On March 18, 2020, this report was posted online as an MMWR Early Release.
Globally, approximately 170,000 confirmed cases of coronavirus disease 2019 (COVID-19)
caused by the 2019 novel coronavirus (SARS-CoV-2) have been reported, including an
estimated 7,000 deaths in approximately 150 countries (
). On March 11, 2020, the World Health Organization declared the COVID-19 outbreak
a pandemic (
). Data from China have indicated that older adults, particularly those with serious
underlying health conditions, are at higher risk for severe COVID-19–associated illness
and death than are younger persons (
). Although the majority of reported COVID-19 cases in China were mild (81%), approximately
80% of deaths occurred among adults aged ≥60 years; only one (0.1%) death occurred
in a person aged ≤19 years (
). In this report, COVID-19 cases in the United States that occurred during February
12–March 16, 2020 and severity of disease (hospitalization, admission to intensive
care unit [ICU], and death) were analyzed by age group. As of March 16, a total of
4,226 COVID-19 cases in the United States had been reported to CDC, with multiple
cases reported among older adults living in long-term care facilities (
). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80%
of deaths associated with COVID-19 were among adults aged ≥65 years with the highest
percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions
or deaths were reported among persons aged ≤19 years. Similar to reports from other
countries, this finding suggests that the risk for serious disease and death from
COVID-19 is higher in older age groups.
Data from cases reported from 49 states, the District of Columbia, and three U.S.
) to CDC during February 12–March 16 were analyzed. Cases among persons repatriated
to the United States from Wuhan, China and from Japan (including patients repatriated
from cruise ships) were excluded. States and jurisdictions voluntarily reported data
on laboratory-confirmed cases of COVID-19 using previously developed data collection
). The cases described in this report include both COVID-19 cases confirmed by state
or local public health laboratories as well as those with a positive test at the state
or local public health laboratories and confirmation at CDC. No data on serious underlying
health conditions were available. Data on these cases are preliminary and are missing
for some key characteristics of interest, including hospitalization status (1,514),
ICU admission (2,253), death (2,001), and age (386). Because of these missing data,
the percentages of hospitalizations, ICU admissions, and deaths (case-fatality percentages)
were estimated as a range. The lower bound of these percentages was estimated by using
all cases within each age group as denominators. The corresponding upper bound of
these percentages was estimated by using only cases with known information on each
outcome as denominators.
As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States,
with reports increasing to 500 or more cases per day beginning March 14 (Figure 1).
Among 2,449 patients with known age, 6% were aged ≥85, 25% were aged 65–84 years,
18% each were aged 55–64 years and 45–54 years, and 29% were aged 20–44 years (Figure
2). Only 5% of cases occurred in persons aged 0–19 years.
Number of new coronavirus disease 2019 (COVID-19) cases reported daily*,† (N = 4,226)
— United States, February 12–March 16, 2020
* Includes both COVID-19 cases confirmed by state or local public health laboratories,
as well as those testing positive at the state or local public health laboratories
and confirmed at CDC.
† Cases identified before February 28 were aggregated and reported during March 1–3.
The figure is a histogram, an epidemiologic curve showing 4,226 coronavirus disease
2019 (COVID-19) cases, by date of case report, in the United States during February
12–March 16, 2020.
Coronavirus disease 2019 (COVID-19) hospitalizations,* intensive care unit (ICU) admissions,
by age group — United States, February 12– March 16, 2020
* Hospitalization status missing or unknown for 1,514 cases.
† ICU status missing or unknown for 2,253 cases.
§ Illness outcome or death missing or unknown for 2,001 cases.
The figure is a bar chart showing the number of coronavirus disease 2019 (COVID-19)
hospitalizations, intensive care unit admissions, and deaths, by age group, in the
United States during February 12– March 16, 2020.
Among 508 (12%) patients known to have been hospitalized, 9% were aged ≥85 years,
36% were aged 65–84 years, 17% were aged 55–64 years, 18% were 45–54 years, and 20%
were aged 20–44 years. Less than 1% of hospitalizations were among persons aged ≤19
years (Figure 2). The percentage of persons hospitalized increased with age, from
2%–3% among persons aged ≤19 years, to ≥31% among adults aged ≥85 years. (Table).
Hospitalization, intensive care unit (ICU) admission, and case–fatality percentages
for reported COVID–19 cases, by age group —United States, February 12–March 16, 2020
Age group (yrs) (no. of cases)
* Lower bound of range = number of persons hospitalized, admitted to ICU, or who died
among total in age group; upper bound of range = number of persons hospitalized, admitted
to ICU, or who died among total in age group with known hospitalization status, ICU
admission status, or death.
