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COVID-19-related hospitalizations in San Francisco have reached an all-time high. On Tuesday, the city reported 262 COVID-positive patients, three more than the maximum reached during last winters surge. Since then, hospitalizations have continued to rise. By Thursday, there were 274 COVID-related hospitalizations in the city, according to data from the California Department of Public Health.

Along with this surge, an important distinction has become key to understanding COVID-related hospitalizations: Are patients being admitted for COVID or with COVID?

According to data from the UCSF, as of last Wednesday, about 60% of COVID-positive patients across its hospitals were admitted primarily for the virus. The remaining roughly 40% were so-called with-COVID hospitalizations patients admitted for non-COVID ailments but incidentally tested positive for the virus.

While UCSFs for-COVID hospitalizations are closing in on their peak, they remain below what they were last winter. On the other hand, incidental cases are at an all-time high. Before omicron, fewer than 15 daily hospitalizations were categorized as incidental. But so far this month, the health system has averaged almost 40 daily incidental hospitalizations and recorded the highest yet of 51 last Wednesday.

Though the distinction between for-COVID and with-COVID patients only recently became central to understanding COVID trends, UCSF has always been tracking this data, said Rhiannon Croci, a UCSF clinical informatics specialist. But it wasnt until this recent surge of incidental cases that UCSF began reporting on these metrics.

Delineating between the two types of hospitalizations was not particularly valuable during previous surges, when 85-90% of their patients were hospitalized primarily for COVID, said Croci.

Compared to previous stages of the pandemic, primary-COVID patients are less likely to require critical care. During the delta surge last summer, around 40% to 50% of for-COVID hospitalizations at UCSF were in the ICU, but so far this month, that share has stayed below 25%.

The small number of people in the ICU is likely the result of vaccines and boosters. Data from earlier in the month shows that though around 20 people with up-to-date vaccines were in the hospital for COVID, very few ended up in the ICU.

Other health systems and government officials also publish data on incidental COVID hospitalizations. But while most places use patients diagnoses as the primary criterion for determining these cases, UCSF considers another key variable: whether patients receive a 5-day course of remdesivir, an antiviral drug used to treat moderate-to-severe COVID infections.

According to an in-depth analysis conducted by a team of UCSF data scientists, using just the admit diagnosis excluded many patients which, after manual review, were clearly suffering from moderate-to-severe COVID. By incorporating the medication into their definition, the percentage of for-COVID hospitalizations increased from about 50% to roughly two thirds. The share of incidental cases decreased from about 50% to roughly a third, which reflected what they were anecdotally experiencing in the hospital.

Parallel trends were observed at the UC San Diego health system, which uses a similar schema to identify for-COVID hospitalizations. According to Brian Clay who is a chief medical information officer at UCSD, previous waves had between 20% to 25% of incidental cases, but starting in December, that share increased to about 35%. In the past week, hes seen the number rise closer to 50%.

Incidental cases, though less severe, can still have large implications for hospitals. Because these patients can transmit the virus, resource-intensive isolation procedures are still necessary. And for patients, though their COVID infections may be milder, other ailments may be worsened by the virus, still putting them in critical care.

Sara Murray, an associate chief medical information officer and director of the health informatics data science and innovation team at UCSF, believes its important to get an accurate count of which hospitalizations are incidental versus primarily for COVID. Without it, hospitals are unable to decide on system-wide policies, which, at health systems as large as UCSF and UCSD, affect tens of thousands of people.

And as more health systems across the country publish data on incidental cases, having a standard definition is increasingly important, says Murray.

We all need to speak the same language on this, and then we can really understand where we are headed in this pandemic, wrote Murray, calling for the Centers for Disease Control and Prevention to create a standard definition.

Nami Sumida is a San Francisco Chronicle data visualization developer. Email: nami.sumida@sfchronicle.com Twitter: @namisumida

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COVID-related hospitalizations are rising in S.F. Data from UCSF sheds light on how many are for COVID or with COVID - San Francisco Chronicle