#15,112
One of the dangers in any pandemic, war, or natural disaster, is that early reports - which are often repeated ad nauseam as fact - can be wrong, or at the very least, misleading. Generally this is due to limited early information, but sometimes it is due to a positive `spin' being put on the reporting by public officials or simply the need for a 15-second, easily digestible `sound bite' for the media.
The narrative - pushed by nearly every government and public health official around the world for the past 7 weeks - is that COVID-19 is primarily a danger to the elderly, and to those with severe comorbidities. Younger adults are far less affected, and children appear almost immune to severe disease.This message - while largely true - also carries the advantage of being hugely reassuring to a large segment of the population; notably parents, and those who are healthy and under the age of 65.
Not a bad thing for governments, who want to maintain calm, and promote `business as usual'.Unfortunately, this narrative has backfired a bit, lulling a large segment of the population into believing they aren't at serious risk of infection, hospitalization, or death from COVID-19. As a result, many aren't taking the threat of the pandemic seriously.
Over the past week, we've heard disturbing reports from France and Italy suggesting that while the elderly are the ones most likely to die from COVID-19, more than half of their ICU patients are under the age of 65.
While roughly 80% of those infected continue to suffer relatively mild illness and can recover at home, for a sizable chunk of the population - including many under the age of 65 - COVID-19 can be a serious, even fatal, illness.Late yesterday the CDC's MMWR published the first look at severe outcomes among more than 500 hospitalized COVID-19 cases in the United States. The data - which is current through March 16th - isn't complete, and many patient outcomes have yet to be finalized.
But what we do have suggests the risks of hospitalization and severe illness to many of those under the age of 65 is greater than originally billed.
The first thing you'll notice by the chart above, is that 75% of cases are in those under the age of 65, including a handful of cases under the age of 20. Thankfully, we've not seen any ICU admissions or deaths in those under 20, although that is far from guaranteed going forward.
For patients above the age of 20, things become more serious, with pandemic-severity CFR numbers (.5% or greater) starting at about age 45, and rising steeply with age.Among the 121 U.S. COVID-19 patients known to have been admitted to an ICU, nearly half (48%) are under the age of 65. Fatal outcomes are still heavily skewed towards an older cohort, but with 20% of the reported deaths again coming from those under the age of 65.
I've only included some excerpts from a much longer MMWR report below, so follow the link to read it in its entirety.
Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020
Early Release / March 18, 2020 / 69
CDC COVID-19 Response Team (View author affiliations)View suggested citation
Summary
What is already known about this topic?
Early data from China suggest that a majority of coronavirus disease 2019 (COVID-19) deaths have occurred among adults aged ≥60 years and among persons with serious underlying health conditions.
What is added by this report?
This first preliminary description of outcomes among patients with COVID-19 in the United States indicates that fatality was highest in persons aged ≥ 85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, < 1% among persons aged 20–54 years, and no fatalities among persons aged ≤ 19 years.
What are the implications for public health practice?
COVID-19 can result in severe disease, including hospitalization, admission to an intensive care unit, and death, especially among older adults. Everyone can take actions, such as social distancing, to help slow the spread of COVID-19 and protect older adults from severe illness.
(SNIP)
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 ≥85, 25% were aged 65–84 years, 18% each were aged 55–64 years and 45–54 years, and 29% were aged 20–44 years (Figure 2). Only 5% of cases occurred in persons aged 0–19 years.
Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years, 26% were aged 65–84 years, 17% were aged 55–64 years, 18% were 45–54 years, and 20% were aged 20–44 years. Less than 1% of hospitalizations were among persons aged ≤19 years (Figure 2). The percentage of persons hospitalized increased with age, from 2%–3% among persons aged ≤9 years, to ≥31% among adults aged ≥85 years. (Table).
Among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults ≥85 years, 46% among adults aged 65–84 years, 36% among adults aged 45–64 years, and 12% among adults aged 20–44 years (Figure 2). No ICU admissions were reported among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table).
Among 44 cases with known outcome, 15 (34%) deaths were reported among adults aged ≥85 years, 20 (46%) among adults aged 65–84 years, and nine (20%) among adults aged 20–64 years. Case-fatality percentages increased with increasing age, from no deaths reported among persons aged ≤19 years to highest percentages (10%–27%) among adults aged ≥85 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 ≥ 65 years with the highest percentage of severe outcomes among persons aged ≥ 85 years.
These findings are similar to data from China, which indicated > 80% of deaths occurred among persons aged ≥ 60 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 ≤ 19 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 ≥65 years as well as those involved in their care (7,8).
(Continue . . . )
