Tuesday, June 16, 2020

MMWR: COVID-19 Case Surveillance — U.S., Jan 22–May 30, 2020















#15,326

Although COVID-19 is a generally mild disease in most people under the age of 50 who are without serious underlying medical conditions, for the rest of us - and that's a lot of people - COVID-19 represents a much greater threat. 

Generally incurable and ongoing, chronic diseases affect approximately 133 million Americans, representing more than 40% of the total population of this country.  By 2020, that number is projected to grow to an estimated 157 million, with 81 million having multiple conditions. 
About half of all adults have a chronic condition, and approximately 8 percent of children ages 5 to 17 were reported by their parents to have limited activities due to at least one chronic disease or disability. 
More and more people are living with not just one chronic illness, such as diabetes, heart disease or depression, but with two or more conditions. Almost a third of the population is now living with multiple chronic conditions. 
One of the wonders of modern medicine is that millions of people who would have died early in life  a century ago can now go on to lead happy and productive lives. But they remain vulnerable to a variety of opportunistic infectious diseases, including COVID-19.

Yesterday the CDC's MMWR published a new surveillance report that reinforces what we previously knew about the impact of COVID-19 on those who are elderly, or who have comorbidities.
While there are no surprises here, this latest report is based on the largest cohort of U.S. cases to date.  I've only included the summary and a brief excerpt from a much longer, and data heavy, report. 
Follow the link to read it in its entirety.

Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020
Early Release / June 15, 2020 / 69
Erin K. Stokes, MPH1,*; Laura D. Zambrano, PhD1,*; Kayla N. Anderson, PhD1; Ellyn P. Marder, DrPH1; Kala M. Raz, MPH1; Suad El Burai Felix, MPH1; Yunfeng Tie, PhD1; Kathleen E. Fullerton, MPH1 
Summary
What is already known about this topic?
Surveillance data reported to CDC through April 2020 indicated that COVID-19 leads to severe outcomes in older adults and those with underlying health conditions.
What is added by this report?
As of May 30, 2020, among COVID-19 cases, the most common underlying health conditions were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.
What are the implications for public health practice?
Surveillance at all levels of government, and its continued modernization, is critical for monitoring COVID-19 trends and identifying groups at risk for infection and severe outcomes. These findings highlight the continued need for community mitigation strategies, especially for vulnerable populations, to slow COVID-19 transmission.
          (EXCERPT)

Among cases with known race and ethnicity, 33% of persons were Hispanic, 22% were black, and 1.3% were AI/AN. These findings suggest that persons in these groups, who account for 18%, 13%, and 0.7% of the U.S. population, respectively, are disproportionately affected by the COVID-19 pandemic.
The proportion of missing race and ethnicity data limits the conclusions that can be drawn from descriptive analyses; however, these findings are consistent with an analysis of COVID-19–Associated Hospitalization Surveillance Network (COVID-NET)††††† data that found higher proportions of black and Hispanic persons among hospitalized COVID-19 patients than were in the overall population (4).
The completeness of race and ethnicity variables in case surveillance has increased from 20% to >40% from April 2 to June 2. Although reporting of race and ethnicity continues to improve, more complete data might be available in aggregate on jurisdictional websites or through sources like the COVID Tracking Project’s COVID Racial Data Tracker
          (Continue . . . .)