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In Reply In the early days of the COVID-19 pandemic, the world witnessed the human cost of Lombardy, Italy’s severe wave. Soria and colleagues rightly note that the hospital strain observed in that region and others is better measured at the level of individual hospitals in such forms as admissions, churn, or census. We did not have information at that level, but we could see what was happening in counties. The associations we observed between county-level burden of COVID-19 and hospital COVID-19 mortality or discharge to hospice1 could reflect those strain mechanisms or they could reflect other causal pathways. Regardless, these associations suggest that the outcomes of individual patients depend in part on the behaviors of those around them. We are all in this together.
Corresponding Author: David A. Asch, MD, Center for Health Care Innovation, University of Pennsylvania, Perelman Center 14-171, 3400 Civic Center Blvd, Philadelphia, PA 19104 (email@example.com).
Published Online: April 12, 2021. doi:10.1001/jamainternmed.2021.0602
Conflict of Interest Disclosures: None reported.
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Asch DA. COVID-19 Mortality and Stress to the Hospital System from High Patient Load—Reply. JAMA Intern Med. 2021;181(8):1134. doi:10.1001/jamainternmed.2021.0602
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