent Need for Enhanced Hospital Reporting Metrics

The recent surge in respiratory-transmitted diseases (RTDs) is extremely concerning. While early discussions cited “immune debt” as a possible explanation, accumulating evidence increasingly discredits this notion, with post-COVID immune dysfunction gaining stronger support. Regardless of the etiology, the rise in infectious diseases appears to be a persistent challenge—and may worsen if proactive measures are not taken.

In response, the Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards Quality/Quality, Safety & Oversight Group, on November 1, 2024, implemented hospital requirements to report patients with confirmed COVID-19, influenza, and respiratory syncytial virus (RSV) infections. Of these, COVID-19 is of utmost concern, with frequent long-term disability and recurrent infections, which can occur any time of the year.

We want to encourage CMS to expand their COVID-19 reporting requirements with the development of the following metrics:

1. Hospital-onset Infections for COVID-19;
2. Total COVID-19 infections in health care workers;
3. Total emergency room visitations and emergency room COVID-19, influenza, and RSV infections.
 
Hospital-onset COVID-19 infections are not currently reported, and when they were, the metric used captured few of the events. However, the UK’s National Health Service (NHS) does require reporting. In Scotland, between the weeks ending on March 1, 2020, and December 18, 2022, there were 18,137 probable and definite hospital-onset COVID-19 cases. In 2023, in New South Wales (NSW), Australia, at least 6,007 patients caught COVID-19 in hospitals, with 297 deaths. A King’s College London study concluded at least one in 8 patients treated for COVID-19 in hospitals caught the infection in the hospital. It should be noted that the UK National Health Service uses a definition of probable hospital-onset COVID-19 infection if it occurs from day 8 to 14 after admission. This definition is more stringent than the one in the US, but it will also capture too few of the actual hospital-onset COVID-19 infections.
 
The impact of COVID-19 on health care workers has been profound. However, in the US, reporting health care worker infections is not mandatory. The United Kingdom’s National Health Service currently requires reporting of absences from work due to acute COVID-19. On October 31, 2024 (the last day data is available), there were 50,155 worker absences, with 990 due to acute COVID-19. However, these acute infections have an accumulative effect and larger peaks during the winter and summer months. A large percentage of these workers are developing long COVID and associated diseases. The King’s College of London “found that 33.6% of surveyed health care workers in England reported symptoms consistent with post-COVID syndrome.” Health care workers are known to have a high occupational risk for acquiring COVID-19 infections, with a high impact on their ability to work.

The total ER visitations for respiratory infections is an electronic medical records metric developed and used by EPIC research (Figure 1). EPIC’s methodology can be used as a basis for metric design. Their implementation of this metric with voluntary participation from health care facilities demonstrates that it would not be burdensome to the health care system.

These are sobering statistics that we feel necessitate the implementation of mitigation strategies. Masking and admission testing have been shown to lower the incidence of COVID-19 acquisitions in hospitals. In the same study, a death rate of 8 in 100 randomly selected infected individuals was recorded. This is consistent with other data showing a 9.5% death rate for hospital-onset Infections of COVID-19. In Australia, of all COVID-19 deaths, 14% may have acquired their infection in a hospital. Increasing ventilation and clean air have also decreased the spread of aerosolized respiratory pathogens. These interventions must be widely implemented throughout our health care system to protect patients and medical staff.CMS can drive mitigation strategies by incorporating COVID-19 metrics into their hospital financial incentive programs.