The predominance of younger, healthier patients where Covid-19 is surging in the U.S. could mean better outcomes, health authorities say, but they are concerned the coronavirus may yet spread to older and more-vulnerable populations.
People currently testing positive for the novel coronavirus which causes Covid-19 are skewing younger and are generally better able to fight off the disease. And hospitals say they have new treatment options and more knowledge about how to successfully treat the disease than previously.
Yet as infections show signs of accelerating in several states, public health authorities say the virus will likely spread from younger, healthier cohorts to vulnerable groups, such as parents, grandparents or neighbors.
“A lot of people are going back to seeing family,” said Nadia Abuelezam, an infectious-disease epidemiologist at Boston College. “This is what’s going to cause the jump from the younger people to the older people.”
While younger and healthier people might fare better, “If they give it to an older population, a more vulnerable population, transplant patients, or cancer patients or diabetics, those people are not going to do well,” said Lilly Lee, medical director of the emergency department at Jackson Memorial Hospital in Miami, Fla.
Steps such as meeting outside, wearing masks and not sharing utensils or food can help reduce transmission risk, Dr. Abuelezam says.
The U.S. has now confirmed more than 2.6 million cases of Covid-19, the disease caused by the coronavirus, and more than 127,000 people have died, according to data compiled by Johns Hopkins University. The pandemic, which hit New York and surrounding states in the Northeast hard in the Spring, is now surging in Arizona, Florida and Texas and elsewhere in the South and West.
In Texas, the number of hospitalized Covid-19 patients is up 60%, and in Arizona it is up 27%, versus a week earlier, according to the states. Florida hasn’t released data on how many patients in hospitals are being treated for Covid-19. Not all states report hospitalization data, and those that do report it differently, making it difficult to get a national snapshot of hospitalized Covid-19 patients.
The number of cases, the percentages of tests coming back positive and hospitalizations have ticked upward in several states including California, Nevada and South Carolina, but nationally the average number of daily deaths hasn’t increased.
It is too early to tell, epidemiologists say, if the pace of deaths will increase proportionally in the next few weeks, but they are expected to rise. Deaths often lag weeks behind cases and hospitalizations in the Covid-19 data. It takes a few days to weeks for a person who has been exposed to develop symptoms, get tested and get results. The Centers for Disease Control and Prevention estimates that deaths typically occur around two weeks after a person shows symptoms, and it can take a week after that for the death to be reported in the data.
Hospitals are filling with larger numbers of younger patients with complications from Covid-19 such as breathing difficulties, kidney injuries and pulmonary embolisms who nonetheless are relatively easier to treat than older people with the disease. Moreover, hospitals in new hotspots say they have learned a lot about how to treat patients effectively, including avoiding intubations as much as possible. “The younger patients, without other medical conditions, create a lot less complexity of care,” said Sam Bagchi, chief clinical officer of Christus Health, an Irving, Texas, chain of 36 hospitals in Texas and surrounding states.
Dr. Bagchi said doctors at Christus hospitals are able to keep more of the younger patients off ventilators, because those with low oxygen levels respond better to treatments other than intubation. “We call it happy hypoxia,” he said.
The risk of getting severely ill and dying from Covid-19 increases with age. Through the end of May, roughly 29% of reported Covid-19 patients with available data in the U.S. who were 80 years old or above died, compared with 7.0% of patients in their 60s, 1% in their 40s and 0.1% in their 20s, according to a June report from the CDC based on data from 1.3 million confirmed cases.
The risks are also greater for those with other health conditions, including cardiovascular disease, obesity and diabetes. Hospitalizations are six times higher—and deaths 12 times higher—among people who report underlying conditions, according to the CDC.
But being younger and healthy isn’t a guarantee of a good outcome, medical experts say, and a flood of younger patients could still overwhelm hospital systems.
Arizona has recorded one of the highest increases in cases—a 36% rise from a week earlier, according to state data, while related deaths are up 18%. “Unfortunately, in Arizona, I don’t think we’ve seen the peak. We anticipate an increased volume of patients over the next two weeks,” said Michael White, the chief medical officer at Valleywise Health, the public safety-net hospital system in Phoenix. “I’m hopeful that we won’t see a rise in mortality as a lagging indicator, but that is certainly a possibility.”
Dennis Bonnen, the Texas Speaker of the House of Representatives, who is a Republican, says that a rise in hospitalizations is foreseeable and that it was critical for everyone to wear face masks while out in public. “Next week’s numbers are already baked in,” he said. “We better start today so that the numbers look better in two or three weeks.”