MMWR Morb Mortal Wkly Rep. 2020 Jul 10;69(27):864-869. doi: 10.15585/mmwr.mm6927a3.
As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals, such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged ≥60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.
截至 2020 年 7 月 5 日，美国报告了约 280 万例 2019 冠状病毒病（COVID-19）病例和 13 万与 COVID-19 相关的死亡病例（1）。在历史上受到健康差异影响的人群，包括某些种族和族裔少数群体，不成比例地受到 COVID-19 的影响并因此住院（2-4）。数据还表明，无家可归者感染严重急性呼吸综合征冠状病毒 2（导致 COVID-19 的病毒）的患病率较高（5）。安全网医院，如为无论其保险状况或支付能力如何都提供医疗保健的波士顿医疗中心（BMC），治疗这些人群的比例更高，并且在 COVID-19 大流行期间可能会遇到挑战。本报告描述了 2020 年 3 月 1 日至 5 月 18 日期间在 BMC 接受实验室确诊的 COVID-19 成年患者的特征和临床结局。在此期间，有 2729 名 SARS-CoV-2 感染患者在 BMC 接受治疗，并分为以下相互排斥的临床严重程度分类之一：单纯门诊管理（1543 例；56.5％），非重症监护病房（ICU）住院治疗（900 例；33.0％），无侵入性机械通气的 ICU 住院治疗（69 例；2.5％），有机械通气的 ICU 住院治疗（119 例；4.4％）和死亡（98 例；3.6％）。该队列包括 44.6％的非西班牙裔黑人（黑人）患者和 30.1％的西班牙裔或拉丁裔（西班牙裔）患者。无家可归者占患者的 16.4％。大多数死亡患者的年龄≥60 岁（81.6％）。临床严重程度因年龄，种族/族裔，潜在疾病和无家可归而有所不同。与黑人（39.5％）或非西班牙裔白人（白人）（34.4％）患者相比，住院治疗的西班牙裔患者比例更高（46.5％），在年龄<60 岁的患者中，这一发现最为明显。非 ICU 住院患者中有更高比例的人无家可归（24.3％），而 ICU 中无机械通气（15.9％），有机械通气（15.1％）或死亡（15.3％）的无家可归患者比例更高。与疾病和临床严重程度相关的患者特征，例如年龄，种族/族裔，无家可归和潜在疾病，可以为可能改善结局和减轻 COVID-19 对医疗保健系统的压力的针对性策略提供信息。
