Letter to Editor: Strategy for Hospitalization and Discharge of COVID-19 Patients: Based on the Nationwide Clinical Course Analysis.

Dear Editor,

Despite the efforts using various prevention/control measures, coronavirus disease 2019 (COVID-19) patients continue to occur due to imported infections and the spread within communities. As of September 22, 2020, there were 23,216 cumulative confirmed cases in Korea, and around 100 confirmed cases per day.1 As this trend continues, there are concerns that COVID-19 may re-surge to a larger scale at the end of this year, which could result in overwhelming of medical facilities and collapse of healthcare system. Thus, maintaining the healthcare system scientific and strategic criteria for hospitalization and discharge are essential to reduce the collapse. Recently, we reported clinical course and outcomes of 3,060 COVID-19 patients.2

Through additional analyses of above 3,060 COVID-19 cases, we can find some important implications regarding hospital admission or discharge, which could prevent overcrowding of medical facilities. In this context, we suggest 5 strategic options.

1. If patients met all of the following criteria at the time of diagnosis, the possibility of requiring oxygen therapy was 1.8% (10/556): 1) age under 50 years, 2) no underlying disease of hypertension, diabetes, chronic lung disease, chronic kidney disease, or dementia, and 3) alert mental status, and 4) no subjective dyspnea. The patients who meet all the conditions mentioned above don’t need hospitalization and stay at home if there are family members or friends who can check condition of the patients.

2. If the patients met all the following criteria at the time of hospital admission, the possibility of requiring oxygen therapy was only 0.1% (1/778): 1) age under 50 years old, 2) no underlying disease of hypertension, diabetes, chronic lung disease, chronic kidney disease, or dementia, 3) alert mental status at the time of diagnosis, 4) oxygen saturation > 93% in room air, 5) respiratory rate < 22 times/min, and 6) systolic blood pressure > 100 mmHg. These patients who meet all the conditions mentioned above could be discharged and stay at home if there are family members or friends who can check condition of the patients.

3. If patients are under 50 and have not required oxygen for 10 days after onset of the first symptom, possibility of requirement for future oxygen therapy was only 0.2% (2/813). Thus, the patients could be discharged and stay at home if there are family members or friends who can check condition of the patients.

4. If patients are under 50 and quit oxygen therapy for three days or more, there was no one who needs additional oxygen therapy. These patients could be discharged and stay at home if there are family members or friends who can check condition of the patients.

5. Following conditions were warning signals of clinical deterioration and that probabilities of requiring mechanical ventilation were around 10% or more: 1) body mass index > 30 (9.9%, 6/64), 2) quick sepsis related organ failure assessment score = 1 or more (17.9%, 20/112), 3) underlying disease of diabetes (22.3%, 23/103), chronic kidney diseases (43.8%, 7/16), or dementia (43.5%, 10/23), and 4) age > 65 (23.7%, 32/135). If the patients had any of above conditions should be hospitalized immediately and closely observed.

Overflow of hospitalization could disrupt the medical care system, which may result in catastrophe under pandemic situation. Thus, it is important to reduce unnecessary hospitalization to save beds for high-risked or severe patients. In this context, we think above findings could be helpful in managing current pandemic of COVID-19 in Korea.