This was CDC's first description of severe COVID-19 outcomes in the United States, published in March 2020, before testing was widespread and before vaccines or most treatments existed. The report was later corrected.
By mid-March 2020, about 170,000 confirmed COVID-19 cases and an estimated 7,000 deaths had been reported in about 150 countries, and on March 11 the World Health Organization had declared a pandemic. Data from China showed that most cases were mild (81%) but that about 80% of deaths were among adults 60 and older, especially those with serious underlying conditions; only one death (0.1%) was in someone 19 or younger.
CDC analyzed U.S. cases reported from February 12 to March 16, 2020, from 49 states, the District of Columbia and three territories, excluding people repatriated from Wuhan, China, and from Japan, including cruise ships. There were no data on underlying health conditions, and many records lacked key information: hospitalization status was missing for 1,514 cases, intensive care admission for 2,253, death for 2,001 and age for 386. So CDC gave each outcome as a range: the lower bound counts every case in an age group, the upper bound only cases where the outcome was known.
The cases
As of March 16, 4,226 cases had been reported, rising to 500 or more a day from March 14. Many were among older adults in long-term care facilities. Of the 2,449 patients whose age was known:
| Age | Share of cases |
|---|---|
| 85 and older | 6% |
| 65–84 | 25% |
| 55–64 | 18% |
| 45–54 | 18% |
| 20–44 | 29% |
| 0–19 | 5% |
Severe outcomes
- Hospitalization: 508 patients (12%) were known to have been hospitalized. Among them, 9% were 85 or older, 36% were 65–84, 17% were 55–64, 18% were 45–54 and 20% were 20–44; under 1% were 19 or younger. The share hospitalized rose with age, from 2–3% among people 19 or younger to 31% or more among those 85 and older.
- Intensive care: of 121 patients known to have been admitted to intensive care, 7% were 85 or older, 46% were 65–84, 36% were 45–64 and 12% were 20–44. None were 19 or younger. The share admitted to intensive care was lowest among adults 20–44 (2–4%) and highest among those 75–84 (11–31%).
- Deaths: of 44 deaths, 15 (34%) were among adults 85 or older, 20 (46%) among those 65–84 and nine (20%) among those 20–64. There were no deaths among people 19 or younger.
Case fatality rose steeply with age:
| Age | Share of patients who died |
|---|---|
| 85 and older | 10% to 27% |
| 65–84 | 3% to 11% |
| 55–64 | 1% to 3% |
| 20–54 | under 1% |
| 19 and younger | none |
Overall, adults 65 and older accounted for 31% of cases, 45% of hospitalizations, 53% of intensive care admissions and 80% of deaths, with the worst outcomes among those 85 and older. That matched China's experience. But severe illness requiring hospitalization, intensive care, and even death occurred in adults of every age, while children and teens appeared to have milder illness.
What CDC advised
About 49 million Americans are 65 or older, and many rely on services and support to stay healthy and independent. CDC urged families and caregivers to know what medications older relatives take and to make sure they had food and medical supplies, and long-term care facilities to be especially vigilant against the virus. Older adults were advised to keep nonperishable food and at least a 30-day supply of medicines, keep their distance from others, stay away from sick people, avoid crowds, cruises and nonessential air travel, and stay home as much as possible. Social distancing was recommended for everyone to slow the spread, protect the health system and protect older adults. Clinicians were reminded that COVID-19 can be severe at any age, and patients were told to call their provider if symptoms worsened and to seek emergency care for persistent severe symptoms.
Limits
Missing data on age and outcomes, from 9% to 53% of cases depending on the measure, likely led to underestimates. Many cases needed more time for outcomes to be known. Early testing focused on travelers and on sicker patients, which may have overstated how often disease was severe. Information on underlying conditions was unavailable, and testing was limited.
Sources
- CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 69(12); posted as an Early Release on March 18, 2020, and later corrected. https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
- The report's figures are not reproduced here because it was corrected after publication.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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