Are There Still Cases of Severe COVID-19 Infection?
Yes, severe COVID-19 infections continue to occur, particularly among elderly patients (≥65 years), those with underlying chronic conditions (diabetes, cardiovascular disease, chronic lung disease, obesity), and immunocompromised individuals. 1
High-Risk Populations for Severe Disease
The following groups remain at elevated risk for severe COVID-19 outcomes, including hospitalization, ICU admission, and death:
Age-Related Risk
- Patients ≥65 years have significantly higher rates of severe outcomes, with 31% of all cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths occurring in this age group 2
- Patients ≥80 years face the highest cumulative incidence at 902.0 cases per 100,000 persons, with the most severe outcomes concentrated in those ≥85 years 3, 2
- Elderly patients in long-term care facilities account for 40% of COVID-19 related deaths despite representing only 3% of total cases 1
Underlying Health Conditions
The most common comorbidities associated with severe disease include:
- Cardiovascular disease (32% of hospitalized patients) 3
- Diabetes mellitus (30% of hospitalized patients) 3, 4
- Chronic lung disease including COPD (18% of hospitalized patients) 3, 4
- Obesity (BMI ≥30), which was present in 42-56% of hospitalized patients and associated with 2-fold increased hospitalization risk 1
- Hypertension (57% of hospitalized patients) 1
- Chronic kidney disease and heart failure, which are most strongly associated with hospitalization risk 1
Severity Outcomes by Comorbidity Status
- Hospitalizations are 6 times higher among patients with reported underlying conditions (45.4%) versus those without (7.6%) 3
- Deaths are 12 times higher among patients with reported underlying conditions (19.5%) versus those without (1.6%) 3
- Among patients with sufficient data on underlying conditions, 78% of ICU admissions and 71% of non-ICU hospitalizations occurred in those with at least one underlying condition 4
Current Treatment Recommendations for High-Risk Patients
Antiviral Therapy Indications
High-risk patients with COVID-19 should receive antiviral treatment, specifically:
- Nirmatrelvir/ritonavir (Paxlovid) initiated within 5 days of symptom onset is the first-line treatment, demonstrating 39% relative risk reduction in hospitalization and 61% reduction in death 5
- High-risk criteria include: age ≥65 years, unvaccinated status, immunocompromised state, diabetes mellitus, cardiovascular disease, chronic lung disease, obesity, chronic kidney disease, active malignancy on chemotherapy, solid organ transplantation, or HIV/AIDS 5
Alternative Antiviral Options
- Remdesivir (VEKLURY) is FDA-approved for hospitalized patients and non-hospitalized patients with mild-to-moderate COVID-19 at high risk for progression to severe disease 6
- Remdesivir demonstrated efficacy in reducing COVID-19 related hospitalization (0.7% vs 5.3% with placebo, p=0.0076) in non-hospitalized high-risk patients 6
Clinical Presentation of Severe Cases
Severe COVID-19 is characterized by:
- Acute respiratory distress syndrome (ARDS), which occurred in 29% of the first 41 confirmed cases in Wuhan 1
- ICU admission requirements (32% of initial cases) 1
- Respiratory failure requiring mechanical ventilation or ECMO 6
- Case-fatality rates highest among elderly with co-morbidities, with 6 deaths (15%) among the initial 41 hospitalized cases 1
Vulnerable Settings Requiring Enhanced Protection
Long-term care facilities remain high-risk environments where elderly residents with weakened immunity and underlying diseases live in semi-confined spaces, creating conditions for rapid transmission and high case-fatality rates 1
The evidence clearly demonstrates that severe COVID-19 cases persist, with mortality and morbidity concentrated among specific high-risk populations who require prioritized vaccination, early antiviral treatment, and enhanced infection control measures 1, 5, 7.