A lack of widespread testing for the virus in the U.S. has made it difficult for health officials to know which groups are most at risk. But doctors and other health workers who spoke to Bloomberg described surprising numbers of younger patients who needed life-saving care.
“It’s young folks, previously healthy,” said Eric Wei, an emergency room doctor and chief quality officer at NYC Health + Hospitals, the city’s public hospital system. “They look like they have the flu. Within hours, they need oxygen. Within a few more hours they need a ventilator.”
At NYU Langone Health’s Medical Center overlooking the East River in Manhattan, dozens of patients in intensive care last week were under age 50, according to a worker who was providing direct medical care to them. A handful were in their 20s, and one was just 7 years old. The hospital declined to provide exact numbers of Covid-19 patients, details about their ages or whether they had underlying health conditions, citing patient privacy.
In China, which was hit first by the virus, just 4.3% of patients age 40 to 49 were hospitalized after developing Covid-19, according to a report published in the journal Lancet Infectious Diseases. It was even lower for younger people, with just 1% of those in their 20s and 3.4% of those age 30 to 39 requiring hospitalization, the report found.
Those gaps could be made up of differences in demographics, the share of people with pre-existing conditions or differing medical practices or resources. Italy, for example, has one of Europe’s oldest populations and people age 80 and up died at a rate of about 20%. In China, the fatality rate for the same age group was 15%.
“These cases in young and middle-aged people are striking,” said Paul Sax, clinical director of infectious diseases at Brigham and Women’s Hospital in Boston. “This isn’t how it was originally perceived from afar. There are definitely people who are surprised that this is a severe infection in this group, people who were previously totally healthy and exercising and doing just fine.”
In New York, 77% of the 914 patients who died had a medical condition such as diabetes, lung disease, heart disease or asthma, according to the city’s health department. Only 1.5% were otherwise healthy, with another 20% of the cases still under review. A broader analysis by the U.S. Centers for Disease Control and Prevention found a similar trend, that three-quarters of Americans who ended up in the ICU because of Covid-19 had one or more underlying health problems. Few people with such problems are able to recover without a hospital stay, the CDC said.
Risk Factors
Two-thirds of the U.S. is overweight or obese, factors shown to increase the risk of Covid-19. Nearly half of adults have high blood pressure. And 1 in 8 Americans haven’t visited a doctor in the past year, meaning that some may have health conditions and not know it.
Experts are seeing the same pattern emerging elsewhere in the U.S. as outbreaks grow. In Philadelphia, 56% of confirmed Covid-19 cases are under 40. A teenager lost their life in Los Angeles, a 12-year-old was intubated in Seattle, an infant was infected in Delaware and a 1-year-old baby died in Chicago.
For patients nursed through the infection with the help of a ventilator, there may be lasting health problems, said Ross McKinney Jr., chief scientific officer of the Association of American Medical Colleges. For even the youngest patients, doctors have to use ventilators set to high pressure, pumping in high levels of oxygen.