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Are hospitals sending home more sick COVID patients? Yes, says Brown University expert

As hospitals fill up across the country, they’re sending home a higher percentage of patients to recover on their own, Dr. Ashish Jha, dean of the Brown University School of Public Health, writes on Twitter.



Dr. Ashish K. Jha wearing glasses and smiling at the camera: Dr. Ashish Jha, dean of the Brown University School of Public Health


© The Providence Journal
Dr. Ashish Jha, dean of the Brown University School of Public Health

“There is something funny happening with COVID hospitalizations,” Jha wrote in a multi-thread post late last night.

The percentage of COVID patients getting hospitalized is falling, he notes.

“My theory?” he writes. “As hospitals fill up, (the) bar for admission (is) rising. A patient who might have been admitted 4 weeks ago may get sent home now.”

The change doesn’t affect just COVID patients, but patients with other conditions, too, such as heart problems, or infections, Jha writes.

The pandemic has forced doctors to make difficult choices on who should be admitted and who should be sent home, Jha writes.

“This is not Doctors being cruel,” he writes, but with “fewer and fewer beds, (the) bar for hospitalizing anyone is rising.”

That “likely means more people are suffering, getting worse, or even dying at home.” 

In Rhode Island, with established hospitals filling up, two field hospitals are opening to accept COVID patients.

In the multiple thread tweet, Jha explains a formula that he says until recently could “reliably predict” hospitalizations.

More: Rhode Island opens its two field hospitals as COVID-19 hospitalizations surge and “the pause” begins

More: RI reports 27 COVID deaths, 2,769 more cases over last 3 days

“For months, you could reliably predict new hospitalizations,” he writes. “How? By taking cases 7 days prior, multiplying by 3.5%.”

He explains that 3.5% or (1 in 29) of those diagnosed on a day would typically be hospitalized about seven days later.

That formula held up in September and October, but the percentage showed a slight decline in early November and a bigger drop by the middle of the month.

It dropped to 3.2% by November 8 and showed weekly declines, falling to 2.1% by Nov. 29, Jha writes.

For example, he writes, there were 146,000 new COVID cases reported nationally on Nov. 15. Based on the formula, 5,111 should have been hospitalized by a week later, Nov. 22, but only 3,670 were hospitalized.

“Here’s the bottom line: 1 in 3 people who would have been admitted on October 1 aren’t being admitted by November 22. That’s a big change!” he writes. “And given big rise in test positivity – its likely much higher.”

Many patients being sent home “will likely do worse at home.” Some may be OK but others will return to the hospital “sicker or even die at home.”

When the admission threshold goes up, it affects all potential patients, he writes.

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This article originally appeared on The Providence Journal: Are hospitals sending home more sick COVID patients? Yes, says Brown University expert

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