SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in the United States during January 2020 ( 1 ). Since then, >980,000 cases have been reported in the United States, including >55,000 associated deaths as of April 28, 2020 ( 2 ). Detailed data on demographic characteristics, underlying medical conditions, and clinical outcomes for persons hospitalized with COVID-19 are needed to inform prevention strategies and community-specific intervention messages. For this report, CDC, the Georgia Department of Public Health, and eight Georgia hospitals (seven in metropolitan Atlanta and one in southern Georgia) summarized medical record–abstracted data for hospitalized adult patients with laboratory-confirmed* COVID-19 who were admitted during March 2020. Among 305 hospitalized patients with COVID-19, 61.6% were aged 0.99 Chronic kidney disease, without dialysis 32 (10.5) 2 (2.2) 12 (12.1) 18 (15.4) 0.003 24 (9.7) 8 (16.0) 0.21 Cancer 12 (3.9) 3 (3.4) 3 (3.0) 6 (5.1) 0.76 10 (4.0) 2 (4.0) >0.99 Rheumatologic or autoimmune condition 8 (2.6) 1 (1.1) 5 (5.1) 2 (1.7) 0.22 6 (2.4) 2 (4.0) 0.63 Abbreviations: BMI = body mass index; COPD = chronic obstructive pulmonary disease; COVID-19 = coronavirus disease 2019; IQR = interquartile range; N/A = not applicable. * Black was defined as non-Hispanic black race/ethnicity; other includes all other racial/ethnic groups. † P-values were calculated using Fisher’s exact tests for proportions. § Eight patients were excluded from race comparisons because race and ethnicity data were missing. ¶ Age ≥65 years was considered a high-risk condition. ** BMI data were missing for 13 patients. §§ Documented conditions included solid organ transplant (eight), human immunodeficiency virus infection (eight), cancer with chemotherapy receipt within the previous year (three), stem cell transplant (three), and leukemia (two); 16 patients were taking immunosuppressive medications. Among the 305 hospitalized patients, the median duration of hospitalization was 8.5 days and duration increased with age (Table 2). Intensive care unit (ICU) admission occurred among 119 (39.0%) patients and increased significantly with age group: among patients aged ≥65 years, 53.8% were admitted to an ICU (p 0.99 Vasopressor support 84 (27.5) 13 (14.6) 21 (21.2) 50 (42.7) 0.99 Outcome Discharged alive 233 (76.4) 85 (95.5) 83 (83.8) 65 (55.6) <0.001 192 (77.7) 34 (68.0) 0.15 Still hospitalized 24 (7.9) 1 (1.1) 7 (7.1) 16 (13.7) 0.002 18 (7.3) 6 (12.0) 0.26 Died** 48 (17.1) 3 (3.4) 9 (9.8) 36 (35.6) <0.001 37 (16.2) 10 (22.7) 0.28 Invasive mechanical ventilation or death** 86 (30.6) 16 (18.2) 22 (23.9) 48 (47.5) <0.001 69 (30.1) 16 (36.4) 0.48 Abbreviations: COVID-19 = coronavirus disease 2019; ICU = intensive care unit; IQR = interquartile range. * Black was defined as non-Hispanic black race/ethnicity; other includes all other racial/ethnic groups. † Eight patients were excluded from race comparisons because race and ethnicity data were missing. § P-values were calculated using Fisher’s exact tests for proportions and the Wilcoxon rank-sum test or the Kruskal-Wallis H test for medians. ¶ Continuous variables are presented as median (IQR). ** Among 281 total patients who were no longer hospitalized, 88 (31.3%) were aged 18–49 years, 92 (32.7%) were aged 50–64 years, and 101 (35.9%) were aged ≥65 years; among 273 patients with available race/ethnicity data who were no longer hospitalized, 229 (83.9%) were non-Hispanic black, and 44 (16.1) were of other race/ethnicity. Among 281 (92.1%) patients who were no longer hospitalized at the time of data abstraction, 48 (17.1%) died. Case fatality among patients aged 18–49 years, 50–64 years, and ≥65 years was 3.4%, 9.8%, and 35.6%, respectively (p<0.001). Black patients were not more likely than were nonblack patients to receive IMV, to die, or to experience the composite outcome of IMV or death (Figure 2). Among patients without high-risk conditions, 22.5% were admitted to the ICU, 15.0% received IMV, and 5.1% died while in the hospital. As of April 24, 2020, 24 (7.9%) patients remained hospitalized, including 14 (58.3%) in the ICU and nine (37.5%) on IMV. Overall, the estimated percentage of deaths among patients who received ICU care ranged from 37.0%, assuming all remaining ICU patients survived, to 48.7%, assuming all remaining ICU patients died. In an adjusted time-to-event analysis of IMV or death as a composite outcome, no significant difference was found between black and nonblack patients (HR = 0.63; 95% CI = 