Study examines relationship of COVID-19 infections and in-person health care visits

August 25, 2020

The authors call for future research to determine whether these findings extend to other populations and health care settings.

Many hospitals and practices across the U.S. have seen a rapid decline in in-person visits since the COVID-19 pandemic.1 Data are limited, however, on how in-person visits to medical facilities may impact a patient’s risk of contracting the virus.

Obstetrical patients are unique in that they required frequent, in-person visits to health care facilities during the pandemic, which is why a team of researchers from Brigham and Women’s Hospital in Boston, MA, set out to investigate whether the number of in-person health care visits were associated with the risk of SARS-CoV-2 infection.2

Published in JAMA Network, the findings suggest that in-person health care visits were not likely to be a major risk factor for SARS-CoV-2 infection and that in-person care can be safely provided when necessary.

“The news here is that there is no news,” says Joshua A. Copel, MD, Professor of Obstetrics, Gynecology, and Reproductive Sciences of Pediatrics at the Yale School of Medicine, and one of Contemporary OB/GYN’’s Editorial Board members.

“The data fail to show an increased risk of COVID-19 associated with in-person prenatal visits, which supports all the efforts we have made to make our offices safe: masks, handwashing, masks, social distancing, and of course, masks,” Dr. Copel says.

The study population included all patients who delivered at 4 hospitals in the Boston area between April 19, 2020, and June 27, 2020, a period when all obstetrical patients were tested for SARS-CoV-2 infection on admission. In total, the study population included 2,968 deliveries; 5 patients were not tested for SARS-CoV-2 infection and were excluded.

Related: COVID-19 Pregnancy Data in the United States: August 21 Update

The research team matched patients who tested positive for SARS-CoV-2 either during pregnancy or at the time of admission with up to 5 control patients. The controls and cases were matched based on gestational age on the date of positive infection results (±6 days), race/ethnicity, insurance type (Medicaid vs commercial), and SARS-CoV-2 infection rate in the patients’ zip codes.

Using electronic medical record data, the researchers assessed the number of in-person visits for patients from March 10, 2020 (2 weeks prior to the closure of nonessential businesses in Massachusetts) to data about the cases’ SARS-CoV-2 infection diagnoses.

Researchers found that 111 patients (3.7% [95% CI, 3.1%-4.5%]) tested positive for SARS-CoV-2 infection. Of them, 45 tested positive antenatally and 66 tested positive at the time of admission for labor and delivery.

Patients excluded from the study were those residing outside Massachusetts (2.2%), and those whose medical records were missing data required for matching (0.8%). After matching 93 cases with 372 control observations, the mean number of in-person visits was 3.1 (SD, 2.2; range, 0-10) for cases and 3.3 (SD, 2.3; range, 0-16) for controls.

The authors call for future research to determine whether these findings extend to other populations and health care settings.

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References

  1. Baum A, Schwartz MD. Admissions to Veterans Affairs Hospitals for Emergency Conditions During the COVID-19 Pandemic. JAMA. 2020;324(1):96–99. doi:10.1001/jama.2020.9972
  2. Reale SC, Fields KG, Lumbreras-Marquez MI, et al. Association Between Number of In-Person Health Care Visits and SARS-CoV-2 Infection in Obstetrical Patients. JAMA. Published online August 14, 2020. doi:10.1001/jama.2020.15242
  3. JAMA. Published online August 14, 2020. doi:10.1001/jama.2020.15242