‘Who COVID-19 kills’ study released

BOSTON — COVID-19 can seem an indiscriminate killer, but a new study out of Brigham and Women’s Hospital suggests several commonalities with its victims.

Researchers looked at the medical records of 2,215 patients in 65 Intensive Care Units across the country during the one-month period of March 4 to April 4, 2020.

"We found 1 in 3 patients died of this disease once they were admitted to the ICU, and that is not a small number," said Shruti Gupta, MD, MPH, a nephrologist at Brigham and Women's and one of the authors of the study.

While those 80 and older were most likely to die, the study found at least 15% of every age group -- including young adults -- did not survive the disease.

"Now it's important to remember that patients who are admitted to the ICU -- these are going to be the sickest of the sick patients," Gupta said. "It's probably that these younger patients who are dying in the ICU have other medical problems that are putting them at risk. But again, this disease really doesn't know any bounds. It's important when we see some of the shifting demographics of the disease in this country."

Demographically, COVID-19 is affecting more young people this summer, as it ravages the Sun Belt -- and, geographically, it’s affecting adults in states well known to have high rates of obesity -- which the study found independently raises the risk of death from COVID-19.

The CDC reports 30-35% of adults in Georgia, Texas, and Florida self-report as obese. Rates are even worse in the Deep South states of Alabama, Mississippi Louisiana, and Arkansas.

For those with a high BMI, Gupta said losing weight may be a way to lessen the severity of a COVID-19 infection, in the absence of other risk factors.

Other independent risk factors for death from COVID-19 include being male and having coronary artery disease or an active case of cancer.

Two striking findings from the study:

First, while African-Americans seemed to be admitted to hospitals and ICUs more frequently, they did not die from COVID-19 in disproportionate numbers.

“We had 30% of our population was African-American, whereas the U.S. as a whole, African-Americans represent only 13% of the population,” Gupta said. “We didn’t find that mortality differed according to race, which is actually similar to a finding from a Louisiana study.”

Second, patients admitted to hospitals with fewer ICU beds to begin with had a much poorer prognosis than those treated in hospitals with large numbers of such beds.

Gupta said it could be a matter of better resources, but she cautions reading too much into it, given the limitations of the study: "We didn't have data on hospital resources and hospital strain and doctor and nursing staffing and socioeconomic status," she said. "And these are all things that perhaps had we adjusted for the association would no longer be present."

The study appears in the Journal of the American Medical Association Internal Medicine.

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