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COVID-19 news from Annals of Internal Medicine

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American College of Physicians

Below please find link(s) to new coronavirus-related content published today in Annals of Internal Medicine. All coronavirus-related content published in Annals of Internal Medicine is free to the public. A complete collection is available at

1. Surges in COVID-19 caseload during pandemic doubled mortality in hardest-hit U.S. hospitals

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A retrospective cohort study found that surges in hospital COVID-19 caseload significantly increased mortality in the hardest hit U.S. hospitals. The findings are published in Annals of Internal Medicine.

Researchers from the National Institutes of Health studied data for a nationally representative cohort of 144,116 hospitalized patients cared for in 558 hospitals to understand the effect of COVID-19 surges on patient outcomes. The researchers devised a unique surge index to measure the strain a hospital experienced each month from COVID-19 volume in relation to baseline bed capacity. The surge index not only enabled capture of the potential detrimental effects of overburdened staff during a surge but also highlighted ongoing needs for specific care settings (for example, ICU) and supplies (such as respiratory support devices). The authors also modeled the surge index over time, to provide perspective on how therapeutic advancements influenced outcomes during waves of the U.S. pandemic.

The researcher found that clusters of high-surge index hospitals existed and varied across geography and time. They also found that the use of therapeutics decreased ICU admissions and mechanical ventilation rates, but the surges were still extremely detrimental to clinical outcomes. After risk adjustment, patients cared for in the highest surge strata experienced 2-fold greater mortality than in hospitals not experiencing surges. The data shows that nearly 1 in every 4 deaths and almost 6,000 total deaths may have been attributable to hospital strain due to COVID-19.

As the delta variant of the virus, a serious global threat, continues to become more prevalent, these findings suggest that many COVID-19 deaths may be preventable through prudent public health and health care organizational interventions that minimize the effect of surges. The author of an accompanying editorial from the University of Michigan details potential strategies for doing just that. Creating a structure for a coordinated, regional approach could help to absorb the shock of rapid increases in COVID-19 volume. The author says that a focus on staff is also imperative, as surveys show that many are considering leaving the field after being battered by wave after wave of COVID-19.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Sameer S. Kadri, MD, MS, can be reached at or

2. Almost a third of persons with mild to moderate, acute COVID-19 suffer long-term symptoms

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A survey of patients previously diagnosed with COVID-19 found that lingering symptoms 7 months after infection were common among otherwise healthy young persons in the outpatient setting. The findings are published in Annals of Internal Medicine.

Researchers from the Geneva University Hospitals surveyed 629 persons who were a part of Geneva's CoviCare program from 18 March to 15 May 2020 using semistructured telephone interviews at enrollment and 30 to 45 days and 7 to 9 months from diagnosis to characterize long-term symptoms after COVID-19 infection. Of the 410 patients that completed follow-up at 7 to 9 months after diagnosis, 39.0% reported residual symptoms. These symptoms included fatigue (20.7%), loss of taste or smell (16.8%), shortness of breath (11.7%), and headache (10.0%).

Based on these findings and findings from similar studies, the authors suggest that persons treated on an outpatient basis for mild to moderate COVID-19 should be informed about the potential for long-term effects and physicians should continue to monitor them. Physicians should also be aware of other causes of such symptoms as fatigue, cognitive and neurologic symptoms, and shortness of breath to avoid misinterpretation.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. To speak with the corresponding author, Mayssam Nehme, MD, please contact HUG Presse at


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