Characteristics and Outcomes among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

Introduction: Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods: This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results: The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC's cohort had shorter hospital stays (4.1 versus 7.2 days, P <. 001) but more African American patients (23% versus 12%, P =. 02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P <. 001) and aspartate (>40U/L; 58.4% versus 42.4%, P =. 012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P =. 004), and mortality (21% versus 1.4%, P <. 001). Conclusions: Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.