The Unpredictable Course of COVID-19


Much has been learned about the novel coronavirus within the past seven months, including risk factors for severe illness, treatments that could benefit hospitalized patients, and the effectiveness of masks and social distancing to prevent the spread of infection. Dr. Kilaru points out however that many questions still remain, like why some patients with COVID-19 worsen several days after initially developing symptoms, in a pattern not characteristic of other viral illnesses.

Clinicians who work in emergency departments must decide whether patients with COVID-19 are sick enough to require hospitalization or can safely recover at home. In the case of COVID-19, clinicians need better data upon which to base guidance and reassurance to patients who are sick but stable.


A team including Austin Kilaru, a PISC Postdoctoral Fellow, Leonard Davis Institute (LDI) associate fellow, emergency physician, and an advanced fellow in the VA Clinical Scholars Program, studied COVID-19 patients who return to the hospital after an initial evaluation in the emergency department. The team analyzed the outcomes of 1,419 patients with COVID-19 who were evaluated and discharged from five University of Pennsylvania Health System (UPHS) hospital emergency departments from March through May.

Nearly 5% of patients returned within 72 hours and needed admission to the hospital, which may be five times higher than that described for all ED patients. An additional 3.5% of patients needed admission within one week. These study findings have implications for systems seeking to monitor patients with COVID-19 as well as clinicians seeking evidence with which to counsel patients.


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