Adults Hospitalized With COVID-19 in Georgia, March 2020

This report comes from the first weeks of the COVID-19 pandemic, before vaccines and most current treatments existed. It describes patients admitted in March 2020 and reflects what was known then.

By April 28, 2020, the United States had reported more than 980,000 COVID-19 cases and more than 55,000 deaths. To learn who was being hospitalized and what happened to them, CDC, the Georgia Department of Public Health and eight Georgia hospitals, seven in metropolitan Atlanta and one in southern Georgia, reviewed the medical records of adults admitted with laboratory-confirmed COVID-19 during March 2020.

The 305 patients were a convenience sample, taken in order from lists of 698 adults hospitalized at those hospitals between March 1 and March 30. Researchers collected data over three weeks on race and ethnicity, age, sex, body mass index (BMI), insurance, whether patients lived in long-term care, risk factors for severe COVID-19, and outcomes.

Who was hospitalized

• Age: the median was 60 (range 23–95), and 61.6% were younger than 65.
• Sex: 50.5% were women.
• Race and ethnicity: among the 297 patients with this information, 247 (83.2%) were non-Hispanic Black, 32 (10.8%) non-Hispanic white, 10 (3.4%) Hispanic, and eight (2.7%) non-Hispanic Asian or Pacific Islander. Median age did not differ significantly between Black patients (60) and others (64.5).
• Insurance: 40.1% had private insurance, 33.4% Medicare, 10.9% Medicaid, and 14.9% none. Black patients were more likely than others to have Medicaid (13.5% versus 0.0%) but not more likely to be uninsured.
• Living situation: 20 patients (6.6%) had lived in long-term care facilities.
• Smoking: 5.2% currently smoked.

Underlying conditions

In all, 225 patients (73.8%) had at least one condition considered high-risk for severe COVID-19, which included being 65 or older. That left 26.2% with none.

• Diabetes: 39.7% overall, most common among those aged 50–64 (46.5%). It was not significantly more common in Black patients.
• Cardiovascular disease: 25.6%, more common at 65 and older (47.0%), and similar by race.
• Chronic lung disease: 20.3%, including asthma (10.5%) and chronic obstructive pulmonary disease (5.2%).
• Severe obesity (BMI 40 or more): 12.7%, most common among those aged 18–49 (21.8%). It did not differ significantly by race, although median BMI was higher in Black patients (31.4 versus 29.6).
• High blood pressure, not counted as a high-risk condition: 67.5%, and more common in Black patients (69.6% versus 54.0%).

What happened to them

The median hospital stay was 8.5 days and lengthened with age. Of the 305 patients, 119 (39.0%) were admitted to intensive care, rising to 53.8% among those 65 and older, and 92 (30.2%) were placed on a ventilator, 77.3% of those in intensive care.

Of the 281 patients who had left the hospital when data were collected, 48 (17.1%) had died. Deaths rose steeply with age: 3.4% among those aged 18–49, 9.8% at 50–64, and 35.6% at 65 and older. Among patients with no high-risk condition, 22.5% went to intensive care, 15.0% were ventilated and 5.1% died. As of April 24, 24 patients were still hospitalized, 14 of them in intensive care and nine on ventilators. The death rate among those who received intensive care was estimated at between 37.0% and 48.7%, depending on whether the remaining patients survived; the authors noted this was comparable to a smaller series of COVID-19 patients in Washington State.

Black patients were no more likely than others to be ventilated or to die. After adjusting for age, sex, BMI, hospital, admission date and underlying conditions, there was no significant difference in the combined outcome of ventilation or death (hazard ratio 0.63; 95% confidence interval 0.35–1.13).

What the authors concluded

Black patients were overrepresented. At four affiliated hospitals that together supplied 67% of the patients, 80% of the COVID-19 patients were Black, compared with 47% of all patients hospitalized there in March 2020. COVID-NET, which tracks laboratory-confirmed COVID-19 hospitalizations at 14 sites nationwide, found the same pattern. The authors called for continued work to understand why, including the role of social and economic factors such as jobs that raise the risk of exposure, and for prevention efforts to prioritize the communities and racial groups most affected.

All adults are at risk. A quarter of patients had no high-risk condition, and 5% of them died. The authors concluded that all adults, whatever their age or health, are at risk of serious illness, and that measures such as social distancing should be widely used to protect not only older and sicker people but also those who may not think of themselves as at risk.

Limits. The patients were a convenience sample gathered quickly and may not represent all COVID-19 patients at those hospitals or in Georgia. Patients were not followed after discharge, and race and ethnicity came from medical records, which hospitals may have recorded differently.

Sources

• Gold JAW, Wong KK, Szablewski CM, et al. Characteristics and Clinical Outcomes of Adult Patients Hospitalized with COVID-19 — Georgia, March 2020. MMWR Morb Mortal Wkly Rep 69(18); posted as an Early Release on April 29, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6918e1.htm
• The report was written jointly by CDC, the Georgia Department of Public Health, Emory University and several hospitals; its figures and social media graphic are not reproduced here.