Morbidity and Mortality Weekly Report

Early Release / Vol. 69 March 18, 2020

Severe Outcomes Among Patients with Coronavirus Disease 2019

(COVID-19) — United States, February 12–March 16, 2020
CDC COVID-19 Response Team

Globally, approximately 170,000 confirmed cases of coro- developed data collection forms (6). The cases described in this
navirus disease 2019 (COVID-19) caused by the 2019 novel report include both COVID-19 cases confirmed by state or local
coronavirus (SARS-CoV-2) have been reported, including an public health laboratories as well as those with a positive test at
estimated 7,000 deaths in approximately 150 countries (1). On the state or local public health laboratories and confirma-tion at
March 11, 2020, the World Health Organization declared the CDC. No data on serious underlying health conditions were
COVID-19 outbreak a pandemic (2). Data from China have available. Data on these cases are preliminary and are miss-ing
indicated that older adults, particularly those with seri-ous for some key characteristics of interest, including hospital-
underlying health conditions, are at higher risk for severe COVID- ization status (1,514), ICU admission (2,253), death (2,001),
19–associated illness and death than are younger persons (3). and age (386). Because of these missing data, the percentages
Although the majority of reported COVID-19 cases in China were of hospitalizations, ICU admissions, and deaths (case-fatality
mild (81%), approximately 80% of deaths occurred among adults percentages) were estimated as a range. The lower bound of
aged ≥60 years; only one (0.1%) death occurred in a person aged these percentages was estimated by using all cases within each
≤19 years (3). In this report, COVID-19 cases in the United States age group as denominators. The corresponding upper bound of
that occurred during February 12–March 16, 2020 and severity of these percentages was estimated by using only cases with
disease (hospi-talization, admission to intensive care unit [ICU], known information on each outcome as denominators.
and death) were analyzed by age group. As of March 16, a total of As of March 16, a total of 4,226 COVID-19 cases had been
4,226 COVID-19 cases in the United States had been reported to reported in the United States, with reports increasing to 500 or
CDC, with multiple cases reported among older adults living in more cases per day beginning March 14 (Figure 1). Among
long-term care facilities (4). Overall, 31% of cases, 45% of 2,449 patients with known age, 6% were aged ≥85, 25% were
hospitalizations, 53% of ICU admissions, and 80% of deaths aged 65–84 years, 18% each were aged 55–64 years and 45–54
associated with COVID-19 were among adults aged ≥65 years with years, and 29% were aged 20–44 years (Figure 2). Only 5% of
the highest percentage of severe outcomes among persons aged ≥85 cases occurred in persons aged 0–19 years.
years. In contrast, no ICU admissions or deaths were reported Among 508 (12%) patients known to have been hospitalized,
among persons aged ≤19 years. Similar to reports from other 9% were aged ≥85 years, 36% were aged 65–84 years, 17%
countries, this finding suggests that the risk for serious disease and were aged 55–64 years, 18% were 45–54 years, and 20% were
death from COVID-19 is higher in older age groups. aged 20–44 years. Less than 1% of hospitalizations were among
persons aged ≤19 years (Figure 2). The percentage of persons
Data from cases reported from 49 states, the District of hospitalized increased with age, from 2%–3% among persons
Columbia, and three U.S. territories (5) to CDC during February aged ≤9 years, to ≥31% among adults aged ≥85 years. (Table).
12–March 16 were analyzed. Cases among persons repatriated Among 121 patients known to have been admitted to an
to the United States from Wuhan, China and from Japan ICU, 7% of cases were reported among adults ≥85 years,
(including patients repatriated from cruise ships) were excluded. 46% among adults aged 65–84 years, 36% among adults
States and jurisdictions voluntarily reported data on laboratory- aged 45–64 years, and 12% among adults aged 20–44 years
confirmed cases of COVID-19 using previously (Figure 2). No ICU admissions were reported among persons

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention
 Early Release

,†
FIGURE 1. Number of new coronavirus disease 2019 (COVID-19) cases reported daily* (N = 4,226) — United States, February 12–March 16, 2020

1,200

1,000

800
No. of cases

600

400

200

0
27 28 29 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Feb Mar
Date of report
* Includes both COVID-19 cases confirmed by state or local public health laboratories, as well as those testing positive at the state or local public health
laboratories and confirmed at CDC.
† Cases identified before February 28 were aggregated and reported during March 1–3.

