Category: COVID-19 Complications, Co-infections, and Clinical Outcomes

Poster Session: COVID-19 Complications, Co-infections, and Clinical Outcomes

368 - Clinical Characteristics of Hospitalized COVID-19 American Indian Patients in Rural Arizona

Presenting Author(s)

AN

Amy Nham

Pharmacist
Indian Health Service
Whiteriver, Arizona
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

RC

Ryan M. Close

Dr. Ryan M. Close
Indian Health Service
Whiteriver, AZ
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: American Indians have an increased risk of serious complications from COVID-19 due to the high prevalence of comorbidities such as diabetes, heart disease, obesity, and asthma. To date, there has been limited analysis of COVID-19 in the AI population. This study describes the characteristics of hospitalized COVID-19 patients from a well-defined AI population in eastern Arizona. Additionally, we explored the impact of early referral via contact tracing versus those who self-presented.

Methods: Retrospective chart reviews were completed for patients hospitalized for COVID from March 29 to May 16, 2020. Summary statistics were used to describe demographics, symptoms, pre-existing conditions, and hospitalization data.

Results: We observed 447 laboratory-confirmed cases of COVID-19, resulting in 71 (15.9%) hospitalizations over a 7-week period and a hospitalization rate of 159 per 1,000 persons. Of the 50 hospitalizations reviewed sequentially, 56% were female, median age of 55 (IQR 44-65). Median number of days hospitalized was 4 (2-6), with 16% requiring intensive care unit support, 15% intubated, 12% readmitted, and 10% deceased. 67% had an epidemiological link, and 32% had an emergency department or outpatient clinic visit within 7 days of hospitalization. All patients were symptomatic; the most common symptoms were cough (90%), shortness of breath (78%), and subjective fever (66%). 86% of patients had a pre-existing condition; the most common pre-existing conditions were diabetes (66%), obesity (58%), and hypertension (52%, Figure 1). All patients had elevated LDH, 94% had elevated CRP, 86% had elevated d-dimer, and 40% had lymphopenia; only 10% had an elevated WBC count and 26% had thrombocytopenia (Table 1). 26% of the patients were referred in by the tracing team (Table 2). Analysis of 500 hospitalizations will be available in October 2020.Figure 1. Frequency of Pre-existing Conditions

Table 1. Characteristics of Hospitalized Patients

Table 2. Hospitalization Data for Self-Presented vs. Referred Patients

Conclusion: Most AI patients hospitalized had a pre-existing condition, symptoms of cough or shortness of breath, and elevated LDH, CRP, and d-dimer. More research is needed to understand the patterns of COVID-19 related disease in vulnerable populations, like AI/AN, and to examine the utility of early referral by contact tracing teams in rural settings which may guide future tracing strategies.