Alon Yehoshua

Coronavirus Disease 2019 (COVID-19) placed a significant burden on healthcare systems that persisted beyond the first waves of the pandemic1–6. Patients at high risk of severe COVID-19, including o...

The COVID-19 pandemic has imposed substantial clinical and economic burdens on healthcare systems, with older adults disproportionately affected by severe outcomes1,2. Advanced age, multimorbidity,...

Background: To characterize Coronavirus disease 2019 (COVID-19) symptom severity, and recovery from pre-infection through one month, overall and by risk groups. Methods: Symptomatic adults aged ≥18 years with test-confirmed COVID-19 were enrolled from ambulatory care clinics within a national U.S. retail pharmacy network between 10/24/2024 and 08/29/2025 ( NCT05160636 ). Adjusted mixed models for repeated measures estimated least-squares mean changes (LSE) and standard errors (SE) from pre-infection and on Days 1-7, 10, 14, and Week 4 from enrollment in composite symptom scores (sum of severity ratings (0-3) across 14 symptoms), counts of mild-to-severe, moderate-to-severe, and severe symptoms, overall and by age and clinical risk status. Effect sizes (ES) were defined as small (0.2-<0.5), medium (≥0.5), and large (≥0.8). Results: The analysis included 608 adults. On Day 1, symptom severity rose sharply from pre-infection for the composite symptom score (LSE 14.2 [SE 0.3]; ES 2.22), mild-to-severe (7.6 [0.1]; 2.72), moderate-to-severe (5.0 [0.2]; 1.77); and severe (1.8 [0.1]; 0.92) (all p<0.001). By Week 4, composite score (0.7 [0.2]; 0.26), mild-to-severe (0.5 [0.1]; 0.23); moderate-to-severe symptoms (0.1 [0.1]; 0.17) and severe symptoms (0.2 [0.1]; 0.5) remained slightly above baseline (all p≤0.025). Elevated severe symptom durations varied: high-risk adults (through Day 3), adults <50 years (through Day 7), and adults ≥50 years (through Day 7). Conclusions: COVID-19 was associated with notable acute symptoms in outpatients, followed by gradual improvement over time, although symptoms still persisted at four weeks. Improvement in severe symptoms varied by individual risk profile, reinforcing the importance risk-based follow-up and ongoing monitoring.

1. COVID-19 poses a substantial public health burden [1], especially in individuals with underlying conditions, such as chronic lung disease, cardiovascular disease, diabetes, and neurologic disord...

According to the Centers for Disease Control and Prevention (CDC), Long COVID, or Post-COVID Conditions (PCC) is characterized as a chronic condition following an infection with SARS-CoV-2, the vir...

Background: The patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥ 65 years in the United States. Methods: This retrospective observational study used the Medicare fee-for-service dataset. We identified Medicare patients hospitalized with COVID-19 from September 2023–February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65–74, ≥ 75 years old). Results: A total of 67,358 patients were included; most were female (55.6%), white (84.9%), and on average 80.8 years (standard deviation: 8.1). The majority (96.4%) had ≥ 1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5.0 (3.0–7.0) days. During index hospitalization, 4.4% of patients were admitted to the ICU and 5.1% required IMV. Post-discharge, 50.5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. Less than half (47.8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge. A total of 11,658 (17.4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7.1% of patients discharged home (self-care), 13.0% of patients discharged home (under care), and 31.8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥ 75 years. The COVID-19-related readmission rate was 4.5% within six months of discharge, and 3.2% occurred within 30 days. Conclusion: The proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission.

