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What Indiana counts as a COVID-19 hospitalization may surprise you

Hospitalized ‘with’ COVID-19 or ‘because’ of COVID-19?
The state’s data does not differentiate between people hospitalized with COVID related illnesses and people who are hospitalized for other reasons and who also test positive for the disease.
Posted at 5:00 AM, Jan 20, 2022
and last updated 2022-01-21 11:37:40-05

INDIANAPOLIS — Indiana has experienced record-high hospitalizations for COVID-19 so far this month.

As of January 18, the state’s dashboard shows 3,492 total COVID-19 hospitalizations — including 3,159 confirmed to have the disease and 333 patients suspected of having COVID-19.

Amid this omicron surge, you may be surprised at what the state counts as a COVID-19 hospitalization.

Many people might think of someone who is hospitalized because they’re sick with COVID-19 related symptoms.

But WRTV Investigates uncovered that’s not always the case.

The state’s data does not differentiate between people hospitalized with COVID-related illnesses and people who are hospitalized for other reasons and who also test positive for the disease.

As COVID-19 maintains its grip on Indiana, state health officials focus on trends when it comes to cases and hospitalizations.

“The number of people hospitalized with COVID has increased 700% since late June,” said Dr. Kris Box, Indiana State Health Commissioner, in a December 29 news conference. “Our workforce is depleted physically and mentally.”

Dr. Brian Dixon is the Director of Informatics at the Regenstrief Institute in Indianapolis, which advises the Indiana State Department of Health on data trends.

Dr. Dixon explains there are many reasons why the state does not distinguish between people who are sick with COVID versus patients who are in the hospital.

For one, COVID-19 impacts a person’s health whether it’s the reason they were first hospitalized or not.

“Just because someone goes to the hospital without any symptoms and without thinking they have COVID, and then they test positive, that doesn’t meant that the COVID didn’t contribute,” Dixon said. “People who think they’re having a heart attack or a stroke, and then show up to the hospital and test positive for COVID-19, that heart attack or stroke probably was caused by the COVID-19. COVID-19 probably exacerbated the stroke or heart attack.”

Dixon says approximately 75% of the people in the hospital for COVID have the disease listed as their primary diagnosis.

“There are some people whose primary diagnosis is pneumonia or respiratory failure or fever ... but later tested positive for COVID,” Dixon said. “A lot of times when people get admitted to the hospital, they may have multiple diagnoses, it can be hard to figure out which one is the primary, which one is the secondary. So, whether it was pneumonia or COVID itself, they get counted because it’s a COVID related hospitalization.”

The Regenstrief Institute also reports its own hospitalization data and does not differentiate.

“One it’s confusing, and two it could expose, especially the small communities, someone’s individual level diagnosis,” Dixon said. “We would never want anyone in a particular community to be identified because of a specific diagnosis they have. That’s why we don’t do it.”

The state has faced skepticism from some people, including Attorney General Todd Rokita, about COVID-19 related data.

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Dixon says neither Regenstrief nor the state is trying to “inflate” hospitalization numbers.

“These numbers are not inflated for any political agenda,” Dixon said. “They really reflect the number of people in the hospital at any given time that have COVID-19 or admitted while positive with COVID-19. No one is fabricating data around COVID-19 to inflate the numbers or to scare people. "

Dixon emphasizes that very few of the patients counted in the state’s COVID-19 hospitalizations are not impacted by the disease.

“There are probably a few people out there who are asymptomatic who came into the hospital for something else and they tested positive because the hospital is testing everybody but that's very, very few numbers,” Dixon said.

The Indiana Hospital Association declined an on camera interview, but in a statement explained it would be time consuming to further break down hospitalization data.

“This distinction is not relevant to the main issue facing the public. Indiana hospitals are overwhelmed with the highest number of patients on record and have reached a state of crisis with dwindling capacity left to care for patients,” said Brian Tabor, IHA President, in a statement to WRTV. “At any given point there are several hundred patients boarding in emergency departments around the state awaiting open beds. The total number of hospitalizations and the current surge in emergency room visits remain our central focus.”

The Indiana Hospital Association represents more than 170 hospitals in Indiana from rural community hospitals to regional and statewide health systems.

“Whether a patient is hospitalized ‘with’ COVID-19 or ‘because’ of COVID-19, treatment requires immense health care services and resources, which are at a scarcity,” Tabor's statement read. “Indiana hospitals remain laser-focused on delivering the care our patients and communities depend on during this unprecedented time.”

Dixon says if a patient tests positive while in the hospital, it’s usually within three days of admission.

He emphasizes developing COVID-19 while in the hospital can still have a profound impact on a patient’s health.

“There’s repeat testing in the hospital because they want to make sure for those individuals in the hospital without COVID that they’re separated right,” Dixon said.

Dixon says health officials are most focused on trends in cases and hospitalizations, not as much the individual counts.

“We try not to focus on any specific count for any given day,” Dixon said. “We are looking for trends. If the numbers are going up that means we have rising disease burden in the community."

The bottom line is that the healthcare system is overburdened right now, and COVID-19 is contributing to that.

COVID-19 patients make up about 25% of all hospitalizations.

The Indiana State Department of Health provided the following statement to WRTV.

"We include everyone who has a diagnosis of COVID-19 and is hospitalized in our COVID hospitalization numbers," read the statement. " If a hospitalized patient tests positive for COVID-19, regardless of initial diagnosis, it still significantly affects that patient’s care and hospitalization, as it requires isolation precautions and that providers and visitors wear advanced PPE and take additional infection prevention measures. It is also difficult to discern how the COVID-19 infection affects the patient’s illness and ability to recover."

Hospitalizations remain at the highest levels we have seen in five years, and COVID-19 infections remain a significant contributing factor to the number of hospitalizations, according to the Indiana State Department of Health.

ISDH went on to say:

The hospitalization metrics included on our dashboard are as follows:
  • COVID hospital census: This is the total number of COVID patients in the hospital at any given time as reported by each hospital.
  • COVID PUI census: This is persons under investigation, which are individuals who are hospitalized and who hospitals believe have COVID but who do not yet have a positive test result.
  • COVID hospital admissions: This data is pulled directly from the Regenstrief Institute and uses their definition of COVID hospital admissions, which is "Number of individuals who have been hospitalized and tested positive for COVID-19.

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