Predictors of hospitalization, death and incomplete/non-recovery from SARS-CoV-2 in an ambulatory global population

Objectives

To provide globally representative data on hospitalization and death in recently SARS-CoV-2-positive ambulatory populations.

Methods

We enrolled SARS-CoV-2-positive ambulatory adults in the cohort studies, ICOS (47 sites, 5 continents), and PCOS (Liberia) and followed for 28-days. Kaplan-Meier estimates of percentage of those hospitalized or died were derived. Risk factors for hospitalization, death, and failure to recover were identified using Cox and logistic models respectively.

Results

9817(ICOS) and 125(PCOS) participants, 46.7% male; median age 43 years; 24.5% with comorbidity(s); 0.8% pregnant; 9.3% SARS-CoV-2 vaccinated, were enrolled June-2020 and January-2022. By 28 days, 424(4.3%) participants were hospitalized or had died; most within 7 days of enrolment(3.4%). Hospitalization or death declined over calendar time i.e. 7.5%(2020); 4.1(first-half 2021) and 2.1%(second-half 2021), P < 0.0001. Older age, male sex, comorbidities, pregnancy, symptomatic disease were each independently associated with hospitalization or death; SARS-CoV-2 vaccination reduced this risk. At 28 days, 26.1% and 29.9% reported ongoing symptoms and failure to return to pre-morbid health respectively.

Conclusions

These global SARS-CoV-2 ambulatory cohort studies identified demographic/clinical risks for hospitalization or death. Vaccination does not fully explain hospitalization and death declines over time. Symptomatic recovery and return to premorbid health were incomplete at 28 days in $\approx$one third.