COVID-19 Clinical Outcomes

MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes

BACKGROUND AND PURPOSE:

Data coming from China has suggested that most coronavirus disease 2019 (COVID-19) deaths have occurred among
- Adults of older age (≥60 years)
- Those with underlying health conditions
In China
- Approximately 81% of cases were mild
- 80% of mortality occurred in those ≥60 years
- Only 1 death has occurred in someone ≤19 years
This summary from the CDC response team (MMWR, 2020) provides the first descriptions of COVID-19 outcomes in the US population

Observational study
Data sources (February 12 through March 16, 2020)
- Cases: From 49 states, the District of Columbia, and three US territories
- Laboratory-confirmed COVID-19 cases
- Excluded: Persons repatriated to the US from Wuhan, China | Japan | Cruise ships
Study design
- COVID-19 confirmation could come from state or local laboratories
- Serious underlying health conditions: No data available
- Percentage ranges were used for some outcomes due to missing data (including hospitalization)

Total 4,226 COVID-19 cases
- ≥500 cases confirmed per day starting March 14th
There were 2,449 patients where age was available
- ≥85 years: 6%
- 65–84 years: 25%
- 55–64 years: 18%
- 45–54 years: 18%
- 20–44 years: 29%
- 0-19 years: 5%
Hospitalizations: 508 patients
- ≥85 years: 9%
- 65–84 years: 36%
- 55–64 years: 17%
- 45–54 years: 18%
- 20–44 years: 20%
- ≤19 years: <1%
Hospitalizations stratified by age
- ≤19 years: 2%–3%
- ≥85 years: ≥31%
ICU admisssions: 121 patients
- ≥85 years: 7%
- 65–84 years: 46%
- 45–64 years: 36%
- 20–44 years: 12%
- ≤19 years: 0%
Percentage of ICU admissions stratified by age
- LOWEST: Adults aged 20 to 44 years (2%–4%)
- HIGHEST: Adults aged 75 to 84 years (11%–31%)
Case-fatality percentages increased with age
- ≥85 years: 15 (34%) deaths
- 65–84 years: 20 (46%) deaths
- 20–64 years 9 (20%) deaths
Case-fatality stratified by age
- LOWEST: Adults aged ≤19 (0%)
- HIGHEST: Adults aged ≥85 years (10% to 27%)

The authors stress the impact of COVID-19 on the elderly
- ≥65 years represented 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths
These findings are similar to those coming from China
The authors point out limitations of their data
- Missing key variables of interest
- Further follow-up will be needed to determine outcomes of ongoing cases
- Initial testing focused on those with travel histories or severe disease, which may lead to overestimation of severe disease
- No data available on risk factors and underlying health conditions
- There is still limited testing being performed in the US

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