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COVID-19 Clinical Outcomes

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

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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

METHODS:

  • 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)

RESULTS:

  • 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%)

CONCLUSION:

  • 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

Learn More – Primary Sources:

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

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Related ObG Topics:

Coronavirus and COVID-19: Clinical Characteristics from 138 Patients in Wuhan, China
COVID-19 Case Series: Pregnancy and Infant Outcomes
Vertical Transmission in Pregnancies with Confirmed COVID-19

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