A GIRFT study examining the profile and outcomes of people hospitalised with COVID-19 in the first and second waves of the pandemic has been published, aiming to help teams prepare for future case surges.
COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England is published in BMJ Thorax, providing a complete record of all COVID-19 related hospital activity over the 13 months from 1st March 2020 to 31st March 2021.
It is written by a Getting It Right First Time (GIRFT) team comprising senior research associate William Gray, honorary fellow Annakan Navaratnam, retired chief information officer Jamie Day and programme Chair Professor Tim Briggs, alongside Julia Wendon from the liver intensive care unit at King’s College London.
The observational study examines the outcomes of the 374,244 patients who had a diagnosis of COVID-19 during a hospital stay in the first and second waves. One in four (93,701 or 25%) died in hospital.
The study found that while rates of hospitalisation at the peak of the second wave were almost double those at the peak of the first, adjusted in-hospital mortality rates fell from 40-50% in March 2020 to less than 10% in March 2021. Advances in hospital management of the disease in the same period, including an expansion in critical care capacity and improvements in the organisation of hospital networks, are likely to have contributed to improved patient outcomes.
However, improvements in mortality rates were less apparent in older patients and those with comorbidities. And while the rates fell between the first and second wave for all ethnic groups, the decline was less pronounced for people of Bangladeshi, Indian, Pakistani and other Asian and Black African ethnicity. The study concludes that the reasons for this higher mortality risk in some ethnic groups should be studied further.
Lead author William Gray said:
In-hospital mortality rates are a key marker for the performance of health services in managing patients with COVID-19, but little has been known about how NHS hospitals coped with the surge in cases during winter 2020/2021. We hope this study enables a better understanding of how outcomes changed over time and which patient groups responded less well to advances in patient management, which will be important in preparing for future case surges.