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COVID-19 community care in Israel-- A nationwide cohort study from a large health maintenance organization
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  • Shirley Shapiro Ben David,
  • Daniella Cohen,
  • Rebekah Karplus ,
  • Angela Irony ,
  • Gili Ofer-Bialer ,
  • Israel Potasman ,
  • Orly Greenfeld ,
  • Joseph Azuri ,
  • Nachman Ash
Shirley Shapiro Ben David
Maccabi Healthcare Services
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Daniella Cohen
Maccabi Healthcare Services
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Rebekah Karplus
Maccabi Healthcare Services
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Angela Irony
Maccabi Healthcare Services
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Gili Ofer-Bialer
Maccabi Healthcare Services
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Israel Potasman
Maccabi Healthcare Services
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Orly Greenfeld
Maccabi Healthcare Services
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Joseph Azuri
Maccabi Healthcare Services
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Nachman Ash
Maccabi Healthcare Services
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Abstract

Introduction: Among the many medical challenges presented by the COVID-19 pandemic, management of the majority of COVID-19 patients in community outpatient settings rather than in hospital is crucial for the resource allocation of healthcare systems. This real-life study describes COVID-19 patients in three management settings: two outpatient settings and one inpatient. Methods: A retrospective database cohort study was conducted in a large Israeli Health Maintenance Organization. All laboratory-confirmed SARS-CoV-2 cases diagnosed 2/28/2020-6/20/2020, were included. Cases in the community setting were managed by physicians and other healthcare personnel through a nationwide remote monitoring center, using preliminary telehealth triage, 24/7 virtual care , all based on the individual patient’s clinical and social circumstances. Data were extracted from medical records. Outcome parameters included hospital admission, disease severity, need for respiratory support and mortality. Results: 5,525 cases tested positive. Seventy-seven cases who live in long- term facilities were excluded. 5448 cases, aged 36.36±20.31 (range 0-97 years) were enrolled. 88.7% were initially managed as outpatient either at home or in designated hotels, and 11.3% were hospitalized. 3.1% and 2.1% of the patients who were initially allocated for home or hotel stay, respectively, later required hospitalization. The main reason for hospitalization was dyspnea; twelve were diagnosed with severe disease. Fifty-six patients (1.3%) died, five (0.1%) of whom were initially allocated to the outpatient settings. Conclusions: Care for appropriately selected COVID-19 patients in the community provides a safe and effective option. This can contribute to reducing the hospitalization burden, with no evidence of increased morbidity or mortality.