Country differences in hospitalisation, length of stay, admission to Intensive Care Units, and mortality due to SARS-CoV-2 infection at the end of the first wave in Europe: a rapid review of available literature

Objectives

Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus is spreading rapidly worldwide and threatening the collapse of national health care systems. The development of effective resource models are critical for long term health planning. The aim was to evaluate the available literature, to consider parameters affecting hospital resources, to effectively guide health policy and planning for future waves of infection.

Design

A detailed search of the literature, using Google Scholar, PubMED, MedRxiv and BioRxiv, was conducted for the time period 1 ^st Dec 2019 to 31 ^st May 2020; using appropriate keywords: resultant articles were scrutinised in detail, and appraised for reported data pertaining to hospitalization and hospital length of stay (LOS).

Results

Disease presentation was described in China; 81 % mild, 14 % moderate and 5 % severe. The experience, thus far, in Europe and the USA are suggestive of a higher degree of severity. Initial reports suggest high hospitalisation and ICU admittance rates. More recent reports from the European Centre for Disease Prevention and Control (ECDC) lower this estimation. Perhaps the relative age, the level of pre-existing conditions, and other health factors may be contributors to differences. Data from Irish cases suggest hospitalisation rate may be lower in parts of Europe and time dependent. Hospital LOS is described in 55 articles, with median lengths of stay between 3 and 52 days. The evidence regarding the LOS in ICU is reported in 31 studies, 26 deemed relevant. The majority of studies report ICU LOS between 7 to 11 days. Many of these studies are likely skewed towards shorter stay due to study cut-off dates. Indications based on ICU LOS reported for patients continuing care suggest median ICU stay will progressively increase.

Conclusions

These parameter estimates are key to the development of an effective health care resource model. Based on our appraisal of the literature, is it essential that Europe manages mitigation measures to ensure that hospital and ICU capacity does not become overwhelmed to manage COVID-19 in subsequent infection waves.

Strengths and limitations of this study

• The study provides timely information on the differences in hospitalisation, length of stay and ICU length of stay due to COVID-19 in a number of countries worldwide at the end of wave one in Europe;

• This rapid review builds on a previously available review paper that reported length of stay in the early phase of the pandemic; many more studies outlining length of stay, and in particular, ICU length of stay, are now available;

• This rapid review reports on study mortality rate giving an interesting insight into differences across countries and continents;

• Limitations associated with any rapid review are pertinent to this study; a narrow aim was set, and the sources of the literature may be limited by the time-limited constraint of gathering relevant literature; and a number of articles available were in pre-print form and only undergoing peer review; and

• This rapid review provides evidence-based estimates of Hospital and ICU length of stay due to COVID-19 infection across a number of countries to steer policy and provide parameter estimates for utilisation within a hospital resource model as preparations are made for subsequent waves of infection.