Navigating the waves in Colombia: a cohort study of inpatient care during four COVID-19 waves

David E Rebellón-Sánchez; Tania M Guzmán; Sarita Rodriguez; Julio Llanos-Torres; Daniela Vinueza; Eric Tafurt; Estefanía Beltrán; Álvaro Martínez; Fernando Rosso

doi:10.1016/j.bjid.2024.103737

Navigating the waves in Colombia: a cohort study of inpatient care during four COVID-19 waves

Braz J Infect Dis. 2024 Mar 11;28(2):103737. doi: 10.1016/j.bjid.2024.103737. Online ahead of print.

Authors

David E Rebellón-Sánchez¹, Tania M Guzmán², Sarita Rodriguez², Julio Llanos-Torres², Daniela Vinueza², Eric Tafurt³, Estefanía Beltrán², Álvaro Martínez⁴, Fernando Rosso⁴

Affiliations

¹ Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia. Electronic address: david.rebellon@fvl.org.co.
² Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia.
³ Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia; Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia.
⁴ Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia; Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia; Fundación Valle del Lili, Servicio de Enfermedades Infecciosas, Cali, Colombia.

Abstract

Introduction: Understanding the intricate dynamics between different waves of the COVID-19 pandemic and the corresponding variations in clinical outcomes is essential for informed public health decision-making. Comprehensive insights into these fluctuations can guide resource allocation, healthcare policies, and the development of effective interventions. This study aimed to compare the characteristics and clinical outcomes of COVID-19 at peak transmission points by including all patients attended during the first four pandemic waves in a referral center in Colombia.

Material and methods: In a prospective observational study of 2733 patients, clinical and demographic data were extracted from the Fundacion Valle de Lili's COVID-19 Registry, focusing on ICU admission, Invasive Mechanical Ventilation (IMV), length of hospital stay, and mortality.

Results: Our analysis unveiled substantial shifts in patient care patterns. Notably, the proportion of patients receiving glucocorticoid therapy and experiencing secondary infections exhibited a pronounced decrease across waves (p < 0.001). Remarkably, there was a significant reduction in ICU admissions (62.83% vs. 51.23% vs. 58.23% vs. 46.70 %, p < 0.001), Invasive Mechanical Ventilation (IMV) usage (39.25% vs. 32.22% vs. 31.22% vs. 21.55 %, p < 0.001), and Length of Hospital Stay (LOS) (9 vs. 8 vs. 8 vs. 8 days, p < 0.001) over the successive waves. Surprisingly, hospital mortality remained stable at approximately 18‒20 % (p > 0.05). Notably, vaccination coverage with one or more doses surged from 0 % during the initial waves to 66.71 % in the fourth wave.

Conclusions: Our findings emphasize the critical importance of adapting healthcare strategies to the evolving dynamics of the pandemic. The reduction in ICU admissions, IMV utilization, and LOS, coupled with the rise in vaccination rates, underscores the adaptability of healthcare systems. Hospital mortality's persistence may warrant further exploration of treatment strategies. These insights can inform public health responses, helping policymakers allocate resources effectively and tailor interventions to specific phases of the pandemic.

Keywords: All-cause mortality; COVID-19; COVID-19 vaccines; Clinical presentations; Pandemic; SARS-COV-2.