COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment
Stephanie A Richard, Simon Pollett, Charlotte Lanteri, Eugene V. Millar, Anthony C Fries, Ryan C. Maves, Gregory Utz, Tahaniyat Lalani, Alfred G. Smith, Rupal Mody, Anuradha Ganesan, Rhonda E Colombo, Christopher Colombo, David A Lindholm, Cristian Madar, Sharon Chi, Nikhil Huprikar, Derek Larson, Samantha Bazan, Caroline English, Edward Parmelee, Katrin Mende, Eric D. Laing, Christopher C. Broder, Paul W. Blair, Josh Chenoweth, Mark P. Simons, David R. Tribble, Brian K. Agan, Timothy Burgess, EPICC COVID-19 Cohort Study Group, John D. Cowden, David A Lindholm, Ana E Markelz, Katrin Mende, T. Allen Merritt, Robert Walter, Trevor Wellington, S Bazan, N Dimascio-Johnson, Evan Ewers, K Gallagher, Derek Larson, M Odom, Ann Rutt, Paul W. Blair, Josh Chenoweth, David J. Clark, Susan Chambers, Christopher Colombo, Rhonda E Colombo, Christopher P. Conlon, K Everson, P Faestel, Trevor S. Ferguson, Leo I. Gordon, Sarah Grogan, S. Bertrán de Lis, C Mount, D Musfeldt, D Odineal, Rebecca Sainato, Carin Schofield, Caroline Skinner, Michal Stein, Mary E. Switzer, M Timlin, S Wood, Rebecca M. Carpenter, L Kim, Karl Kronmann, Tahaniyat Lalani, T Lee, Adrian D. Smith, Tyler Warkentien, John Arnold, Catherine M Berjohn, S. Cammarata, S. Ali Husain, Aoife Lane, Ryan C. Maves, Scott Parrish, Gregory Utz, Sharon Chi, E Filan, K Fong, Timothy S. Horseman, Milissa U. Jones, A Kanis, A Kayatani, William Londeree, Cristian Madar, Joanna Masel, Melissa McMahon, G Murphy, Viseth Ngauy, Peter Schmidt, E Schoenman, Catherine Uyehara, R Villacorta Lyew
Abstract
BACKGROUND: We evaluated clinical outcomes, functional burden, and complications 1 month after coronavirus disease 2019 (COVID-19) infection in a prospective US Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. METHODS: MHS beneficiaries presenting at 9 sites across the United States with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, a COVID-19-like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and International Classification of Diseases-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. RESULTS: A total of 1202 participants were enrolled. There were 1070 laboratory-confirmed SARS-CoV-2 cases and 132 SARS-CoV-2-negative participants. In the first month post-symptom onset among the SARS-CoV-2-positive cases, there were 212 hospitalizations, 80% requiring oxygen, 20 ICU admissions, and 10 deaths. Risk factors for COVID-19-associated hospitalization included race (increased for Asian, Black, and Hispanic compared with non-Hispanic White), age (age 45-64 and 65+ compared with <45), and obesity (BMI≥30 compared with BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen, and 31% had not returned to normal daily activities at 1 month post-symptom onset. CONCLUSIONS: Older age, reporting Asian, Black, or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by 1 month.