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.