Coronavirus and Younger people

[deirdre]

Starting a thread specifically for how the virus (and hospital/medical resources) are being affected by younger people. The CDC released a report (data as of March 16). I added bold and color for highlight.

As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States, with reports increasing to 500 or more cases per day beginning March 14 (Figure 1). Among 2,449 patients with known age, 6% were aged ≥85, 25% were aged 65–84 years, 18% each were aged 55–64 years and 45–54 years, and 29% were aged 20–44 years (Figure 2). Only 5% of cases occurred in persons aged 0–19 years.


Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years, 26% were aged 65–84 years, 17% were aged 55–64 years, 18% were 45–54 years, and 20% were aged 20–44 years. Less than 1% of hospitalizations were among persons aged ≤19 years (Figure 2). The percentage of persons hospitalized increased with age, from 2%–3% among persons aged ≤9 years, to ≥31% among adults aged ≥85 years. (Table).


Among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults ≥85 years, 46% among adults aged 65–84 years, 36% among adults aged 45–64 years, and 12% among adults aged 20–44 years (Figure 2). No ICU admissions were reported among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table).

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

 

[Mendel]

It's been well known that old ageis a big risk factor for Covid-19.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

I have looked at the data included in the article, and I don't like it. Their table 2 has two percentages apiece, one is the fraction of total cases, and I've calculated the raw numbers from that. Two columns are off by 1 on the totals for that,and given the precision of the percentages, I guess that's acceptable. But I've also tried to work with the other numbers, which are supposed to be the percentage of known cases, from the raw numbers I obtained in the first step, and nothing works out.

But anyway, have some graphs based on these raw numbers:

These graphs refelct the situation you'd see in the average hospital.
If you want to compare percentages, the risk for a specific age group, the graph changes, because we have fewer cases outside of 45-75. (And note that this risk is a low estimate, since it includes cases whose outcome may get worse!) It looks like this:

 

[Agent K]

The CDC hid this bar graph on their page about older adults to point out that older adults are a higher risk of death, but it also shows that younger adults take up hospital and ICU beds too. The younger ICU patients are much more likely to survive, and the oldest group had more deaths than ICU admissions.

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications/older-adults.html

8 out of 10 deaths reported in the U.S. have been in adults 65 years old and older
​

Among adults with confirmed COVID-19 reported in the U.S.:

• Estimated percent requiring hospitalization
  • 31-70% of adults 85 years old and older
  • 31-59% of adults 65-84 years old
• Estimated percent requiring admission to intensive care unit
  • 6-29% of adults 85 years old and older
  • 11-31% of adults 65-84 years old
• Estimated percent who died
  • 10-27% of adults 85 years old and older
  • 4-11% of adults 65-84 years old

 

[deirdre]

about older adults

we already all know about older adults. this thread is for information on younger patients.

 

[Agent K]

When comparing different epidemics, it's common to compare the death tolls, but epidemics that kill younger people have a bigger effect on the average life expectancy. "The 1918 (flu) pandemic actually caused the average life expectancy in the United States to drop by about 12 years for both men and women" because it tended to kill young adults. The 2009 H1N1 flu pandemic killed fewer Americans than the average seasonal flu, but 2-3 times more of them were under 65. That is, it killed about 12,500 Americans, and 87% of them, or 10900, were under 65, while the seasonal flu kills 30,000, but only 10-20%, or 4500, are under 65.

Here's the age breakdown of fatality rate for flu versus COVID-19 based on early data from China. Since we don't know the number of unreported COVID-19 cases, that graph may need to be scaled way down by some unknown factor.

Earlier this year, it was reported that "Life expectancy in the U.S. rose in 2018, the first such increase in four years"
https://abcnews.go.com/Health/us-life-expectancy-rose-2018-1st-time-years/story?id=68584064

Those gains were driven by declines in 6 of the 10 leading causes of death between 2017 and 2018, and a notable drop in drug overdose deaths.
Overdose deaths, after increasing for decades, fell for the first time in 28 years, from 70,237 in 2017 to 67,367 in 2018, according to the report.

Source: National Center for Health Statistics (ABC News ILLUSTRATION)

"It's really the drug overdose deaths that are driving that trend," said Robert Anderson, chief of the mortality statistics branch at NCHS.
Drug overdose deaths, Anderson explained, have a profound impact on average life expectancy because many occur at younger ages than other leading causes of death -- cancer, heart disease, stroke, Alzheimer's disease.
"When folks die at younger ages, they have a disproportionate impact on life expectancy," Anderson said.

