{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:11:41Z","timestamp":1753877501955,"version":"3.41.2"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Clinical severity of coronavirus disease 2019 (COVID-19) may vary over time; trends in clinical severity at admission during the pandemic among hospitalized patients in the United States have been incompletely described, so a historical record of severity over time is lacking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We classified 466677 hospital admissions for COVID-19 from April 2020 to April 2021 into 4 mutually exclusive severity grades based on indicators present on admission (from most to least severe): Grade 4 included intensive care unit (ICU) admission and invasive mechanical ventilation (IMV); grade 3 included non-IMV ICU and\/or noninvasive positive pressure ventilation; grade 2 included diagnosis of acute respiratory failure; and grade 1 included none of the above indicators. Trends were stratified by sex, age, race\/ethnicity, and comorbid conditions. We also examined severity in states with high vs low Alpha (B.1.1.7) variant burden.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Severity tended to be lower among women, younger adults, and those with fewer comorbidities compared to their counterparts. The proportion of admissions classified as grade 1 or 2 fluctuated over time, but these less-severe grades comprised a majority (75%\u201385%) of admissions every month. Grades 3 and 4 consistently made up a minority of admissions (15%\u201325%), and grade 4 showed consistent decreases in all subgroups, including states with high Alpha variant burden.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Clinical severity among hospitalized patients with COVID-19 has varied over time but has not consistently or markedly worsened over time. The proportion of admissions classified as grade 4 decreased in all subgroups. There was no consistent evidence of worsening severity in states with higher vs lower Alpha prevalence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofab599","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T15:04:40Z","timestamp":1638371080000},"source":"Crossref","is-referenced-by-count":3,"title":["Trends in Clinical Severity of Hospitalized Patients With Coronavirus Disease 2019\u2014Premier Hospital Dataset, April 2020\u2013April 2021"],"prefix":"10.1093","volume":"9","author":[{"given":"Geoffrey P","family":"Whitfield","sequence":"first","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron M","family":"Harris","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer S","family":"Kadri","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Warner","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sapna","family":"Bamrah Morris","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer E","family":"Giovanni","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica S","family":"Rogers-Brown","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison F","family":"Hinckley","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyudmyla","family":"Kompaniyets","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanta D","family":"Sircar","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussain R","family":"Yusuf","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilia H","family":"Koumans","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth K","family":"Schweitzer","sequence":"additional","affiliation":[{"name":"COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"author":"Centers for Disease Control and Prevention.","key":"2021122506520995000_CIT0001"},{"author":"National Institutes of 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