0.35–1.13). Discussion This report characterizing a cohort of hospitalized adults with COVID-19 in Georgia (primarily metropolitan Atlanta) found that most patients in the cohort were black, and black patients had a similar probability of receiving IMV or dying during hospitalization compared with nonblack patients. Although a larger proportion of older patients had worse outcomes (IMV or death), a considerable proportion of patients aged 18–64 years who lacked high-risk conditions received ICU-level care and died (23% and 5%, respectively). Estimated case fatality among patients who received ICU care was high (37%–49%) but comparable with that observed in a smaller case series of COVID-19 patients in the state of Washington ( 5 ). Among hospitalized patients, 26% lacked high-risk factors for severe COVID-19, and few patients (7%) lived in institutional settings before admission, suggesting that SARS-CoV-2 infection can cause significant morbidity in relatively young persons without severe underlying medical conditions. Community mitigation recommendations (e.g., social distancing) should be widely instituted, not only to protect older adults and those with underlying medical conditions, but also to prevent the spread of SARS-CoV-2 among persons in the general population who might not consider themselves to be at risk for severe illness ( 6 ). The proportion of hospitalized patients who were black was higher than expected based on overall hospitalizations. At four affiliated hospitals, which accounted for 67% of patients in the cohort, 80% of cohort patients were black compared with 47% of hospitalized patients overall during March 2020 (D. Murphy, personal communication, April 7, 2020). Similarly, COVID-NET, which conducts population-based surveillance for laboratory-confirmed COVID-19–associated hospitalizations across 14 sites nationwide, ¶ found that black persons were disproportionately represented among hospitalized patients with COVID-19 ( 7 ). It is important to continue ongoing efforts to understand why black persons are disproportionately hospitalized for COVID-19, including the role of social and economic factors (including occupational exposures) in SARS-CoV-2 acquisition risk. It is critical that public health officials ensure that prevention activities prioritize communities and racial groups most affected by COVID-19. The findings in this report are subject to at least three limitations. First, the data are from a convenience sample of hospitalized adult patients in metropolitan Atlanta and southern Georgia, and data collection for this assessment was limited by the intention to conduct the investigation quickly. These patients do not necessarily represent all hospitalized patients with COVID-19 at those hospitals, or within Georgia. Second, patients were not tracked after discharge in this investigation. Finally, race and ethnicity were abstracted from medical records, and methods for recording these categories might have differed across hospitals, which could result in misclassification. This report provides valuable clinical data on a large cohort of hospitalized patients. Although frequency of IMV and fatality did not differ by race, black patients were disproportionately represented among hospitalized patients, reflecting greater severity of COVID-19 among this population. Public officials should consider racial differences among patients affected by COVID-19 when planning prevention activities. Approximately one quarter of patients had no high-risk conditions, and 5% of these patients died, suggesting that all adults, regardless of underlying conditions or age, are at risk for serious COVID-19–associated illness. Summary What is already known about this topic? Older adults and persons with underlying medical conditions are at higher risk for severe COVID-19. Non-Hispanic black patients are overrepresented among hospitalized U.S. COVID-19 patients. What is added by this report? In a cohort of 305 hospitalized adults with COVID-19 in Georgia (primarily metropolitan Atlanta), black patients were overrepresented, and their clinical outcomes were similar to those of nonblack patients. One in four hospitalized patients had no recognized risk factors for severe COVID-19. What are the implications for public health practice? Prevention activities should prioritize communities and racial groups most affected by severe COVID-19. Increased awareness of the risk for serious illness among all adults, regardless of underlying medical conditions or age, is needed.
