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From a variety of Facebook posts about COVID-19:

Que raro ese COVID-19 ...en casa se curan, pero en los hospitales se mueren

(Example 1, 2, 3, with slightly different texts)

Translation into English: "How strange is COVID-19 ... at home you get cured, but in hospitals you die".

Are you more likely to die of a COVID-19 infection in a hospital than at home, and is that unique to COVID-19, or is it common to many other diseases?

I assume that deaths are more common in hospitals than at home, but that's because hospital handle more severe cases, and that the same phenomenon would occur with lots of other diseases, but I can't find anything confirming that.

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In the US, more people have died of COVID-19 in hospitals* (ca. 82,000) than in all other locations (ca. 48,000) from February 1 to July 18, 2020. However, as you surmised, this is the case for many conditions. Hospitals were the single most frequent location of death for respiratory diseases in general (2,3 out of 4,9 million in 1999-2018), as well as for deaths from any cause (17.3 million out of 50,6 million; both stats from the CDC).

And, as you also surmised, it stands to reason that people with mild symptoms are less likely to either be hospitalized or die from COVID-19. The CDC states:

Among all patients, a range of 3% to 17% developed ARDS compared to a range of 20% to 42% for hospitalized patients

Patients with a mild clinical presentation (absence of viral pneumonia and hypoxia) may not initially require hospitalization, and many patients will be able to manage their illness at home. The decision to monitor a patient in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend on the clinical presentation, requirement for supportive care, potential risk factors for severe disease, and the ability of the patient to self-isolate at home.

Some patients with COVID-19 will have severe disease requiring hospitalization for management.

Thus, it is correct to say that, to date, more people who have died from COVID-19 in the US have done so in hospitals than at home. However, this does not mean that a specific patient is more likely to die from COVID-19 if transferred to a hospital; on the opposite, there have been studies showing that, for example, distance from an intensive care unit (ICU) increases the mortality rate.

*Note: I always take "hospital" to mean "inpatient"; if we include emergency rooms, the hospital numbers would be higher in all cases.

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  • 2
    An average US resident is very unlikely to die from snake poison. Those who get an anti-serum are quite likely to die. Knowing this, if you’re bitten by a snake, would you take an anti-serum? – gnasher729 Aug 5 at 16:27
  • The best surgeon in a hospital could have the highest death rate - because he is given all the almost hopeless cases and the most junior doctor treats all the ingrown toe-nails. – gnasher729 Aug 5 at 16:31

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