Background: Long COVID remains a significant public health concern. This study investigated risk factors for long COVID in outpatient settings. Methods: A US-based prospective survey study (clinicaltrials.gov NCT05160636) was conducted in 2022 and replicated in 2023. Symptomatic adults testing positive for SARS-CoV-2 at CVS Pharmacies were recruited. CDC-based long COVID symptoms were collected at Week 4, Month 3, and Month 6 following SARS-CoV-2 testing. Logistic regression was used to develop a predictive model for long COVID using data from the 2022 cohort. The model was validated with data from the 2023 cohort. Model performance was evaluated with c-statistics. Results: Patients characteristics were generally similar between the 2022 (N = 328) and 2023 (N = 505) cohorts. The prevalence of long COVID defined as ≥3 symptoms at Month 6 was 35.0% and 18.2%, respectively. The risk factors associated with long COVID were older age, female sex, lack of up-to-date vaccination, number of acute symptoms on the day of SARS-CoV-2 testing, increase in symptoms at Week 1, underlying comorbidities and asthma/chronic lung disease. The c-statistic was 0.79, denoting good predictive power. Conclusions: A predictive model for long COVID was developed for an outpatient setting. This research could help differentiate at-risk groups and target interventions.

Conduct a comprehensive analysis of the health and economic outcomes of patients with a COVID-19-associated hospitalization in the US during the predominance of the XBB and JN.1 Omicron lineages. This analysis used data from the PINC AI Healthcare Database (PHD) for all patients with a hospital admission date occurring between February 4, 2023, and February 29, 2024 with an ICD-10-CM code U07.1 "COVID-19" in any position. The data were used to estimate the mean and median length of stay (LOS), mean and median hospitalization cost, and proportion of patients that died in the hospital, by age and level of care (normal ward, intensive care [ICU], invasive mechanical ventilation [IMV]). LOS, hospitalization costs, and inpatient mortality increased with both the level of care and age. Patients not receiving ICU care had the shortest LOS, lowest inpatient mortality, and lowest hospitalization costs. LOS, hospitalization costs, and inpatient mortality were higher for those receiving ICU care and highest for those receiving IMV in the ICU. Within each level of care (normal ward, ICU without IMV, and ICU with IMV), the LOS, inpatient mortality, and hospitalization cost generally increased with age, indicating that older adults with COVID-19 required a longer recovery period, have a higher likelihood of death, and accrue higher costs. However, the proportion of pediatric patients with an ICU admission and/or IMV usage remained high. The PHD data may not be representative of all hospitalized patients in the US. These findings suggest that COVID-19 continues to have severe and costly consequences in all age groups, but particularly for older adults including long LOS, ICU admission, need for IMV, mortality, and high hospital costs.

ObjectivesThis study investigates the utilization of work absence benefits among United States (US) employees diagnosed with COVID-19, examining frequency, duration, cost, and types of work loss benefits used.MethodsThis retrospective analysis of the Workpartners Research Reference Database (RRDb) included employees eligible for short- and long-term disability (STD and LTD employer-sponsored benefits, respectively), and other paid work absence benefits from 2018-2022. Workpartners RRDb includes over 3.5 million employees from over 500 self-insured employers across the US. Employees were identified by codes from adjudicated medical and disability claims for COVID-19 (2020-2022) and influenza, as well as prescription claims for COVID-19. Associated payments were quantified for each absence reason.ResultsApproximately 1 million employees were eligible for employer-sponsored paid leave benefits between January 2018 and December 2022. The mean age was 37 years (22% >50 years), and 49.9% were female. COVID-19 was the 2^nd most common reason for an STD claim (6.9%) and 13^th for an LTD claim (2020-2022). The mean duration for COVID-19 STD claims was 24 days (N = 3731, mean claim=$3477) versus 10 days for influenza (N = 283, mean claim=$1721). The mean duration for an LTD claim for COVID-19 was 153 days (N = 24, mean claim=$19,254). Only 21.5% of employees with STD claims in the COVID-19 cohort had prior COVID-19-associated medical or pharmacy claims; over half (range 53%-61%) had documented high risk factors for severe COVID-19.ConclusionCOVID-19 and influenza have the potential to cause work loss in otherwise healthy employees. In this analysis, COVID-19 was the second most frequent reason for an STD claim at the start of the pandemic and remained high (ranked 5^th) in 2022. These results highlight the impact of COVID-19 on work loss beyond the acute phase. Comprehensively evaluating work loss implications may help employers prioritize strategies, such as vaccinations and timely treatments, to mitigate the impact of COVID-19 on employees and their companies.