Understanding COVID-19 in Young Adults

September 21, 2020

Medical science needs to understand the disease more clearly in this understudied patient population.

The SARS-CoV-2/COVID-19 pandemic teaches us something new nearly each day. From learning our weaknesses and vulnerabilities, to the challenges of testing, and the long-haul symptoms of infection.

Currently, the United States has seen 6.7 million cases of COVID-19. Despite so many cases, we still struggle to understand the dynamics of infection in children and young adults. The Centers for Disease Control and Prevention (CDC) releases data continuously to shed light on the pandemic and the impact on the United States.

Currently, there is data on 4.9 million cases by age group and of those, the majority (23.4%) were in those aged 18-29, and 20.8% were in 50-64 year-olds. For deaths by age group, the majority were in those aged older than 50, with the rates climbing for every 10 years. What do we really know about those young adult cases?

A new article published in JAMA Internal Medicine helped answer this question by digging into the clinical outcomes of those hospitalized young adults battling COVID-19. Since this age group is experiencing rapid transmission, understanding the clinical aspects of their hospitalization is critical. The research group evaluated the clinical care and outcomes of 3222 young adults hospitalized in the United States.

Young adults were defined as those aged 18-34 years. The study period included those hospitalized between April 1-June 30, 2020. Data was pulled from a Premier Healthcare Database, which has over eight million inpatient admissions annually. Those patients who were pregnant and admitted for childbirth were excluded and only those a patient’s first COVID-19 hospitalization were evaluated.

Of those 780,969 adults hospitalized during this timeframe, 8.1% had an ICD-10 code for COVID-19 and of those, 3222 were non-pregnant young adults admitted across 419 hospitals. The average age was 28.3 and 57.6% were male. 57% were black or Hispanic and 36.8% had obesity.

The authors noted that “during hospitalization, 684 patients (21%) required intensive care, 331 (10%) required mechanical ventilation, and 88 (2.7%) died. Vasopressors or inotropes were used for 217 patients (7%), central venous catheters for 283 (9%), and arterial catheters for 192 (6%). The median length of stay was 4 days (interquartile range, 2-7 days). Among those who survived hospitalization, 99 (3%) were discharged to a postacute care facility.”

The authors found that morbid obesity (18.2% of young adults) and hypertension, as well as being male, were associated with a greater risk of death or requiring mechanical ventilation. Of those patients who died or required mechanical ventilation, 41% were morbidly obese. What was particularly startling though, was the rate of those young adults experiencing adverse outcomes. Considering that 21% required care an in intensive care unit, this is something we heavily need to consider if rates stay consistent in new COVID cases and hospitalization.

Awareness of comorbidities and the sex-based findings should guide focused prevention efforts and ultimately, targeted communication. More and more, there is a need to understand the clinical outcomes of those with COVID-19, but it is also important we don’t just focus on hospitalizations, but also long-term health implications of the infection. Awareness of the disease in young adults and the their outcomes, both short and long-term, is vital for prevention efforts.