Report: Severe Outcomes Among Patients with Coronavirus Disease

IATA on COVID-19: Coronavirus Impacts
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Globally, approximately 170,000 confirmed cases of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) have been reported, including an estimated 7,000 deaths in approximately 150 countries (1). On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic (2). Data from China have indicated that older adults, particularly those with serious underlying health conditions, are at higher risk for severe COVID-19โ€“associated illness and death than are younger persons (3). Although the majority of reported COVID-19 cases in China were mild (81%), approximately 80% of deaths occurred among adults aged โ‰ฅ60 years; only one (0.1%) death occurred in a person aged โ‰ค19 years (3). In this report, COVID-19 cases in the United States that occurred during February 12โ€“March 16, 2020 and severity of disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged โ‰ฅ65 years with the highest percentage of severe outcomes among persons aged โ‰ฅ85 years. In contrast, no ICU admissions or deaths were reported among persons aged โ‰ค19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups.

Data from cases reported from 49 states, the District of Columbia, and three U.S. territories (5) to CDC during February 12โ€“March 16 were analyzed. Cases among persons repatriated to the United States from Wuhan, China and from Japan (including patients repatriated from cruise ships) were excluded. States and jurisdictions voluntarily reported data on laboratory-confirmed cases of COVID-19 using previously developed data collection forms (6). The cases described in this report include both COVID-19 cases confirmed by state or local public health laboratories as well as those with a positive test at the state or local public health laboratories and confirmation at CDC. No data on serious underlying health conditions were available. Data on these cases are preliminary and are missing for some key characteristics of interest, including hospitalization status (1,514), ICU admission (2,253), death (2,001), and age (386). Because of these missing data, the percentages of hospitalizations, ICU admissions, and deaths (case-fatality percentages) were estimated as a range. The lower bound of these percentages was estimated by using all cases within each age group as denominators. The corresponding upper bound of these percentages was estimated by using only cases with known information on each outcome as denominators.

As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States, with reports increasing to 500 or more cases per day beginning March 14 (Figure 1). Among 2,449 patients with known age, 6% were aged โ‰ฅ85, 25% were aged 65โ€“84 years, 18% each were aged 55โ€“64 years and 45โ€“54 years, and 29% were aged 20โ€“44 years (Figure 2). Only 5% of cases occurred in persons aged 0โ€“19 years.

Among 508 (12%) patients known to have been hospitalized, 9% were aged โ‰ฅ85 years, 36% were aged 65โ€“84 years, 17% were aged 55โ€“64 years, 18% were 45โ€“54 years, and 20% were aged 20โ€“44 years. Less than 1% of hospitalizations were among persons aged โ‰ค19 years (Figure 2). The percentage of persons hospitalized increased with age, from 2%โ€“3% among persons aged โ‰ค9 years, to โ‰ฅ31% among adults aged โ‰ฅ85 years. (Table).

Among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults โ‰ฅ85 years, 46% among adults aged 65โ€“84 years, 36% among adults aged 45โ€“64 years, and 12% among adults aged 20โ€“44 years (Figure 2). No ICU admissions were reported among persons aged โ‰ค19 years. Percentages of ICU admissions were lowest among adults aged 20โ€“44 years (2%โ€“4%) and highest among adults aged 75โ€“84 years (11%โ€“31%) (Table).

Among 44 cases with known outcome, 15 (34%) deaths were reported among adults aged โ‰ฅ85 years, 20 (46%) among adults aged 65โ€“84 years, and nine (20%) among adults aged 20โ€“64 years. Case-fatality percentages increased with increasing age, from no deaths reported among persons aged โ‰ค19 years to highest percentages (10%โ€“27%) among adults aged โ‰ฅ85 years (Table) (Figure 2).

