- Researchers found that adults between 18 and 34 years old hospitalized with COVID-19 had a relatively high risk of severe illness.
- These patients had an over 20 percent risk of being taken to the intensive care unit.
- About 10 percent needed mechanical ventilation.
COVID-19 is seen as a disease that most affects older people, but new research published in the Journal of the American Medical Association finds young adults still carry significant risk.
According to the research letter, young adults can also experience high rates of severe outcomes.
One in 5 younger patients in intensive care
Researchers found that hospitalized adults between 18 and 34 years old had a relatively high risk of severe illness:
- Over 20 percent required intensive care.
- About 10 percent were placed on mechanical ventilation.
- Almost 3 percent died.
The average age of this group was 28 years old, and just over 57 percent were men. Fifty-seven percent of patients were Black or Hispanic.
Researchers found that while the in-hospital mortality rate was lower than reported for older adults with COVID-19, it was still double that of young people experiencing a heart attack.
Dr. Nikhil Bhayani, an infectious disease physician with Texas Health Resources in Bedford, Texas, told Healthline that recent evidence has shown that young people are also at risk for severe COVID-19 outcomes.
According to a Centers for Disease Control and Prevention report of hospitalized patients, 20 percent were aged 20 to 44 years, Bhayanif told Healthline.
Of the patients admitted to intensive care, almost 40 percent were aged 45 to 64 years and 12 percent were between 20 and 44 years old, Bhayani said.
Young adults in marginalized groups with preexisting conditions
Older people and patients with chronic health issues like diabetes, high blood pressure, and heart disease are considered at higher risk of severe illness, according the Centers for Disease Control and Prevention (CDC).
Researchers found these factors can affect outcomes for younger patients as well.
“Morbid obesity, hypertension, and diabetes were common and associated with greater risks of adverse events,” the researchers wrote. Over half of hospitalized patients were African American or Hispanic, “consistent with prior findings of disproportionate illness severity in these demographic groups.”
According to the study, young adults with more than one of these conditions faced COVID-19 risks similar to those seen in middle-aged adults without them.
“This study, as well as my clinical experience taking care of patients with COVID-19, reinforces the findings that persons with obesity, diabetes, and hypertension are at much greater risk for adverse outcomes,” said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York. “This includes the potential for ICU admission, intubation, and death, compared to older persons.”
Glatter emphasized that we need to better address racial health disparities, not just for patients with COVID-19, but for all patients in the U.S. healthcare system.
He said the pandemic has further exposed inequalities in our society that result in disparate healthcare outcomes. “As part of this reality, one thing is clearer than ever: we need to address structural racism and make it a thing of the past.”
Obesity a major factor
According to the CDC, obesity is an increasingly serious health issue in the United States, affecting over 40 percent of the population. The CDC reports that over the last 20 years, the prevalence of obesity increased from 30.5 to 42.4 percent, and severe obesity increased from under 5 to 9.2 percent.
“We also know that obesity increases the risk of thrombosis [a blood clot], which has been demonstrated by the association of severe COVID-19,” Glatter said. He added that obesity also increases the incidence of deep-vein blood clots and a condition called disseminated intravascular coagulation, which can cause excessive bleeding.
Glatter said obesity adversely effects lung function by impeding movement of the diaphragm, “making ventilation and oxygen problematic, increasing risk for infection and ARDS [acute respiratory distress syndrome].”
According to Glatter, past experience with patients experiencing H1N1 influenza [swine flu], “also informs us as to a similar complicated course with COVID-19,” with higher rates of complications and death among those with obesity, diabetes, and hypertension.
Social distancing is critical
Mask use and social distancing work, and until a vaccine is available, these are the most effective ways to prevent catching or spreading the virus that causes COVID-19.
The CDC lists several tips for practicing social distancing before you go out, including:
- Before going out, know and follow guidance from local public health authorities where you live.
- Stay socially connected with friends and family who don’t live in your home by calling, using video chat, or staying connected through social media.
- Avoid crowded places and gatherings where it may be difficult to stay at least 6 feet away from others who are not from your household.
- Try to keep 6 feet of space between yourself and others at all times, and wear a mask.
Younger adults have lower risk, but COVID-19 still dangerous
According to data compiled from France, one of the countries most affected by COVID-19, a 25-year-old adult with the disease is roughly 250 times less likely to die than someone age 85 with the virus. The average estimated death count for people younger than 35 is less than one.
The World Health Organization reports that mortality for COVID-19 appears higher than for influenza, and “the true mortality of COVID-19 will take some time to fully understand.”
However, they confirm that data suggests a crude mortality ratio (number of reported deaths divided by reported cases) is between 3 and 4 percent for COVID, while seasonal influenza typically has a mortality ratio below 1 percent.
The bottom line
COVID-19 is considered a serious health issue for older people, but new research finds that young people who develop COVID-19 are also at high risk for severe illness.
Although those between 18 and 34 with the disease are much less likely to die from COVID-19, researchers found that 20 percent of these patients are admitted to an intensive care unit.
The severity of illness in African American and Hispanic patients also calls attention to racial inequities in healthcare.
Findings suggest that younger patients with obesity, diabetes, and high blood pressure were at highest risk for severe illness.
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