Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020

Abstract

, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). 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-19-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 ≥60 years; only one (0.1%) death occurred in a person aged ≤19 years (3). In this report, COVID-19 cases in the United States that occurred during February 12-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 ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 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 12-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 CDC COVID-19 Response Team

Clinical Decision Support Tool and Rapid Point-of-Care Platform for Determining Disease Severity in Patients with COVID-19

“…Initial reports suggest that COVID-19 is associated with severe disease that requires intensive care in approximately 5% of proven infections. 8 A report from the Chinese Center for Disease Control and Prevention stated that the case fatality rate was higher for those with cardiovascular disease (10.5%), diabetes (7.3%), chronic respiratory disease (6.3%), hypertension (6.0%), and cancer (5.6%). Growing evidence suggests that COVID-19 interacts with the cardiovascular system on multiple levels with increased morbidity and mortality in those with underlying cardiovascular conditions.…”

“…Additional model information is included in the Supplemental Materials, including model coefficients (Figure S1) and AUC values ( Table S1). The median (IQR) COVID-19 Severity Scores were significantly higher for those that died vs. those that were discharged (59 [40-83] vs. 9 [6][7][8][9][10][11][12][13][14][15][16][17], respectively). Patients who underwent any invasive or noninvasive ventilation were at an intermediate risk of death with median (IQR) scores of 17 (10-39) (Figure S2).…”

“…7 A larger analysis of 2449 patients reported hospitalization rates of 20 to 31 percent and ICU admission rates of 4.9 to 11.5 percent. 8 This large number of patients requiring intensive care threatens to overwhelm healthcare systems around the world. There is a need for a COVID-19 disease severity test to prioritize care for patients at elevated risk of mortality and manage low risk patients in outpatient settings or at home through self-quarantine.…”

Community pharmacists and communication in the time of COVID-19: Applying the health belief model

“…The Centers for Disease Control and Prevention estimates that 38% of COVID-19 hospitalizations may have occurred in patients under the age of 55. 10 It may be worthwhile to ask patients if they would tolerate a comparable chance of a similarly-negative avoidable outcome, such as an automobile accident that results in injury. Community-level threats may also be salient to those at lower individual risk.…”

Estimating number of cases and spread of coronavirus disease (COVID-19) using critical care admissions, United Kingdom, February to March 2020

“…We estimated the age-dependent risk of an infected case being admitted to CC by fitting our models to analyses of case data from China [5] and the United States (US) [6], with recently released Italian data [7] used in a sensitivity analysis (details in Supplement Chapter 1).…”