Massachusetts saw a record number of COVID-19 hospitalizations during the Omicron wave, but a recent report found that about half of those cases involved people who tested positive after being admitted for another reason.
Hospitals have long been accused of inflating COVID-19 cases by including anyone who tests positive, even if they only had a mild case and sought care for a different ailment. To help paint a clearer picture of the impact COVID-19 is having on people, Massachusetts is now requiring hospitals to report the number of COVID-positive patients receiving the steroid dexamethasone.
On Tuesday, there were 3,187 people with COVID-19 in Massachusetts hospitals, according to the Massachusetts Department of Health. Of those patients, 49 percent were considered “incidental,” in that they tested positive while hospitalized for other reasons. The remaining 51 percent of patients were reported as being hospitalized primarily for COVID-19.
Dr. Shira Doron, an infectious disease physician and epidemiologist at Tufts Medical Center, told Newsweek that using dexamethasone as a standard for classifying COVID-19 cases isn’t a perfect system. The steroid is standard of care for someone who is hospitalized with a moderate or severe case of COVID-19, so reporting could miss COVID cases where people’s lungs aren’t treated and could include people being treated with dexamethasone for another ailment.
“But since dexamethasone is the standard of care for patients with COVID lung involvement, it is a decent proxy,” Doron told Newsweek. “[I] determined that dexamethasone administration would be a reliable, objective and feasible measure for hospitals to collect and report.”
Dexamethasone is the only drug that’s shown to decrease mortality from COVID-19, doctors told Newsweek, but it can only be used in patients that need supplemental oxygen. This means if a patient is being treated for heart problems or blood clots related to COVID-19 or are admitted for lingering COVID-19 problems, they could be left out of the primary group.
Under Massachusetts’ new reporting system, patients are reevaluated each day. So, if a person who is admitted for a non-COVID reason later needs dexamethasone because their condition deteriorates, they’ll be added to the list of primary COVID patients.
COVID hospitalizations are starting to wane in Massachusetts after hitting a record high in January. An estimated 16 percent of hospital beds in the state are being used for COVID-positive patients, according to the Department of Health and Human Services, and 32 percent of beds in intensive care units are filled with COVID patients.
There’s no national standard for differentiating between patients who are being treated primarily for COVID-19 and those who test positive but need unrelated care. Other states have also asked hospitals to differentiate between the two categories and the push comes as people have grown critical of hospitals for lumping all COVID-positive patients into one group.
Some have lamented the reporting for the lack of transparency and hospitals have been accused of inflating COVID hospitalizations and deaths.
While dexamethasone is not a perfect metric, a Department of Public Health spokeswoman told WBUR it should capture more than 90 percent of COVID cases. However, Dr. Jason Wasfy, medical director of the Massachusetts General Physicians Organization, told WBUR he believes the new classification system will lead to an undercounting of acute COVID patients.