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At the outset of the COVID-19 pandemic in the U.S., elderly people were most susceptible to acquiring infection, developing severe disease, and dying as a result of it. Using three indicators for the incidence of infection (COVID-19-like illness–related visits to emergency departments, test results for infection based on reverse transcription–polymerase chain reaction, and reported confirmed cases), the CDC now reports that between May and the end of August, 2020, the median age of COVID-19 infection has shifted downward. Nationwide, as the total number of cases and COVID-19-related deaths climbed in several southern states, the median age for COVID-19 cases declined from 46 years in May to 37 years in July and 38 years in August.
Results for all three indicators were stratified into four groups (0–19 years, 20–39 years, 40–59 years and ≥60 years), and all three indicators of infection showed a similar trend for decreased median age. From June through August, incidence was highest in persons aged 20–29 years and accounted for >20% of all confirmed cases. Positive test results in this age group preceded those in adults aged ≥60 years by an average of 8.7 days, suggesting that the younger group contributed to transmission to the older group.
Another study, published as a research letter, reported the clinical outcomes and comorbidities in 3222 young adults aged 18 to 34 years admitted to 419 U.S. hospitals with a diagnosis of COVID-19 between April 1 and June 30, 2020. Males comprised 57.6% and Black and Hispanic patients 57.0% of this group. The most frequent comorbidities were obesity (61%, including morbid obesity in 24.5%), diabetes (18.2%) and hypertension (16.1%). While hospitalized, 21% received intensive care, 10% received mechanical ventilation, and 2.7% died. Of survivors, 3% were discharged to a postacute care facility.
Boehmer TK et al. Changing age distribution of the COVID-19 Pandemic — United States, May–August 2020. MMWR Morb Mortal Wkly Rep 2020 Oct 2; 69:1404. (https://doi.org/10.15585/mmwr.mm6939e1)
Cunningham JW et al. Clinical outcomes in young US adults hospitalized with COVID-19. JAMA Intern Med 2020 Sep 9; [e-pub]. (https://doi.org/10.1001/jamainternmed.2020.5313)
Comment
While there may have been a bias in the test criterion due to increased availability of testing for younger age groups, the results of the first study seem to confirm what anyone walking their dog, visiting a beach, or passing an outdoor dining establishment this past summer could report: Mask-wearing and social distancing are much less common among younger people than in older populations. The second study underscores the fact that when COVID-19 does affect a younger population, it is far from benign. A recent report (NEJM JW Infect Dis Sep 23 2020; [e-pub] and MMWR Morb Mortal Wkly Rep 2020; 69:1324) details risk factors for severe illness and death in this younger population. With the return of this population to universities and front-line jobs, greater effort must be made to persuade these young adults that they themselves are at risk for life-threatening disease and hold great responsibility for infecting other, older people.