How One Health System Got to Lower Mortality Rates Early in the Pandemic

PHILADELPHIA – COVID-19 was first declared a pandemic by the World Health Organization (WHO) on March 11, 2020. In the following weeks, hospitals across the globe were overwhelmed and the capacity of intensive care units (ICUs) pushed to the brink with critically ill patients. By the end of August 2020, more than 30 million cases were reported worldwide, with the death toll in the U.S. reaching 200,000 out of 6.5 million cases. In the early days of the pandemic as physicians and researchers grappled with how this new virus spread and the disease it caused, hospitals had to shift a thousand processes and treatment plans. Researchers at the 14-hospital Jefferson Health system examined how their efforts helped lower mortality rates more than similar health systems in the first few months of the pandemic. They published their findings in Journal of Clinical Medicine Research on March 3.

“Similar to the global trend, our highest mortality rate was at the beginning of the pandemic in March 2020,” explains senior study author Jack Jallo, MD, PhD, director of neurotrauma and executive director for critical care at Jefferson Health. “But as time went on, we noticed mortality rates and ICU admissions waning, and we wanted to take a closer look.”

The Jefferson Health system serves the greater Philadelphia area and southern New Jersey, and has cared for more COVID-19 patients than any other health system in the Philadelphia area. Clinical researchers across the enterprise conducted a retrospective analysis of 1,204 patients who were diagnosed with COVID-19 and admitted to the ICU across the system between March and August 2020. They found that by the end of August 2020, the mortality rate had declined significantly — from 46% in March 2020 to 14% just six months later. Among other parameters, their collected patient data included demographics, comorbidities, blood laboratory values and medical interventions. The researchers believe that a shift in infections of younger populations may have contributed to the declining mortality rates, as well as improved understanding of the coronavirus and the system’s ability to rapidly share evolving treatments for the virus.

“At the start of the pandemic, hydroxycholoriquine was touted as having benefits against COVID-19,” explains Syed Omar Shah, MD, MBA, assistant professor of Neurology and Neurological Surgery and one of the authors of the study. “We actually found that hydroxychloroquine was associated with increased mortality, and once we stopped using it, our mortality rate started to improve.”

First author Sohaib Roomi, MD, an internal medicine doctor at Abington Hospital-Jefferson Health credits the infectious diseases department for leading the charge in testing different drugs and entering trials for new drugs. “Because the medical literature around COVID-19 is changing quickly, it is critical to use the most current drug regimens to give our patients the best outcome, without throwing the whole kitchen sink at them,” says Dr. Roomi. “The communication with our infectious diseases colleagues allowed for that real-time assessment and enabled us to follow the data.”

Dr. Shah adds that this communication spanned the enterprise – when there was a change in approach or new information was gathered at one site, it was quickly relayed to the other hospitals. “This is the advantage of a large health system like ours,” he says. “We were able to not only share resources, but also plan strategically and dynamically – when one ICU started to have an influx of patients, we designated and moved patients between hospitals so that no one ICU was overwhelmed.”

Dr. Shah hopes that Jefferson Health has modelled a strategy for other multi-center health systems not just through the next phase of the COVID-19 pandemic, but any other pandemic in the future.

“We’ve learned that the pandemic affects the whole of society, so health care should respond like a society,” he says. “Jefferson Health’s hospitals came together, but ideally all the healthcare systems in an area should come together to ensure that no one hospital gets overloaded, and no patient is left without getting the treatment they need.”

No internal or external funding was used for this study. The authors report no conflicts of interest.

By Karuna Meda

Article Reference: Sohaib Roomi, Syed Omar Shah, Waqas Ullah, Shan Ul Abedin, Karyn Butler, Kelly Schiers, Benjamin Kohl, Erika Yoo, Matthew Vibbert, Jack Jallo, “Declining Intensive Care Unit Mortality of COVID-19: A Multi-Center Study,” Journal of Clinical Medicine Research,  DOI: 10/14740/jocmr4452, 2021