U.S. studies offer clues to COVID-19 spread, severity

March 19, 2020

Although severe illness and death from COVID-19 infection can occur in people of any age, 80 percent of U.S. deaths so far have been in those 65 years and older, with the worst outcomes in people 85 and older, according to an analysis in the March 18 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC).

In another report in the same journal, experts analyzing the highly publicized novel coronavirus outbreak in a Washington state long-term care facility said that the virus can quickly spread in residents, workers, and visitors and that "substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19."

The first description of outcomes in 4,226 U.S. COVID-19 cases reported to the CDC from February 12 to March 16 shows that 31 percent of cases, 45 percent of hospitalizations, 53 percent of intensive care unit (ICU) admissions and 80 percent of deaths occurred in people 65 years or older.

Fatality rates for people 85 years and older ranged from 10-27 percent. Of those aged 65 to 84 years, 3-11 percent died. Death rates fell to 1-3 percent among those 55 to 64, less than 1 percent in those 20 to 54, and 0 percent in those 19 and younger.

"These preliminary data also demonstrate that severe illness leading to hospitalization, including ICU admission and death, can occur in adults of any age with COVID-19," the authors wrote. "In contrast, persons aged ≤19 years appear to have milder COVID-19 illness, with almost no hospitalizations or deaths reported to date in the United States in this age group."

The percentage of people hospitalized with the virus rose with age, from 2-3 percent of those 9 years and younger to 31 percent of those 85 and older. The percentage of patients admitted to an ICU ranged from 2-4 percent among those 20 to 44 years to 11-31 percent of those 75 to 84 years.

Of the 2,449 infected patients whose age was known, 6 percent were 85 years or older, 26 percent were 65 to 84, 18 percent were 45 to 54, 17 percent were 55 to 64, and 20 percent were 20 to 44. Only 5 percent of infections occurred in people 19 years and younger.

The data support findings from China that 80 percent of coronavirus deaths have occurred in people 60 years and older and those with underlying health conditions, the authors wrote. Only one person (1 percent) 19 or younger in the Chinese study died from the virus.

People 65 years and older in the United States total 49 million, many of whom might need services to help them stay healthy and independent. "To prepare for potential COVID-19 illness among persons at high risk, family members and caregivers of older adults should know what medications they are taking and ensure that food and required medical supplies are available," the investigators said.

The report on the coronavirus outbreak in a King County, Washington, nursing facility, which sickened 129 people (81 of about 130 residents, 34 of 170 workers, and 14 visitors) and killed 23 from February 27 to March 9, underscores the ability of the novel coronavirus to spread quickly in such settings.

"Limitations in effective infection control and prevention and staff members working multiple facilities contributed to intra- and inter-facility spread," the researchers wrote.

Other factors that likely fed the spread included staff members who worked while ill; lack of knowledge and adherence to standard, droplet, contact precautions and eye protection; inadequate stocks of personal protective equipment (PPE) and infection-control items such as hand sanitizer; delayed diagnosis; limited testing capabilities; and difficulty identifying infection based solely on signs and symptoms, according to the authors.

Of those infected, the median age was 81 years (range, 54 to 100) in residents, 42.5 years in staff members (range, 22 to 79), and 62.5 years (range, 52 to 88) for visitors. Eighty-four (65.1 percent) were women.

Hospitalization rates were 56.8 percent for residents, 35.7 percent for visitors, and 5.9 percent of staff members. Death rates were 27.2 percent for residents and 7.1 percent for visitors; no staff members died.

The most common underlying diseases in residents were high blood pressure (69.1 percent), heart disease (56.8 percent), kidney disease (43.2 percent), diabetes (37 percent), obesity (33.3 percent) and lung disease (32.1 percent). The only underlying condition in six residents and one visitor was high blood pressure.

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