Looking at that graph, the drop in drug overdoses is not that big, yet it drove the increase in life expectancy because overdose deaths occur at younger ages.

 

[Agent K]

we already all know about older adults. this thread is for information on younger patients.

Please finish reading my sentence.

 

[deirdre]

Please finish reading my sentence.

your external quote is 100% about old people. This thread is about the effects of coronavirus, not drug use or flu or life expectancies, on young people medically and on the resources -those effects will have -on the medical structure as a whole.

 

[Agent K]

Age breakdown of deaths in Italy from March 13. Two deaths in the 30-49 year-old group.

At the time, Maurizio Cecconi, head of anesthesiology & ICU at Humanitas Research Hospital in Lombardy, said the region has about 700-800 patients in ICU, most of them on ventilators. The median age of ICU patients was 65, which means that half were younger. He suggested that there were enough ICU beds for everyone.
Here's the Twitter thread about this:

Source: https://twitter.com/HelenBranswell/status/1238452389864263681


But on March 9, Politico reported that some hospitals were near saturation and had to prioritize younger patients over older ones.
https://www.politico.eu/article/coronavirus-italy-doctors-tough-calls-survival/

Lombardy has some 900 beds available for patients needing intensive care, but in some provinces, particularly in Bergamo, Lodi and Pavia, hospitals are "near saturation," the doctor said.
"We are aware that the body of an extremely fragile patient is unable to tolerate certain treatments compared to that of a healthy person" — Luigi Riccioni, anesthesiologist
For now, the marching orders are: Save scarce resources for those patients who have the greatest chance of survival. That means prioritizing younger, otherwise healthy patients over older patients or those with pre-existing conditions.

 

[deirdre]

This article which says it got it's data from official data from the Istituto Superiore di Sanita, published March 16 but the data footnote says March 13

Currently, 21% of cases have been admitted to hospital, and 1545 patients are in intensive care. The median age of those in intensive care is 69 (age 51-70: 46%; age >70: 44%), with no cases under the age of 18. However, a significant percentage of patients are under 30, which confirms how crucial this age group is in transmitting the virus.

https://www.bmj.com/content/bmj/368/bmj.m1065.full.pdf

I don't think the "significant percentage of patients are under 30" is referring to icu??? since there are only 10% age 50 and under in icu based on her numbers.
and so far I haven't found the original doc on the official site https://www.epicentro.iss.it/coronavirus/sars-cov-2-sorveglianza-dati

 

[Mendel]

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html

Tabelle 2: Demografische Daten und Symptome COVID-19-Erkrankter aus Deutschland (Stand 18.03.2020)

Überblick zu Daten aus Deutschland
Demografie
Geschlechterverhältnis	56 % männlich
Altersmedian	47 Jahre
Altersverteilung	< 5 Jahre: 0,8 % 5–14 Jahre: 2,4 % 15–59 Jahre: 80 % ≥ 60 Jahre: 16,3 %

Table 2: Demographic data and symptoms of Covid-19-patients from Germany (as of 03/18/2020) [I did not quote the symptoms]

Overview for the data from Germany
Demographics
Gender ratio	56 % male
Median age	47 years
Age distribution	< 5 years: 0,8 % 5–14 years: 2,4 % 15–59 years: 80 % ≥ 60 years: 16,3 %

The median age is close to the median fo the whole population; our age distribution is 18% under 20 and 28% over 60, which means that so far, the virus has spread less to the "outside" ages.

 

[DavidB66]

I previously raised a question as to why the COVID-19 death rate in Germany (deaths as a proportion of infections) is so low compared to that in other large European countries (France, Italy, Spain, UK). I wondered whether the German authorities are using a narrower definition of COVID-related deaths. The briefing note from the Robert Koch Institute (see Mendel's post above) doesn't entirely clear this up. There are versions of the note in both German and English. The Summary in the English version refers to 'deaths due to COVID-19', while further down (page 4) it uses the phrase 'COVID-19-related deaths'. In the Summary the German text refers to 'Todesfalle in Zusammenhang mit COVID-19-Erkrankungen'. The main text of the German version is longer and differently organised than the English version. Under the section 'Klinische Aspekte' it refers to 'Personen in Deutschland im Zusammenhang mit einer COVID-19-Erkrankung verstorben'. The English phrase 'due to' normally implies a definite causal connection, whereas 'COVID-related' is more ambiguous'. I think the German phrase 'in Zusammenhang mit' would usually be translated as 'in connection with', which again is somewhat ambiguous. The RKI's welcome page also links to 'Weitere Informationen' (in German only). I have looked at this, but my knowledge of German is not sufficient for a thorough read. I do not see anything, for example in the 'FAQ' section, directly relevant to the criteria for recording COVID-related deaths, but I may well have missed something.

