COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment

Stephanie A Richard; Simon D Pollett; Charlotte A Lanteri; Eugene V Millar; Anthony C Fries; Ryan C Maves; Gregory C Utz; Tahaniyat Lalani; Alfred Smith; Rupal M Mody; Anuradha Ganesan; Rhonda E Colombo; Christopher J Colombo; David A Lindholm; Cristian Madar; Sharon Chi; Nikhil Huprikar; Derek T Larson; Samantha E Bazan; Caroline English; Edward Parmelee; Katrin Mende; Eric D Laing; Christopher C Broder; Paul W Blair; Josh G Chenoweth; Mark P Simons; David R Tribble; Brian K Agan; Timothy H Burgess; EPICC COVID-19 Cohort Study Group

doi:10.1093/ofid/ofab556

COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment

Open Forum Infect Dis. 2021 Nov 10;8(12):ofab556. doi: 10.1093/ofid/ofab556. eCollection 2021 Dec.

Authors

Stephanie A Richard^{1

2}, Simon D Pollett^{1

2}, Charlotte A Lanteri³, Eugene V Millar^{1

2}, Anthony C Fries⁴, Ryan C Maves^{1

5}, Gregory C Utz^{1

2

5}, Tahaniyat Lalani^{1

2

6}, Alfred Smith⁶, Rupal M Mody⁷, Anuradha Ganesan^{1

2

8}, Rhonda E Colombo^{1

2

9

10}, Christopher J Colombo^{9

10}, David A Lindholm^{11

10}, Cristian Madar¹², Sharon Chi^{1

2

12}, Nikhil Huprikar^{8

10}, Derek T Larson^{10

13}, Samantha E Bazan¹⁴, Caroline English^{1

2}, Edward Parmelee^{1

2}, Katrin Mende^{1

2

11}, Eric D Laing¹⁵, Christopher C Broder¹⁵, Paul W Blair^{16

17}, Josh G Chenoweth^{2

17}, Mark P Simons¹, David R Tribble¹, Brian K Agan^{1

2}, Timothy H Burgess¹; EPICC COVID-19 Cohort Study Group

Collaborators

EPICC COVID-19 Cohort Study Group:
J Cowden, D Lindholm, A Markelz, K Mende, T Merritt, R Walter, T Wellington, S Bazan, N Dimascio-Johnson, E Ewers, K Gallagher, D Larson, M Odom, A Rutt, P Blair, J G Chenoweth, D Clark, S Chambers, C Colombo, R Colombo, C Conlon, K Everson, P Faestel, T Ferguson, L Gordon, S Grogan, S Lis, C Mount, D Musfeldt, D Odineal, R Sainato, C Schofield, C Skinner, M Stein, M Switzer, M Timlin, S Wood, R Carpenter, L Kim, K Kronmann, T Lalani, T Lee, A Smith, T Warkentien, J Arnold, C Berjohn, S Cammarata, S Husain, A Lane, R Maves, J Parrish, G Utz, S Chi, E Filan, K Fong, T Horseman, M Jones, A Kanis, A Kayatani, W Londeree, C Madar, J Masel, M McMahon, G Murphy, V Ngauy, P Schmidt, E Schoenman, C Uyehara, R Villacorta Lyew, B Agan, C Broder, T Burgess, C Byrne, C Coles, C English, P Hickey, E Laing, J Livezey, A Malloy, T Oliver, E Parmelee, S Pollett, M Rajnik, S Richard, J Rozman, M Sanchez, A Scher, M Simons, A L Snow, D Tribble, A Fries, A Farmer, B Barton, D Hostler, C Maldonado, T Musich, R Radcliffe, M Swain, M Banda, B Davis, T Hunter, O Ikpekpe-Magege, S Kemp, R Mody, M Wiggins, A Ganesan, D Gunasekera, N Huprikar

Affiliations

¹ Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
² Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
³ Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
⁴ US Air Force School of Aerospace Medicine, Wright-Patterson, Ohio, USA.
⁵ Naval Medical Center San Diego, San Diego, California, USA.
⁶ Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
⁷ William Beaumont Army Medical Center, El Paso, Texas, USA.
⁸ Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
⁹ Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.
¹⁰ Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹¹ Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA.
¹² Tripler Army Medical Center, Honolulu, Hawaii, USA.
¹³ Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA.
¹⁴ Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA.
¹⁵ Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁶ Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁷ Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA.

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.

Keywords: COVID-19; burden; outcomes; predictive symptoms; risk.