aged ≤19 years. Percentages of ICU admissions were lowest appear to have milder COVID-19 illness, with almost no
among adults aged 20–44 years (2%–4%) and highest hospitalizations or deaths reported to date in the United
among adults aged 75–84 years (11%–31%) (Table). States in this age group. Given the spread of COVID-19
Among 44 cases with known outcome, 15 (34%) deaths in many U.S. communities, CDC continues to update
were reported among adults aged ≥85 years, 20 (46%) current recommendations and develop new resources and
among adults aged 65–84 years, and nine (20%) among guidance, including for adults aged ≥65 years as well as
adults aged 20–64 years. Case-fatality percentages increased those involved in their care (7,8).
with increasing age, from no deaths reported among persons Approximately 49 million U.S. persons are aged ≥65 years (9),
aged ≤19 years to highest percentages (10%–27%) among and many of these adults, who are at risk for severe COVID-19–
adults aged ≥85 years (Table) (Figure 2). associated illness, might depend on services and support to
maintain their health and independence. To prepare for potential
Discussion COVID-19 illness among persons at high risk, family members
Since February 12, 4,226 COVID-19 cases were reported in and caregivers of older adults should know what medications they
the United States; 31% of cases, 45% of hospitalizations, 53% are taking and ensure that food and required medical supplies are
of ICU admissions, and 80% of deaths occurred among adults available. Long-term care facilities should be particularly vigilant
aged ≥65 years with the highest percentage of severe outcomes to prevent the introduction and spread of COVID-19 (10). In
among persons aged ≥85 years. These findings are similar to addition, clinicians who care for adults should be aware that
data from China, which indicated >80% of deaths occurred COVID-19 can result in severe disease among persons of all ages.
among persons aged ≥60 years (3). These preliminary data also Persons with suspected or confirmed COVID-19 should monitor
demonstrate that severe illness leading to hospitalization, their symptoms and call their pro-vider for guidance if symptoms
including ICU admission and death, can occur in adults of any worsen or seek emergency care for persistent severe symptoms.
age with COVID-19. In contrast, persons aged ≤19 years Additional guidance is available

2 MMWR  /  March 18, 2020  /  Vol. 69

 Early Release

† §
FIGURE 2. COVID-19 hospitalizations,* intensive care unit (ICU) admissions, and deaths, by age group — United States,
February 12– March 16, 2020

140
No. of hospitalizations, ICU admissions, and deaths

120 Hospitalizations
ICU admissions
Deaths
100

80

60

40

20

0
0–19 20–44 45–54 55–64 65–74 75–84 ≥85
Age group (yrs)

* Hospitalization status missing or unknown for 1,514 cases.

†
ICU status missing or unknown for 2,253 cases.
§
Illness outcome or death missing or unknown for 2,001 cases.

for health care providers on CDC’s website (https://www.cdc. TABLE. Hospitalization, intensive care unit (ICU) admission,
and case– fatality percentages for reported COVID–19 cases,
gov/coronavirus/2019-nCoV/hcp/index.html).
by age group — United States, February 12–March 16, 2020
This report describes the current epidemiology of COVID-19
Age group (yrs) %*
in the United States, using preliminary data. The findings in this
(no. of cases) Hospitalization ICU admission Case-fatality
report are subject to at least five limitations. First, data were
0–19 (123) 1.6–2.5 0 0
missing for key variables of interest. Data on age and outcomes, 20–44 (705) 14.3–20.8 2.0–4.2 0.1–0.2
including hospitalization, ICU admission, and death, were 45–54 (429) 21.2–28.3 5.4–10.4 0.5–0.8
missing for 9%–53% of cases, which likely resulted in an 55–64 (429) 20.5–30.1 4.7–11.2 1.4–2.6
65–74 (409) 28.6–43.5 8.1–18.8 2.7–4.9
underestimation of these outcomes. Second, further time for 75–84 (210) 30.5–58.7 10.5–31.0 4.3–10.5
follow-up is needed to ascertain outcomes among active cases. ≥85 (144) 31.3–70.3 6.3–29.0 10.4–27.3
Third, the initial approach to testing was to identify patients Total (2,449) 20.7–31.4 4.9–11.5 1.8–3.4
among those with travel histories or persons with more severe * Lower bound of range = number of persons hospitalized, admitted to ICU,
or who died among total in age group; upper bound of range = number of
disease, and these data might overestimate the prevalence of persons hospitalized, admitted to ICU, or who died among total in age
severe disease. Fourth, data on other risk factors, including group with known hospitalization status, ICU admission status, or death.
serious underlying health conditions that could increase risk for
The risk for serious disease and death in COVID-19 cases
complications and severe illness, were unavailable at the time of
among persons in the United States increases with age. Social
this analysis. Finally, limited testing to date underscores the
importance of ongoing surveillance of COVID-19 cases. distancing is recommended for all ages to slow the spread of the
Additional investigation will increase the understanding about virus, protect the health care system, and help protect
persons who are at risk for severe illness and death from vulnerable older adults. Further, older adults should maintain
COVID-19 and inform clinical guidance and community-based adequate supplies of nonperishable foods and at least a 30-day
mitigation measures.* supply of necessary medications, take precautions to keep space
between themselves and others, stay away from those who are
* https://www.cdc.gov/coronavirus/2019- sick, avoid crowds as much as possible, avoid cruise travel and
ncov/downloads/community-mitigation-strategy.pdf.

