The Washington PostDemocracy Dies in Darkness

Patients with underlying conditions were 12 times as likely to die of covid-19 as otherwise healthy people, CDC finds

Coronavirus patients with underlying health problems were substantially more likely to be hospitalized than other people with covid-19, a CDC report released Monday finds. (John Minchillo/AP)

People with underlying medical conditions such as heart disease and diabetes were hospitalized six times as often as otherwise healthy individuals infected with the novel coronavirus during the first four months of the pandemic, and they died 12 times as often, according to a federal health report Monday.

The Centers for Disease Control and Prevention released data on more than 1.7 million coronavirus cases and 103,700 deaths from covid-19, the disease caused by the virus, reported to the agency from state and territorial health departments from Jan. 22 through May 30. The data is consistent with earlier reports showing the disproportionate impact the pandemic has had on people with underlying medical conditions. The report also highlighted the disease’s stark disparities between whites and minority groups.

Among nearly 600,000 people who were sickened and for whom the CDC has race and ethnicity information, 33 percent of patients were Hispanic, although they make up 18 percent of the U.S. population; 22 percent were black, while they constitute 13 percent of the population; and 1.3 percent were Native American or Alaskan Natives, nearly double their representation in the overall population.

As states reopen, and with reports of surges in infections, the report offers more details about the groups most vulnerable to illness and death based on four months of data.

Race and ethnicity data were missing from more than half of the cases reported to CDC. Because of that missing data, the agency did not provide estimates by race and ethnicity for the incidence of underlying health conditions.

In many metropolitan areas, majority-black areas have high rates of chronic health conditions including diabetes, obesity and heart disease. Those conditions compound a lack of access to medical care and the legacy of racism and its effect on health. In the District, neighborhoods that flank the eastern edge of the city are predominantly African American and have rates of these diseases above national levels. Those same neighborhoods have some of the highest incidence of coronavirus cases in the District, according to city health data.

Figures from a separate CDC hospital surveillance system that began collecting information March 1 on laboratory-confirmed hospitalizations show much higher hospitalization rates for minority groups. Native Americans or Alaska Natives are hospitalized at five times the rate of whites; rates for blacks are 4.5 times higher; and rates for Hispanics are four times higher.

In Monday’s report, the CDC said the most common underlying conditions reported in people with covid-19 were heart disease (32 percent), diabetes (30 percent) and chronic lung disease (18 percent). Other preexisting conditions included liver disease, kidney disease, neurodevelopmental or intellectual disability, and immunocompromised conditions.

Although the disease is typically more severe among older people, people of any age with underlying medical conditions are at increased risk if they contract the virus, for which there is no vaccine and only limited drug treatment.

About 45 percent of patients with underlying conditions were hospitalized, compared with 7.6 percent of those who did not have significant preexisting conditions. Deaths were 12 times as high among patients with these underlying conditions (19.5 percent) compared with those without reported conditions (1.6 percent).

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The information released Monday also breaks down the data by age. Even for patients in their 20s and 30s, those already dealing with health challenges were about six times as likely to be hospitalized than healthy individuals.

“The COVID-19 pandemic continues to be severe, particularly in certain population groups,” the report said. “These preliminary findings underscore the need to build on current efforts to collect and analyze case data, especially among those with underlying health conditions.”

The report doesn’t provide a complete picture of the demographic characteristics and underlying health conditions of those who were sickened or died. There are probably more people who fell ill from the coronavirus but who are not included in data about the disease because they were never tested. And the findings on underlying medical conditions probably understate the role they played in contributing to deaths because of missing data.

Perhaps most important, people who are infected with the virus but don’t have symptoms are not likely to be “captured well” in the surveillance data, the report said. Asymptomatic people are unlikely to seek testing because of limitations in testing capacity and because initial guidance prioritized people with symptoms.

Asymptomatic transmission does occur, but researchers don’t know how frequently. Some modeling studies have suggested as much as 41 percent of disease spread may be attributable to asymptomatic people, but it remains an open question whether they are a large force driving transmission.

Meanwhile, the CDC sent a report Sunday to four congressional committees, as required by the Paycheck Protection Program and Health Care Enhancement Act, one of the coronavirus relief packages lawmakers adopted this spring. The new report, obtained from an individual on Capitol Hill on the condition of anonymity, follows an earlier one consisting of four pages that congressional Democrats criticized as inadequate.

Like its predecessor, the new 22-page report was required to provide Congress “disaggregated” data on who is getting tested for the virus. The expanded version said CDC had received reports of nearly 20 million diagnostic tests administered as of June 4, with 11 percent of them positive. It does not provide a demographic breakdown of who was tested. The report includes a variety of other demographic information about the cases, hospitalizations and deaths.

As with a congressionally required report in late May on a national testing strategy, federal health officials did not release this new report publicly. Katherine McKeogh, a Health and Human Services spokesman, said Monday evening, “This report aims to provide more fulsome information with the data available. . . . However, we do not typically share beyond Congressional committees.”

Amy Goldstein contributed to this report.

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