Among 121 patients known to have been admitted to an ICU, 7% of cases were reported
among adults ≥85 years, 46% among adults aged 65–84 years, 36% among adults aged 45–64
years, and 12% among adults aged 20–44 years (Figure 2). No ICU admissions were reported
among persons aged ≤19 years. Percentages of ICU admissions were lowest among adults
aged 20–44 years (2%–4%) and highest among adults aged 75–84 years (11%–31%) (Table).
Among 44 cases with known outcome, 15 (34%) deaths were reported among adults aged
≥85 years, 20 (46%) among adults aged 65–84 years, and nine (20%) among adults aged
20–64 years. Case-fatality percentages increased with increasing age, from no deaths
reported among persons aged ≤19 years to highest percentages (10%–27%) among adults
aged ≥85 years (Table) (Figure 2).
Since February 12, 4,226 COVID-19 cases were reported in the United States; 31% of
cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths occurred
among adults aged ≥65 years with the highest percentage of severe outcomes among persons
aged ≥85 years. These findings are similar to data from China, which indicated >80%
of deaths occurred among persons aged ≥60 years (
). These preliminary data also demonstrate that severe illness leading to hospitalization,
including ICU admission and death, can occur in adults of any age with COVID-19. In
contrast, persons aged ≤19 years appear to have milder COVID-19 illness, with almost
no hospitalizations or deaths reported to date in the United States in this age group.
Given the spread of COVID-19 in many U.S. communities, CDC continues to update current
recommendations and develop new resources and guidance, including for adults aged
≥65 years as well as those involved in their care (
Approximately 49 million U.S. persons are aged ≥65 years (
), and many of these adults, who are at risk for severe COVID-19–associated illness,
might depend on services and support to maintain their health and independence. To
prepare for potential COVID-19 illness among persons at high risk, family members
and caregivers of older adults should know what medications they are taking and ensure
that food and required medical supplies are available. Long-term care facilities should
be particularly vigilant to prevent the introduction and spread of COVID-19 (
). In addition, clinicians who care for adults should be aware that COVID-19 can result
in severe disease among persons of all ages. Persons with suspected or confirmed COVID-19
should monitor their symptoms and call their provider for guidance if symptoms worsen
or seek emergency care for persistent severe symptoms. Additional guidance is available
for health care providers on CDC’s website (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html).
This report describes the current epidemiology of COVID-19 in the United States, using
preliminary data. The findings in this report are subject to at least five limitations.
First, data were missing for key variables of interest. Data on age and outcomes,
including hospitalization, ICU admission, and death, were missing for 9%–53% of cases,
which likely resulted in an underestimation of these outcomes. Second, further time
for follow-up is needed to ascertain outcomes among active cases. Third, the initial
approach to testing was to identify patients among those with travel histories or
persons with more severe disease, and these data might overestimate the prevalence
of severe disease. Fourth, data on other risk factors, including serious underlying
health conditions that could increase risk for complications and severe illness, were
unavailable at the time of this analysis. Finally, limited testing to date underscores
the importance of ongoing surveillance of COVID-19 cases. Additional investigation
will increase the understanding about persons who are at risk for severe illness and
death from COVID-19 and inform clinical guidance and community-based mitigation measures.*
The risk for serious disease and death in COVID-19 cases among persons in the United
States increases with age. Social distancing is recommended for all ages to slow the
spread of the virus, protect the health care system, and help protect vulnerable older
adults. Further, older adults should maintain adequate supplies of nonperishable foods
and at least a 30-day supply of necessary medications, take precautions to keep space
between themselves and others, stay away from those who are sick, avoid crowds as
much as possible, avoid cruise travel and nonessential air travel, and stay home as
much as possible to further reduce the risk of being exposed (
). Persons of all ages and communities can take actions to help slow the spread of
COVID-19 and protect older adults.
What is already known about this topic?
Early data from China suggest that a majority of coronavirus disease 2019 (COVID-19)
deaths have occurred among adults aged ≥60 years and among persons with serious underlying
What is added by this report?
This first preliminary description of outcomes among patients with COVID-19 in the
United States indicates that fatality was highest in persons aged ≥85, ranging from
10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons
aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons
aged ≤19 years.
What are the implications for public health practice?
COVID-19 can result in severe disease, including hospitalization, admission to an
intensive care unit, and death, especially among older adults. Everyone can take actions,
such as social distancing, to help slow the spread of COVID-19 and protect older adults
from severe illness.