COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment
Authors: Richard Stephanie A , Pollett Simon D , Lanteri Charlotte A , Millar Eugene V , Fries Anthony C , Maves Ryan C , Utz Gregory C , Lalani Tahaniyat , Smith Alfred , Mody Rupal M , Ganesan Anuradha , Colombo Rhonda E , Colombo Christopher J , Lindholm David A , Madar Cristian , Chi Sharon , Huprikar Nikhil , Larson Derek T , Bazan Samantha E , English Caroline , Parmelee Edward , Mende Katrin , Laing Eric D , Broder Christopher C , Blair Paul W , Chenoweth Josh G , Simons Mark P , Tribble David R , Agan Brian K , Burgess Timothy H ,   EPICC COVID-19 Cohort Study Group, Cowden J , Lindholm D , Markelz A , Mende K , Merritt T , Walter R , Wellington T , Bazan S , Dimascio-Johnson N , Ewers E , Gallagher K , Larson D , Odom M , Rutt A , Blair P , Chenoweth J G , Clark D , Chambers S , Colombo C , Colombo R , Conlon C , Everson K , Faestel P , Ferguson T , Gordon L , Grogan S , Lis S , Mount C , Musfeldt D , Odineal D , Sainato R , Schofield C , Skinner C , Stein M , Switzer M , Timlin M , Wood S , Carpenter R , Kim L , Kronmann K , Lalani T , Lee T , Smith A , Warkentien T , Arnold J , Berjohn C , Cammarata S , Husain S , Lane A , Maves R , Parrish J , Utz G , Chi S , Filan E , Fong K , Horseman T , Jones M , Kanis A , Kayatani A , Londeree W , Madar C , Masel J , McMahon M , Murphy G , Ngauy V , Schmidt P , Schoenman E , Uyehara C , Villacorta Lyew R , Agan B , Broder C , Burgess T , Byrne C , Coles C , English C , Hickey P , Laing E , Livezey J , Malloy A , Oliver T , Parmelee E , Pollett S , Rajnik M , Richard S , Rozman J , Sanchez M , Scher A , Simons M , L Snow A , Tribble D , Fries A , Farmer A , Barton B , Hostler D , Maldonado C , Musich T , Radcliffe R , Swain M , Banda M , Davis B , Hunter T , Ikpekpe-Magege O , Kemp S , Mody R , Wiggins M , Ganesan A , Gunasekera D , Huprikar N 
Published: November 2021

Abstract

Background
We evaluated clinical outcomes, functional burden, and complications 1 month after coronavirus disease 2019 (COVID-19) infection in a prospective US Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review.

Methods
MHS beneficiaries presenting at 9 sites across the United States with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, a COVID-19-like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and International Classification of Diseases–based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression.

Results
A total of 1202 participants were enrolled. There were 1070 laboratory-confirmed SARS-CoV-2 cases and 132 SARS-CoV-2-negative participants. In the first month post–symptom onset among the SARS-CoV-2-positive cases, there were 212 hospitalizations, 80% requiring oxygen, 20 ICU admissions, and 10 deaths. Risk factors for COVID-19-associated hospitalization included race (increased for Asian, Black, and Hispanic compared with non-Hispanic White), age (age 45–64 and 65+ compared with &lt;45), and obesity (BMI≥30 compared with BMI&lt;30). Over 2% of survey respondents reported the need for supplemental oxygen, and 31% had not returned to normal daily activities at 1 month post–symptom onset.

Conclusions
Older age, reporting Asian, Black, or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by 1 month.