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| Nearly All Patients Hospitalized With Covid-19 Had Chronic Health Issues, Study Finds | Nearly All Patients Hospitalized With Covid-19 Had Chronic Health Issues, Study Finds |
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| A new study of thousands of hospitalized coronavirus patients in the New York City area, the epicenter of the outbreak in the United States, has found that nearly all of them had at least one major chronic health condition, and most — 88 percent — had at least two. | A new study of thousands of hospitalized coronavirus patients in the New York City area, the epicenter of the outbreak in the United States, has found that nearly all of them had at least one major chronic health condition, and most — 88 percent — had at least two. |
| Though earlier research has shown chronic conditions like obesity, high blood pressure and diabetes are common risk factors for severe Covid-19, the ubiquity of serious medical conditions in these patients was striking: Only 6 percent of them had no underlying health conditions. | Though earlier research has shown chronic conditions like obesity, high blood pressure and diabetes are common risk factors for severe Covid-19, the ubiquity of serious medical conditions in these patients was striking: Only 6 percent of them had no underlying health conditions. |
| “The number of patients who had chronic comorbidities surprised us,” said Karina Davidson, a senior vice president at the Feinstein Institutes for Medical Research, who was the paper’s senior author. | “The number of patients who had chronic comorbidities surprised us,” said Karina Davidson, a senior vice president at the Feinstein Institutes for Medical Research, who was the paper’s senior author. |
| The paper, published in the Journal of the American Medical Association, analyzed data about 5,700 Covid-19 patients admitted between March 1 and April 4 to a dozen hospitals in New York City, Long Island and Westchester County that are part of the Northwell Health system. Scientists at the Feinstein Institutes, the research arm of Northwell, used electronic health records and other demographic information to analyze the characteristics of the patients. | The paper, published in the Journal of the American Medical Association, analyzed data about 5,700 Covid-19 patients admitted between March 1 and April 4 to a dozen hospitals in New York City, Long Island and Westchester County that are part of the Northwell Health system. Scientists at the Feinstein Institutes, the research arm of Northwell, used electronic health records and other demographic information to analyze the characteristics of the patients. |
| Dozens of children and teenagers got sick but survived, the researchers found. Women had a clear edge: Fewer were hospitalized to begin with, and they were more likely to survive. | Dozens of children and teenagers got sick but survived, the researchers found. Women had a clear edge: Fewer were hospitalized to begin with, and they were more likely to survive. |
| One in five of the hospital stays ended with the patient dying, but more than half of the patients studied were still hospitalized when the study ended. In total, 553 of the patients died. | One in five of the hospital stays ended with the patient dying, but more than half of the patients studied were still hospitalized when the study ended. In total, 553 of the patients died. |
| About a fifth of the patients — 1,151 — were put on ventilators, and most of those — 831 — were still on the machines when the study ended. | About a fifth of the patients — 1,151 — were put on ventilators, and most of those — 831 — were still on the machines when the study ended. |
| Of the other 320 intubated patients, 282 died and 38 were discharged from the hospital. Their mortality rate, 88 percent, is higher than some other early case reports, which found death rates for coronavirus patients on ventilators ranging from 50 percent to close to 70 percent. Given that the length of hospital stay for these Northwell cases was relatively short, four days on average, it’s possible that those who died were mainly patients who were so ill that they were unlikely to be helped by any treatment. | Of the other 320 intubated patients, 282 died and 38 were discharged from the hospital. Their mortality rate, 88 percent, is higher than some other early case reports, which found death rates for coronavirus patients on ventilators ranging from 50 percent to close to 70 percent. Given that the length of hospital stay for these Northwell cases was relatively short, four days on average, it’s possible that those who died were mainly patients who were so ill that they were unlikely to be helped by any treatment. |
| While the study provided a valuable granular look at the characteristics of an early onslaught of patients in the United States, Dr. Davidson cautioned that it was observational in nature, and that there was no comparison group with which to contrast frailties or outcomes. | While the study provided a valuable granular look at the characteristics of an early onslaught of patients in the United States, Dr. Davidson cautioned that it was observational in nature, and that there was no comparison group with which to contrast frailties or outcomes. |
| “We’re simply describing the patients who came in and required hospitalization,” she said. “We are not comparing them to those who were positive and stayed out of the hospital, or who didn’t get infected, or to patients with any other disease.” | “We’re simply describing the patients who came in and required hospitalization,” she said. “We are not comparing them to those who were positive and stayed out of the hospital, or who didn’t get infected, or to patients with any other disease.” |
| The researchers reported that when patients first came to the hospital and were triaged, 17 percent had an abnormal respiratory rate of more than 24 breaths per minute, and 28 percent received supplemental oxygen. | The researchers reported that when patients first came to the hospital and were triaged, 17 percent had an abnormal respiratory rate of more than 24 breaths per minute, and 28 percent received supplemental oxygen. |
