Temporal trends in inpatient oncology census before and during the COVID-19 pandemic and rates of nosocomial COVID-19 among patients with cancer at a large academic center
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Background : The Coronavirus Disease‐2019 (COVID‐19) pandemic has significantly impacted healthcare systems. However, to date, the trend of hospitalizations in the oncology patient population has not been studied and the frequency of nosocomial spread to cancer patients is not well‐understood. The objectives of this study were to evaluate the impact of COVID‐19 on inpatient oncology census and determine the nosocomial rate of COVID‐19 in cancer patients admitted at a large academic center.
Materials and methods : Medical records of cancer patients diagnosed with COVID‐19 and admitted were reviewed to evaluate the temporal trends in inpatient oncology census during pre‐COVID (Jan 2019‐Feb 2020), COVID (March‐May 2020), and post‐COVID surge (June‐August 2020) in the region. In addition, nosocomial infection rates of SARS‐CoV‐2 were reviewed.
Results : Overall, the daily inpatient census was steady in 2019 (median=103; range:92‐118) and until February 2020 (median=112; range:102‐114). However, there was a major decline from March to May 2020 (median=68; range:57‐104), with 45.4% lower admissions during April 2020. As the COVID surge eased, the daily inpatient census over time returned to the pre‐COVID baseline (median=103; range:99‐111). One patient (1/231, 0.004%) had SARS‐CoV‐2 positive test 13 days after hospitalization and it is unclear if it was nosocomial or community spread.
Conclusion : In this study, inpatient oncology admissions decreased substantially during the COVID surge, but over time returned to the pre‐COVID baseline. With aggressive infection control measures, the rates of nosocomial transmission were exceedingly low and should provide reassurance to those seeking medical care, including inpatient admissions when medically necessary.
Implications for Practice : The COVID‐19 pandemic has had a major impact on the healthcare system, and cancer patients are a vulnerable population. As a result of the urgent need for inpatient capacity, non‐COVID care has been deferred or delayed. In our study, we observe a drastic decline in the daily inpatient oncology census from March to May 2020 compared to the same time frame in the previous year. We investigate reasons for this decline. The concern is that some patients and providers may be deferring admission because of fear of the individual acquiring COVID in the hospital. However, we analyzed the nosocomial rate of COVID infection in admitted cancer patients to our center confirming that none of the patients in this study acquired the infection while hospitalized. These findings suggest that aggressive infection control measures can help mitigate the nosocomial infection risk among cancer patients and that the inpatient setting is a safe environment, providing reassurance to those seeking medical care.
The Oncologist , article en libre accès, 2020