PURPOSE:

• An important characteristic of COVID-19 is the association between comorbidities and mortality
• The CDC COVID-19 Response Team (MMWR, 2020) analyzed the current data to determine the relationship between underlying medical disorders and SARS-CoV-2 infection in the US population

METHODS:

• Observational study
• Data sources (February 12 to March 28, 2020)
  • Cases: From 50 states, the District of Columbia, and 4 US territories
  • Laboratory-confirmed COVID-19 cases
  • Excluded: Persons repatriated to the US from Wuhan, China | Diamond Princess cruise ship
• Underlying health condition/Risk factor for severe outcomes from respiratory infection included
  • Chronic lung disease (inclusive of asthma, chronic obstructive pulmonary disease [COPD], and emphysema) | Diabetes mellitus | Cardiovascular disease | Chronic renal disease | Chronic liver disease | Immunocompromised condition | Neurologic disorder, neurodevelopmental, or intellectual disability | Pregnancy | Current smoking status | Former smoking status | Other chronic disease (includes hypertension, thyroid disease, GI, hyperlipidemia, cancer, rheumatologic disorder, hematologic disorder, obesity, non-rheumatoid arthritis and other)
• Statistical analysis
  • “Data reported to CDC are preliminary and can be updated by health departments over time; critical data elements might be missing at the time of initial report; thus, this analysis is descriptive, and no statistical comparisons could be made”

RESULTS:

• COVID-19 cases: 122,653 | 2,112 deaths
  • Underlying health conditions known: 7,162 (5.8%)
    • ≥1 underlying disorder: 2,692 (37.6%)
    • 0 underlying disorders: 4,470 (62.4%)
• ≥1 underlying disorder or risk factor identified in
  • 78% of those requiring ICU
  • 71% of those requiring hospitalization without ICU admission
  • 27% of those not requiring hospitalization
• Among those individuals with complete information regarding underlying conditions or risk factors
  • 184 deaths occurred (all among patients aged ≥19 years)
  • 94% of these deaths were reported among patients with ≥1 underlying disorder or risk factor
• Most common reported conditions
  • Diabetes mellitus: 10.9%
  • Chronic lung disease: 9.2%
  • Cardiovascular disease: 9.0%
• Remaining disorders were less common
  • Immunocompromised: 3.7%
  • Chronic renal disease: 3.0%
  • Pregnancy: 2.0%
  • Neurologic disorder: 0.7%
  • Chronic liver disease: 0.6%
  • Other chronic disease: 16.5%
  • Former smoker: 2.3%
  • Current smoker: 1.3%

CONCLUSION:

• Data are still preliminary and available only for a small subset of patients
  • An open question is whether severity or control of underlying disease is a factor in prognosis and mortality
• The authors conclude that

These preliminary findings suggest that in the United States, persons with underlying health conditions or other recognized risk factors for severe outcomes from respiratory infections appear to be at a higher risk for severe disease from COVID-19 than are persons without these conditions

Persons with underlying health conditions who have symptoms of COVID-19, including fever, cough, or shortness of breath, should immediately contact their health care provider

These persons should take steps to protect themselves from COVID-19, through washing their hands; cleaning and disinfecting high-touch surfaces; and social distancing, including staying at home, avoiding crowds, gatherings, and travel, and avoiding contact with persons who are ill

Maintaining at least a 30-day supply of medication, a 2-week supply of food and other necessities, and knowledge of COVID-19 symptoms are recommended for those with underlying health conditions

Learn More – Primary Sources:

MMWR (CDC): Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020

Related ObG Topics:

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

Coronavirus and COVID-19: Clinical Characteristics from 138 Patients in Wuhan, China

COVID-19 Guidance: Key Highlights for Healthcare Professionals