A new analysis of pre-vaccine data from scientists at the Centers for Disease Control and Prevention (CDC) shows that 18% of hospitalized patients and 44% of those admitted to an intensive care unit (ICU) for COVID-19 died, with wide variations among different groups.
The study was published yesterday in Emerging Infectious Diseases and is based on 2,479,423 cases from 21 jurisdictions with hospitalization information reported to the CDC from May 1, 2020, to December 1, 2020, to create a hospitalization dataset. The authors also analyzed 4,708,444 cases from 22 jurisdictions for a death dataset during the same time frame. The case-hospitalization dataset covers 25.5% of the US population, and the case-fatality dataset covers 43.7% of the US population, the authors said.
Before the mid-December 2020 introduction of COVID-19 vaccines, the pandemic caused approximately 480,000 hospitalizations, and 350,000 deaths in the United States.
"Few precise estimates of hospitalization and mortality rates exist in the COVID-19–naive population in the United States, especially among demographic and clinical subgroups," the authors said.
26% of those 75 and older hospitalized
The overall case-hospitalization rate among patients was 5.7%, and the rate by sex was 6.2% for male and 5.2% for female. Hospitalization rates were lowest for children ages 5 to 14 (0.6%), and highest in case-patients 75 years and older (25.9%).
When looking at racial and ethnic demographics, the highest case-hospitalization rates were among African American or Black (14.0%) and Asian or Pacific Islander (11.2%) patients. White patients had the lowest rate (6.8%).
Few precise estimates of hospitalization and mortality rates exist in the COVID-19–naive population in the United States.
In the deaths dataset, the overall case-fatality rate was 1.7%. The lowest death rates were seen in infants and young children (0.05% for infants and 0.01% for children 1 to 14 years of age). Ten infants died in the study period.
Case-fatality rates increased steadily with age. The rate was 4.7% in patients 65 to 74 years old, 12.0% in those 75 to 84, and 23.6% in people 85 and older.
Case-fatality rates for female patients were lower than or equal to those for male patients in every age-group except infants, the authors said.
Asian or Pacific Islanders had the highest crude mortality rate (3.0%), followed by Black and African Americans (2.8%).
The fatality rate was 0.6% in people who were not hospitalized. The rate was 17.6% among all people who were hospitalized and 44.2% in those admitted to an ICU.
Age biggest predictor of death
"Age was a primary driver of SARS-CoV-2 hospitalization and death; rates had a U-shaped curve, being higher in infants, lowest in children 5 to 14 years of age, and highest among persons >65 years of age, confirming previous reports, " the authors concluded.
The analysis confirmed prior studies that have shown a nearly 50% mortality rate for ICU patients early in the pandemic. Moreover, the authors said, the findings present a baseline of data for future comparisons.
