Frontline Report: COVID-19’s Third Wave Has Arrived

It’s no longer just a matter of case counts and hospitalizations due to COVID-19, but it’s what we’re seeing in terms of the demographic groups being affected and associative complications.

It’s a hard thing to deny and a difficult pill to swallow—we’re in a third wave. Over ten months since the U.S. began to have cases of Coronavirus’ disease 2019 (COVID-19), and we’re still learning more about this pandemic and the transmission dynamics. Perhaps what is most daunting though, is not just the growing case counts and hospitalizations, but what we’re seeing in terms of demographics and data on complications.

Two new reports from the Centers for Disease Control and Prevention (CDC) in their Morbidity and Mortality Weekly Report (MMWR) shed light on some concerning trends we’re seeing with COVID-19. First, a research team analyzed over 9,000 hospitalized patients through the national Veterans Health Administration (VHA). Ultimately, they assess in-hospital complication risks for those with COVID-19 and influenza and found that those with COVID-19 had a higher risk for not only 17 complications, but also a five-times higher risk of dying in the hospital. The authors noted that “compared with patients with influenza, patients with COVID-19 had two times the risk for pneumonia; 1.7 times the risk for respiratory failure; 19 times the risk for ARDS; 3.5 times the risk for pneumothorax; and statistically significantly increased risks for cardiogenic shock, myocarditis, deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, cerebral ischemia or infarction, intracranial hemorrhage, acute kidney failure, dialysis initiation, acute hepatitis or liver failure, sepsis, bacteremia, and pressure ulcers.”

A second study looked at excessive deaths associated with COVID-19 from January 26 to October 3 of this year. Not only did the study find that there were nearly 300,000 excess deaths during the study period (66% were attributed to COVID-19), but the largest increases were in those aged 25-44 and among Hispanic or Latino patients. The authors shared that “excess deaths reached their highest points to date during the weeks ending April 11 (40.4% excess) and August 8, 2020 (23.5% excess).” In terms of racial and ethnic trends in excess mortality, the research team noted that “among racial and ethnic groups, the smallest average percentage increase in numbers of deaths compared with previous years occurred among White persons (11.9%) and the largest for Hispanic persons (53.6%), with intermediate increases (28.9%–36.6%) among AI/AN, Black, and Asian persons. “

These 2 MMWR reports are not only deeply disturbing about the direction of this pandemic, but should be seen as a blueprint for what we need to do. Focus on excess deaths, targeted prevention and testing resources, and ultimately acknowledging that currently we’re seeing a younger population being particularly impacted. It has been widely known that there COVID-19 has underscored disparities among underrepresented racial and ethnic groups, so the question is: What are we doing about it? From an infection prevention standpoint, incorporating public health into our rounding and education can be helpful. Discussing vulnerable patient populations and how we can better serve them in the community, but also in the hospital. Ultimately, we need to start approaching infection prevention for what it is—the intersection of healthcare and public health.