In a recent study posted to the medRxiv* preprint server, researchers in Australia characterized hospitalization volumes, patient epidemiological and clinical outcome data of patients admitted to virtual wards during the predominance of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant of concern (VOC) BA.1 sub-VOC and the Omicron BA.2 sub-VOC.

The Metro North COVID-19 Virtual Ward was designed to provide care at home for people with COVID-19 in South-East Queensland, Central West, and Norfolk Island. This area covers an estimated 900,000 people and 4157 square kilometers. There are 22 public hospitals within these catchments, including one quaternary, one tertiary, and two secondary hospitals.

Study: COVID-19 (Omicron strain) hospital admissions from a virtual ward: who required further care? Image Credit: fizkes / Shutterstock

About the study

In the present retrospective study, researchers evaluated hospitalization requirements among virtual ward patients during Omicron BA.1 and Omicron BA.2 predominance.

The study comprised care individuals admitted to virtual wards aged above 16 years and hospitalized between January 1, 2022, and March 25, 2022. Clinical, laboratory, and epidemiological data of patients requiring hospitalization were analyzed. The team excluded short-term admissions in emergency departments (ED) and individuals hospitalized to receive intravenously delivered anti-SARS-CoV-2 therapeutics.

Data were obtained from several online clinical note systems such as the Power BI (Ward dashboard), Virtual Care Stream, The Viewer, and iEMR. Virtual ward admissions of the individuals were based on opt-in modeling, and SARS-CoV-2-positive RAT (rapid antigen test) or PCR (polymerase chain reaction) reports.

In addition, other practitioners (such as ED or general practitioners) referred patients or the care individuals were admitted based on self-referrals from telephonic calls or electronic platforms. The ward comprised nursing, administration, pharmacy, social, and medical work staff. During initial consultations, patients were categorized based on their risks of potential COVID-19 progression into very-high, high, moderate, and low/very-low-risk groups.

Participants were contacted daily via telephone, and their symptoms were evaluated based on standardized criteria for patient escalation. In addition, a pulse oximeter was distributed to high-risk COVID-19 patients. The ward allowed patient escalation to MO (Medical Officers) for reviewing and ED transfers if needed, with informing the Senior MO (SMO) of the corresponding ED of the patient’s arrival.

Analgesics, antibiotics, antivirals, and antiemetics were prescribed based on the national guidelines of Australia and were available for home delivery when required. The individuals received ward discharge a week after meeting the national guidelines concerning symptom improvement. Immunocompromised individuals, such as those with liver or lung transplants, were followed up for two weeks in the virtual ward in case of ongoing COVID-19 symptoms.

Data were obtained on the total count of virtual ward patients, consultations, ED-attended patients, and hospitalized patients. Details of hospitalized patients, including demographics, comorbidities, the status of vaccination, SARS-CoV-2 testing reports, reasons for patient escalation, hospital assessments and treatments, pathology reports, virtual ward dispositions, and treatment outcomes, were obtained. In addition, data on in-hospital mortality or deaths within 30 days post-discharge and re-hospitalizations were also obtained.

Results

In total, 7,021 COVID-19 patients were looked after in the virtual ward, and 473 were referred to hospitals for assessment. Of the ward patients, 26 patients were hospitalized during their care period, of which 85% (n=22) were associated with SARS-CoV-2 infections. Of the hospital-admitted patients, 53%, 31%, and 15% had received full vaccinations, partial vaccinations, and no vaccinations, respectively, and 11 patients had been treated by COVID-19 therapeutics.

The median age of the hospitalized patients was 62 years, and most (65%) of them were females. 50%, 42%, eight percent, and zero percent of hospitalized patients belonged to the very high, high, moderate, and low/very low-risk categories, respectively. One patient was admitted to the intensive care unit (ICU), and one patient died in the hospital.

Breathlessness (50%) and pain in the chest of non-cardiac origin (39%) were the most commonly observed reasons for hospitalization. Among ward-treated patients, 27%, eight percent, four percent, four percent and 58% were treated with budesonide, increased inhalational corticosteroids, sotrovimab, molnupiravir, and none of the drugs, respectively. Within 30 days of discharge, one patient was re-hospitalized.

The median length of stay among hospitalized patients was three days. 23% of cases were mild, 39% moderate, 27% severe, and 8% critical COVID-19. Among the patients hospitalized, 19% were given budesonide or other inhaled corticosteroids, 42% used dexamethasone, 38% used oral steroids, 4% used remdesivir, 8% baricitinib, while 38% received oxygen therapy.

Overall, the study findings showed that only a few COVID-19 patients cared for in the virtual ward required hospitalizations during Omicron BA.1 and Omicron BA.2 sub-VOC predominance as a direct effect of SARS-CoV-2 infections. The findings could aid hospital-need planning and optimizing care in virtual ward settings.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.