Discussion

Since February 12, 4,226 COVID-19 cases were reported in the United States; 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths occurred among adults aged โ‰ฅ65 years with the highest percentage of severe outcomes among persons aged โ‰ฅ85 years. These findings are similar to data from China, which indicated >80% of deaths occurred among persons aged โ‰ฅ60 years (3). These preliminary data also demonstrate that severe illness leading to hospitalization, including ICU admission and death, can occur in adults of any age with COVID-19. In contrast, persons aged โ‰ค19 years appear to have milder COVID-19 illness, with almost no hospitalizations or deaths reported to date in the United States in this age group. Given the spread of COVID-19 in many U.S. communities, CDC continues to update current recommendations and develop new resources and guidance, including for adults aged โ‰ฅ65 years as well as those involved in their care (7,8).

Approximately 49 million U.S. persons are aged โ‰ฅ65 years (9), and many of these adults, who are at risk for severe COVID-19โ€“associated illness, might depend on services and support to maintain their health and independence. To prepare for potential COVID-19 illness among persons at high risk, family members and caregivers of older adults should know what medications they are taking and ensure that food and required medical supplies are available. Long-term care facilities should be particularly vigilant to prevent the introduction and spread of COVID-19 (10). In addition, clinicians who care for adults should be aware that COVID-19 can result in severe disease among persons of all ages. Persons with suspected or confirmed COVID-19 should monitor their symptoms and call their provider for guidance if symptoms worsen or seek emergency care for persistent severe symptoms. Additional guidance is available for health care providers on CDCโ€™s website.

This report describes the current epidemiology of COVID-19 in the United States, using preliminary data. The findings in this report are subject to at least five limitations. First, data were missing for key variables of interest. Data on age and outcomes, including hospitalization, ICU admission, and death, were missing for 9%โ€“53% of cases, which likely resulted in an underestimation of these outcomes. Second, further time for follow-up is needed to ascertain outcomes among active cases. Third, the initial approach to testing was to identify patients among those with travel histories or persons with more severe disease, and these data might overestimate the prevalence of severe disease. Fourth, data on other risk factors, including serious underlying health conditions that could increase risk for complications and severe illness, were unavailable at the time of this analysis. Finally, limited testing to date underscores the importance of ongoing surveillance of COVID-19 cases. Additional investigation will increase the understanding about persons who are at risk for severe illness and death from COVID-19 and inform clinical guidance and community-based mitigation measures.

TABLE. Hospitalization, intensive care unit (ICU) admission, and caseโ€“ fatality percentages for reported COVIDโ€“19 cases, by age group โ€” United States, February 12โ€“March 16, 2020

Age group (yrs) (no. of cases)

%*

Hospitalization

ICU admission

Case-fatality

0โ€“19 (123)

1.6โ€“2.5

0

0

20โ€“44 (705)

14.3โ€“20.8

2.0โ€“4.2

0.1โ€“0.2

45โ€“54 (429)

21.2โ€“28.3

5.4โ€“10.4

0.5โ€“0.8

55โ€“64 (429)

20.5โ€“30.1

4.7โ€“11.2

1.4โ€“2.6

65โ€“74 (409)

28.6โ€“43.5

8.1โ€“18.8

2.7โ€“4.9

75โ€“84 (210)

30.5โ€“58.7

10.5โ€“31.0

4.3โ€“10.5

โ‰ฅ85 (144)

31.3โ€“70.3

6.3โ€“29.0

10.4โ€“27.3

Total (2,449)

20.7โ€“31.4

4.9โ€“11.5

1.8โ€“3.4

The risk for serious disease and death in COVID-19 cases among persons in the United States increases with age. Social distancing is recommended for all ages to slow the spread of the virus, protect the health care system, and help protect vulnerable older adults. Further, older adults should maintain adequate supplies of nonperishable foods and at least a 30-day supply of necessary medications, take precautions to keep space between themselves and others, stay away from those who are sick, avoid crowds as much as possible, avoid cruise travel and nonessential air travel, and stay home as much as possible to further reduce the risk of being exposed (7). Persons of all ages and communities can take actions to help slow the spread of COVID-19 and protect older adults.

About the author

Avatar of Juergen T Steinmetz

Juergen T Steinmetz

Juergen Thomas Steinmetz has continuously worked in the travel and tourism industry since he was a teenager in Germany (1977).
He founded eTurboNews in 1999 as the first online newsletter for the global travel tourism industry.

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