Discussion
Patients who survived hospitalization with COVID-19 experienced varying
time to achieve clinical stability before hospital discharge. While much
of the focus has been on the severity of COVID-19 among those who
required hospitalization, less is known regarding the characteristics of
patients who recovered promptly. Clinical features associated with a
favorable hospital course could help clinicians triage competing
resources in the care of patients especially at institutions challenged
by the demands from the ebb and flow in COVID-19 cases.
Our findings indicate that female sex, longer time from symptom onset to
hospitalization, less severe presentation upon admission (fevers, septic
shock, ICU, supplemental oxygen), and absence of bacterial co-infection
are factors favoring prompt recovery. We observed a similar prevalence
of COVID-19 requiring hospitalization between male and female sex in our
study. Although literature has shown a correlation between men with
COVID-19 and worse outcomes including death, our data is the first to
show an association between female sex and shortened recovery
time.6,7 Our data is also the first to show that an
extended time from symptom onset to hospital admission is a predictor
for prompt recovery.
We found that significantly less patients with prompt recovery had
bacterial co-infections especially concurrent pneumonia compared to
those in the prolonged TTS group. Nonetheless, 86% of patients in the
short TTS group were prescribed antibacterial therapy for a median
duration of 4 days despite the absence of bacterial co-infection. This
finding underscores the need for continued antimicrobial stewardship to
minimize indiscriminant antibacterial use in hospitalized COVID-19
patients. As expected, those with a short TTS had a less complicated
course with less than one week length of hospital stay in this cohort.
While we identified distinguishing clinical features between groups with
varying time to achieve clinical stability, our study is limited by the
relatively small number of patients at a single center and the lack of
viral load or host immune response measurements to provide a biological
basis to our clinical observations.