COVID-19: Does Age Matter?

There are very few individuals alive who experienced the last great pandemic in 1918. Those that can remember, and those of us who have studied this globally tragic event are acutely aware that age mattered. That distant emergence of influenza A(H1N1) was associated with a “W” shaped mortality curve, with unexpectedly high numbers of deaths in the 20—40 year old range, which is in stark contrast to seasonal influenza with its typical “J” shaped curve (some mortality for the very young and a preponderance at older ages). An important question for coronavirus disease 19 (COVID-19) is whether age matters for significant outcomes.

The quick answer appears to be yes. CDC epidemiologist evaluated the first 4,226 COVID-19 cases in the United States for three significant outcomes: hospitalization, intensive care unit (ICU) admission, and death.[1] These are of importance as they provide guidance for deployment of scarce medical resources and for community mitigation efforts. I have taken the liberty to illustrate data—as presented in this paper’s table—as graphics. The two lines in each figure demonstrate the low and high bounds of the estimated ranges for the outcomes. Of note is the marked effect of age—particularly ≥60 years on mortality. It should be noted that these estimates are early and will likely change over time.

A second assessment pertaining strictly to children comes from China. Dong and colleagues evaluated a case series of 2,143 children with suspected (65.9%) or laboratory-confirmed (34.1%) COVID-19.[2] There were no differences between boys and girls. Most cases were mild (50.9%), asymptomatic (4.4%) or with moderate symptoms (38.8%); 5.8% of cases were severe or critical. The proportions of cases that were deemed severe or critical, however, depended upon age:

 

Age matters with COVID-19. There can be significant outcomes at all ages, but current evidence points to more severity for the very young, and especially for the very old.