Who Develops Severe COVID-19?

In this post, I’ll take a deeper dive to examine which patients develop severe COVID-19 symptoms.

More information about the clinical characteristics of COVID-19 is available here. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

In this paper, severe COVID-19 was defined by the guidelines for community acquired pneumonia: https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST. To make things simpler, severe COVID-19 is the state where you need mechanical ventilation.

Definition of Severe Pneumonia
Source: Metlay et al. ATS Guidelines. 2019

Age

Ages of people with severe and nonsevere COVID-19
Source: Guan et al. NEJM 2020

My takeaway from these demographics is that everyone above 14 is susceptible to severe COVID-19. This is unlike community acquired pneumonia where we worry about hospitalization predominately in people older than 65.

Smoking

People with severe COVID-19 were more often former/current smokers (16.9% versus 11.8%).

Smoking prevalence in all, nonsevere, and severe COVID-19
Source: Guan et al. NEJM 2020

Fever

Both patients with severe and nonsevere COVID-19 have fever during hospitalization. To my eyes, I do not observe an obvious relationship between the severity of fever and progression to severe COVID-19.

Fevere in all, nonsevere, and severe COVID-19
Source: Guan et al. NEJM 2020

Symptoms

People with severe COVID-19 more often had shortness of breath as their initial symptom before hospitalization (37.6% versus 15.1%).

There was not much difference in the prevalence of other symptoms like congestion, headache, cough, sore throat, fatigue, diarrhea, myalgias, or chills between severe and nonsevere COVID-19.

Symptoms in all, nonsevere, and severe COVID-19
Source: Guan et al. NEJM 2020

Coexisting Disorder

People with severe COVID-19 more often had a coexisting disorder (38.7% versus 21%). Specifically, those with diabetes, hypertension, or coronary artery disease had more severe symptoms.

Coexisting disorder in all, nonsevere, and severe COVID-19
Source Guan et al. NEJM 2020

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