COVID-19 in Critically Ill Patients in the Seattle Region — Case Series

The first U.S. COVID-19 infection was reported in the state of Washington on January 29, 2020, followed by an immediate rapid rise in additional cases. This case series details 24 critically ill Seattle patients identified by PCR analysis who required admission to nine Seattle-area ICUs between February 24 and March 9. For this cohort, the mean age was 64 (63% male), with symptoms beginning 7 days before admission. The most common symptoms were cough and shortness of breath (88% for both) while fever >100.4° F was present in only 50% at admission. Underlying medical conditions were common, including 14 with diabetes, 5 with chronic renal failure, and 3 with asthma and recent use of corticosteroids.

All were admitted for hypoxemic respiratory failure; 18 of the 24 needed mechanical ventilation, and 17 needed vasopressors for hypotension. None had other respiratory pathogens. Lymphocytopenia was the most distinctive laboratory finding (median, 750 cells/mm³). Chest radiographs obtained at admission showed bilateral pulmonary opacities. Chest computed tomography in 5 patients showed either bilateral ground-glass opacities (4) or nodules (1). None of the 9 patients who had an echocardiogram showed evidence of new cardiac dysfunction. Patients received a range of potential therapies (7 remdesivir, 1 lopinavir/ritonavir, and 1 hydroxychloroquine); data were insufficient to report linked outcomes. As of March 23, 12 had died between ICU days 1 and 18; mortality was higher for those over 65 years old (62%), versus younger than 65 (37%). Oxygen requirements were high for those requiring mechanical ventilation (with mean plateau and driving pressures of 25 and 12–13 cm of water, respectively). The earliest extubation occurred after 9 days.