| But fewer than one third of the patients had a fever, even though they were sick enough to be hospitalized, a similar observation to one noted by a large Chinese study. That has important policy implications, indicating that taking people’s temperatures in order to screen them for the coronavirus — a measure that was used on cruise ships and as a way to detect illness in returning travelers at airports, and that has also been proposed for use in the workplace — is likely to miss many people who are not only asymptomatic but also acutely ill. | But fewer than one third of the patients had a fever, even though they were sick enough to be hospitalized, a similar observation to one noted by a large Chinese study. That has important policy implications, indicating that taking people’s temperatures in order to screen them for the coronavirus — a measure that was used on cruise ships and as a way to detect illness in returning travelers at airports, and that has also been proposed for use in the workplace — is likely to miss many people who are not only asymptomatic but also acutely ill. |
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| Nearly 60 percent of those hospitalized at the Northwell facilities had high blood pressure, 40 percent were obese, and about one-third had diabetes. Smaller numbers of patients suffered from other chronic illnesses, such as heart disease, kidney disease and chronic respiratory illnesses. | Nearly 60 percent of those hospitalized at the Northwell facilities had high blood pressure, 40 percent were obese, and about one-third had diabetes. Smaller numbers of patients suffered from other chronic illnesses, such as heart disease, kidney disease and chronic respiratory illnesses. |
| Other smaller reports from New York City area hospitals have also highlighted obesity as a complicating risk factor. One hypothesis is that obesity causes chronic, low-grade inflammation that can lead to an increase in circulating, pro-inflammatory cytokines, which may play a role in the worst Covid-19 outcomes. | Other smaller reports from New York City area hospitals have also highlighted obesity as a complicating risk factor. One hypothesis is that obesity causes chronic, low-grade inflammation that can lead to an increase in circulating, pro-inflammatory cytokines, which may play a role in the worst Covid-19 outcomes. |
| Updated June 12, 2020 | Updated June 12, 2020 |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Dr. Leora Horwitz, an associate professor at NYU Langone Health whose recent study of Covid-19 patients found that obesity was the most significant predictor of disease severity after age, said that the new paper described similar rates of chronic disease and obesity, but that it was descriptive, so “it is hard to tell the relative importance of the various comorbidities.” She noted that the obesity rate on Long Island is 24 percent, suggesting the hospitalized patients “are disproportionately obese.” | Dr. Leora Horwitz, an associate professor at NYU Langone Health whose recent study of Covid-19 patients found that obesity was the most significant predictor of disease severity after age, said that the new paper described similar rates of chronic disease and obesity, but that it was descriptive, so “it is hard to tell the relative importance of the various comorbidities.” She noted that the obesity rate on Long Island is 24 percent, suggesting the hospitalized patients “are disproportionately obese.” |
| The report adds new evidence of the greater susceptibility of men to the coronavirus: Men represented 60 percent of the hospitalized patients in the Northwell system, and an even greater share — 66 percent — of the patients treated in the intensive care unit. | The report adds new evidence of the greater susceptibility of men to the coronavirus: Men represented 60 percent of the hospitalized patients in the Northwell system, and an even greater share — 66 percent — of the patients treated in the intensive care unit. |
| The risk of dying increased with age for all patients but it climbed faster and higher for men. The risk of dying for male patients was in the single digits through their 40s, and then climbed steadily with each decade, with 60 percent of men in their 80s dying. Women’s death rates were in the single digits through their 50s, but reached 48 percent for women in their 80s. | The risk of dying increased with age for all patients but it climbed faster and higher for men. The risk of dying for male patients was in the single digits through their 40s, and then climbed steadily with each decade, with 60 percent of men in their 80s dying. Women’s death rates were in the single digits through their 50s, but reached 48 percent for women in their 80s. |
| Another counterintuitive finding was that adults aged 18 to 65 were more likely to be treated in the intensive care unit or to receive mechanical ventilation than those over 65. The reasons were unclear, but may have reflected a reluctance to seek medical care until the condition was exacerbated. | Another counterintuitive finding was that adults aged 18 to 65 were more likely to be treated in the intensive care unit or to receive mechanical ventilation than those over 65. The reasons were unclear, but may have reflected a reluctance to seek medical care until the condition was exacerbated. |
| Additional analyses of the data will try to identify the clusters of symptoms that are most predictive of a patient developing severe coronavirus disease, and of experiencing a cytokine storm, a harmful immune response in which the immune system attacks the body’s own cells, Dr. Davidson said. | Additional analyses of the data will try to identify the clusters of symptoms that are most predictive of a patient developing severe coronavirus disease, and of experiencing a cytokine storm, a harmful immune response in which the immune system attacks the body’s own cells, Dr. Davidson said. |
| Pam Belluck contributed reporting. | Pam Belluck contributed reporting. |