Hospitalization period of COVID-19 for future plans in hospital.

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The ongoing pandemic (COVID-19) effects can be seen as collateral health effects on countries' health care systems, however, hidden aspects of management such as hospitalization period (HP) and effects on treatment facilities such as the number of hospital and critical care beds (CCBs) have not been duly acknowledged. Therefore, shortfalls of the hospitals under different scenarios like COVID-19 epidemic can be predicted. Most pandemic outcomes unfortunately start from the hospital front lines. In addition, HP is an important factor for health systems which can be effective in estimation of the required mechanical ventilators, supplies and staff[1,2]. Therefore, we estimated HP of COVID-19 using a systematic review and meta-analysis approach.

A registered systematic review and meta-analysis (CRD42020176951) using the PRISMA guidelines was conducted in the PubMed, Scopus and Web of science Databases. All the published peer-reviewed ducuments (Original research, short survey, and case series) on COVID-19 patients since inception till 18 April 2020, during which HP was reported or calculated (mean/median period with standard deviation (±SD) or 95 per cent CI), were included in our work. The data was quantitatively analyzed using comprehensive meta-analysis software (CMA, version 2.2.064).

According to our results (), the mean Combined HP (14·88 days (95 per cent CI 13·79-15·96)) is approximately similar to that of reported for Middle East Respiratory Syndrome (MERS) (mean: 13-17 days) and longer than of Severe acute respiratory syndrome (SARS) (median 10 days; IQR: 6-15). Although clinical features COVID-19 is not very different SARS, its own clinical parameter studied, and therefore the required treatment facilities, is almost similar to that of MERS. For this reason, and according to review of studies, the lessons learned from SARS and MERS can be based to take the efficient treatment and/or preventive measures in healthcare settings[3,4]. High hospitalization and case-fatality rates for COVID-19, implies on an emergence to provide sufficient hospital-based supplies. Furthermore, the mean HP was 14·56 days (95 per cent CI 14·23 to 14·90) in severe patient's categories and 11·54 days (95 per cent CI 11·40 to 11·70) in non-severe category (). This result is important for hospital managers and government to prepare financial and hospital resources in intensive care wards. There is a large gap between need for hospital services and available capacity, especially for inpatient and ICU beds, which may dictate the biggest challenge in time of outbreaks due to difficulty in triaging, allocation, and shortage of both trained staff and high-level care beds[2,3]. This study develops the current clinical knowledge on COVID-19. Depending on the HP and disease incidence rates, governments and policy makers can consider various programs to prevention and control of this pandemic such as increase financial resources, social distancing, providing personal protective equipment, isolation and quarantine program and hospital equipment.

Fig. 1

Random effect model meta-analysis of hospitalization period for COVID-19 patient A) combined value (I2 = 98·18, P < 0·001); B) subgroup value: severe and non-severe (I2 = 97·89, P < 0·002). Mean values show hospitalization period in COVID-19 patients. Lower and upper limit is 95 per cent confidence intervals =95 per cent CI, I-squared: percentage of total variation across studies. For each study, areas of blue Square are proportional to weight, horizontal line shows 95 per cent CI, and red diamonds sign indicate combined effect measures. For each study, brown diamond shows mean subgroup

Appendix S1. Supporting Information

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