 

[Mendel]

I do not see anything, for example in the 'FAQ' section, directly relevant to the criteria for recording COVID-related deaths, but I may well have missed something.

This is the RKI FAQ (German): https://www.rki.de/SharedDocs/FAQ/NCOV2019/FAQ_Liste.html
The pertinent question is "Wie funktioniert der Meldeweg, was ist alles meldepflichtig und welche Informationen zu den Erkrankten werden ans RKI übermittelt?": How does the official reporting chain work, what must be reported, and what data about the patient is reported to the RKI?
The last paragraph reveals the information you seek:

In den Meldedaten erfasst werden auch alle Todesfälle, die mit einer COVID-19-Erkrankung in Verbindung stehen: Sowohl Menschen, die direkt an der Erkrankung gestorben sind ("gestorben an"), als auch Patienten mit Grundkrankheiten, die mit COVID-19 infiziert waren und bei denen sich nicht klar nachweisen lässt, was letzten Endes die Todesursache war ("gestorben mit"). Verstorbene, die zu Lebzeiten nicht auf COVID-19 getestet worden waren, aber in Verdacht stehen, an COVID-19 gestorben zu sein, können post mortem auf das Virus untersucht werden.

The reported data contains all fatalities that are connected to a Covid-19-illness: both people who died of the disease directly ("died of"), as well as patients with existing conditions/illnesses and where the eventual cause of death is unclear ("died with"). Deceased, who had not been tested for Covid-19 while alive, can be tested posthumously.
This is essentially the same answer I gave you before: if you're infected and die in a house fire, you won't be counted, but in cases where it's unclear, your death is registered for the statistic. This judgment call is up to the physician who examines the body ("Leichenschau"), determines the cause of death and then reports it to the county health agency ("Gesundheitsamt"), who pass the data on to the RKI. The purpose of this (and the reason why the RKI exists) is to track epidemics, not to produce pleasant numbers.

 

[DavidB66]

This is the RKI FAQ (German): https://www.rki.de/SharedDocs/FAQ/NCOV2019/FAQ_Liste.html
The pertinent question is "Wie funktioniert der Meldeweg, was ist alles meldepflichtig und welche Informationen zu den Erkrankten werden ans RKI übermittelt?": How does reporting work, what must be reported, and what data about the patient is reported to the RKI?
The last paragraph reveals the information you seek:

In den Meldedaten erfasst werden auch alle Todesfälle, die mit einer COVID-19-Erkrankung in Verbindung stehen: Sowohl Menschen, die direkt an der Erkrankung gestorben sind ("gestorben an"), als auch Patienten mit Grundkrankheiten, die mit COVID-19 infiziert waren und bei denen sich nicht klar nachweisen lässt, was letzten Endes die Todesursache war ("gestorben mit"). Verstorbene, die zu Lebzeiten nicht auf COVID-19 getestet worden waren, aber in Verdacht stehen, an COVID-19 gestorben zu sein, können post mortem auf das Virus untersucht werden.

The reported data contains all fatalities that are connected to a Covid-19-illness: both people who died of the disease directly ("died of"), as well as patients with existing conditions/illnesses and where the eventual cause of death is unclear ("died with"). Deceased, who had not been tested for Covid-19 while alive, can be tested posthumously.
This is essentially the same answer I gave you before: if you're infected and die in a house fire, you won't be counted, but in cases where it's unclear, your death is registered for the statistic. This judgment call is up to the physician who determines the cause of death and then reports it to the county health agency ("Gesundheitsamt"), who passes the data on to the RKI. The purpose of this (and the reason why the RKI exists) is to track epidemics, not to produce pleasant numbers.

Thanks. That's very helpful. I didn't know the word 'Meldeweg', so I didn't notice the relevance of that question.

 

[Mendel]

The official German data provided by the RKI for the dashboard lists the cases by age group and sex, here's a timeline (using yesterday's data). Note that the last few days are typically incomplete, as some county health offices take a while to enter the paper forms online.

Observations:
- fewer cases registered on Saturdays and Sundays
- every age group gets a fair share of COVID-19, but...
- at first, the old population wasn't infected as much, but that changed over time
- mostly old people die
- the young people need to better protect the old ones from getting infected

Please don't forget that all age groups, even those with no deaths, have very severe cases of pneumonia/ARDS.

 

[Mendel]

https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm?s_cid=mm6915e3_w