OBJECTIVE: This retrospective medical chart review explores how COVID-19 care patterns in the US changed over the course of 2020.

METHODS: We captured data from 409 patients hospitalized with laboratory-confirmed COVID-19 on or after February 1, 2020 across three healthcare organizations. Patients were stratified into 3 groups based on month of first COVID-19 hospitalization: early (February-April), middle (May-August), and late (September-December). Medications (azithromycin [sole therapy], corticosteroids [dexamethasone and methylprednisolone], hydroxychloroquine, remdesivir, and tocilizumab), procedures, and mortality outcomes were captured from the medical chart and reported descriptively. Up to three lines of therapy (LOTs) were captured.

RESULTS: Patients were on average 62.5 (SD: 17.2) years old, 57.3% were male, and 69.5% were White. Overall, 75 were hospitalized in the early period, 223 in the middle period, and 111 in the late period. In Early 2020, azithromycin (30.7%) and hydroxychloroquine (28.0%) were the most common first LOTs, and 69.6% of patients who started on azithromycin switched or were augmented with hydroxychloroquine. Corticosteroids were the most common first LOT in middle (34.5%) and late (67.6%) 2020, and 27.3% (middle) and 45.3% (late) of patients who started on corticosteroids were augmented with remdesivir. The number of unique drug combinations decreased from 8 and 10 in early and middle 2020, respectively, to 6 in late 2020. Use of any invasive mechanical ventilation (32.0%) and prone ventilation specifically (12.0%) were most common in early 2020. Clinical trial enrollment was most common in mid 2020 (14.3%). The frequency of chest x-rays was steady at 0.4-0.5 scans per day. Overall, 61 (14.9%) patients died due to COVID-19, but the mortality rate decreased from 26.7% in early 2020 to 9.9% in late 2020.

CONCLUSIONS: Treatment patterns evolved over the course of 2020 with the most variation in care observed 4-7 months after the arrival of SARS-CoV-2 in the US.