- There has been a noted increase in young people getting seriously sick with coronavirus infection
- While young people are much less likely to become seriously ill with the infection, it was always clear that it could happen
- There may be medical reasons behind these serious illnesses including immune problems. Some individuals immune systems may just not recognize or eliminate the virus. However the most likely reason is proportionally more young people in the US are getting infected.
- This strongly argues for the need for appropriate behaviors such as social distancing in all age groups..
One of the most disconcerting things that people have noticed in the past few days is an increased recognition of young patients who have become seriously ill with Coronavirus infection. This was documented in a recent MMWR/CDC publication entitled “Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020.” While the likelihood of dying from Coronavirus remains much higher in the population over 60 years of age, young people in the United States (even in their teens and 20s) can develop serious illness and die from this infection. In fact, the number of hospitalizations and, ICU admissions is relatively consistent across different age groups (Figure 1),
This is disconcerting, however the rates of severe disease and death clearly are higher in older patients (see Table). This increasing rate of severe disease with age has been documented since the beginning of the pandemic in both China and Europe. Given this, however, the breakdown in age numbers of severe disease in the US would suggest that proportionally more young people in the US are becoming infected with the virus as compared to what was seen in China.
So, why would young people have higher rates of infection in the US? There may be medical reasons. Higher percentages of individuals in the US may be on immunosuppressive drugs or have diseases like cystic fibrosis that would predispose to more severe disease. In addition, the human immune system is remarkable in that it is different in every individual. There are genetic immune tendencies that may be different in racial and ethnic groups that cause individuals immune systems to not work well with this particular virus. However, if this were the case we would expect more deaths in younger individuals. In fact, no one under the age of 19 has died from the infection in the United States.
The most likely scenario is that more young people are becoming exposed and infected with the virus. An obvious concern are the reports that young people are not taking social distancing recommendations seriously and in fact are gathering in large groups in areas like Florida beaches. This should be a wake up call to young people; they are not immune to this infection and although they are less likely to die many will get seriously ill. I think some felt that they were immune to the impact of the virus on their health because of the lower rates of severe disease they should practice the same social distancing activities as everyone else. If they are getting it infected at increased rates they also have the potential of spreading the virus to older individuals that are likely more likely to get severe infections or die.
Finally, I believe that young people with severe coronavirus infections should be offered every medical treatment option available. If they were in good health before they became infected they are much more likely to recover from their infection, even if it is severe, than an individual who had medical problems such as heart or lung disease. In the unlikely event that we wind up rationing healthcare there is some argument that young people with severe infections should be considered first for treatment. It would be infinitely better if they practice appropriate behaviors so we are not required to make these decisions!