MMWR  /  March 18, 2020  /  Vol. 69 3

 Early Release

All authors have completed and submitted the International

Summary Committee of Medical Journal Editors form for disclosure of potential
What is already known about this topic? conflicts of interest. No potential conflicts of interest were disclosed.
Early data from China suggest that a majority of
coronavirus disease 2019 (COVID-19) deaths have References
occurred among adults aged ≥60 years and among 1. World Health Organization. Coronavirus disease 2019 (COVID-19)
persons with serious underlying health conditions. situation report–57. Geneva, Switzerland: World Health Organization;
What is added by this report? 2020. https://www.who.int/docs/default-source/coronaviruse/situation-
reports/20200317-sitrep-57-covid-19.pdf?sfvrsn=a26922f2_2
This first preliminary description of outcomes among patients with
COVID-19 in the United States indicates that fatality was highest in 2. World Health Organization. Coronavirus disease 2019 (COVID-19)
situation report–51. Geneva, Switzerland: World Health Organization;
persons aged ≥85, ranging from 10% to 27%, followed by 3% to
2020. https://www.who.int/docs/default-source/coronaviruse/situation-
11% among persons aged 65–84 years, 1% to 3% among persons reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10
aged 55-64 years, <1% among persons aged 20–54 years, and no 3. Novel Coronavirus Pneumonia Emergency Response Epidemiology
fatalities among persons aged ≤19 years. Team. The epidemiological characteristics of an outbreak of 2019
What are the implications for public health practice? novel coronavirus diseases (COVID-19) in China [Chinese]. Chinese
Center for Disease Control and Prevention Weekly 2020;41:145–51.
COVID-19 can result in severe disease, including
4. CDC. CDC, Washington State report first COVID-19 death [Media
hospitalization, admission to an intensive care unit, and
statement]. Atlanta, GA: US Department of Health and Human Services,
death, especially among older adults. Everyone can take CDC; 2020. https://www.cdc.gov/media/releases/2020/s0229-COVID-19-
actions, such as social distancing, to help slow the spread first-death.html
of COVID-19 and protect older adults from severe illness. 5. CDC. Coronavirus disease 2019 (COVID-19): cases in U.S. Atlanta,
GA: US Department of Health and Human Services, CDC; 2020.
https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
nonessential air travel, and stay home as much as possible 6. CDC. Coronavirus disease 2019 (COVID-19): information for health
to further reduce the risk of being exposed (7). Persons of departments on reporting a person under investigation (PUI), or
all ages and communities can take actions to help slow presumptive positive and laboratory-confirmed cases of COVID-19.
† Atlanta, GA: US Department of Health and Human Services, CDC; 2020.
the spread of COVID-19 and protect older adults. https://www.cdc. gov/coronavirus/2019-ncov/php/reporting-pui.html
† https://www.whitehouse.gov/wp- 7. CDC. Coronavirus disease 2019 (COVID-19): if you are at higher risk.
content/uploads/2020/03/03.16.20_ coronavirus- Get ready for COVID-19 now. Atlanta, GA:US Department of Health
guidance_8.5x11_315PM.pdf. and Human Services; 2020. https://www.cdc.gov/coronavirus/2019-
ncov/specific-groups/high-risk-complications.html
Acknowledgments 8. CDC. Coronavirus disease 2019 (COVID-19): schools, workplaces, &
community locations. Atlanta, GA: US Department of Health and Human
State and local health departments; clinical staff members Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/
caring for patients. community/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.
cdc.gov%2Fcoronavirus%2F2019-ncov%2Fpreparing-individuals-
CDC COVID-19 Response Team communities.html
9. Administration for Community Living. 2017 profile of older Americans.
Stephanie Bialek, CDC; Ellen Boundy, CDC; Virginia Bowen,
Washington, DC: US Department of Health and Human Services,
CDC; Nancy Chow, CDC; Amanda Cohn, CDC; Nicole Dowling, Administration for Community Living; 2018. https://acl.gov/sites/
CDC; Sascha Ellington, CDC; Ryan Gierke, CDC; Aron Hall, default/files/Aging%20and%20Disability%20in%20America/2017Ol
CDC; Jessica MacNeil, CDC; Priti Patel, CDC; Georgina Peacock, derAmericansProfile.pdf
10. McMichael TM, Clark S, Pogosjans S, et al. COVID-19 in a long-term
CDC; Tamara Pilishvili, CDC; Hilda Razzaghi, CDC; Nia Reed,
care facility—King County, Washington, February 27–March 9, 2020.
CDC; Matthew Ritchey, CDC; Erin Sauber-Schatz, CDC. MMWR. Morb Mortal Wkly Rep 2020. Epub March 18, 2020.
Corresponding author: Hilda Razzaghi for the CDC COVID-19 Response
Team, HRazzaghi@cdc.gov, 770-488-6518.

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4 MMWR  /  March 18, 2020  /  Vol. 69