Comorbidities Drive Risk of Severe Outcomes with COVID-19 Save

The current edition of the MMWR from the CDC shows that among those vaccinated against COVID-19, there is a low risk of severe outcomes (hospitalization and death); the highest risk is seen in those with multiple comorbidities.

Between 12/2020 and 10/2021 and among 1,228,664 who completed primary COVID-19 vaccination, severe COVID-19–associated outcomes (0.015%) or death (0.0033%) were rare. In this analysis, severe COVID-19 outcomes were defined as hospitalization with a diagnosis of acute respiratory failure, need for noninvasive ventilation (NIV), admission to an intensive care unit (ICU) including all persons requiring invasive mechanical ventilation, or death (including discharge to hospice).

The risk factors for severe outcomes included age ≥65 years, immunosuppressed, and six other underlying conditions. All persons with severe outcomes had at least one risk factor; 78% of persons who died had at least four of these risk factors that include:

• Age ≥65 years (aOR = 3.22; 95% CI = 1.81–5.74)
• Immunosuppression (aOR = 1.91; 95% CI = 1.37–2.66)
• Pulmonary disease (aOR = 1.69; 95% CI = 1.31–2.18)
• Liver disease (aOR = 1.68; 95% CI = 1.12–2.52)
• Chronic kidney disease (aOR = 1.61; 95% CI = 1.19–2.19)
• Neurologic disease (aOR = 1.54; 95% CI = 1.06–2.25)
• Diabetes (aOR = 1.47; 95% CI = 1.14–1.89)
• Cardiac disease (aOR = 1.44; 95% CI = 1.01–2.06)

All persons with severe COVID-19 outcomes after primary vaccination had at least one of the eight risk factors identified as significant in the model. The frequency of having four or more risk factors increased with disease severity, ranging from 18.8% (386) among persons who had nonsevere outcomes, 56.9% (87) among survivors who had respiratory failure or were admitted to an ICU, to 77.8% (28) among persons who died. Among 36 persons who died, 15 (41.7%) had do-not-resuscitate orders at the time of hospital admission.

Severe COVID-19 outcomes after primary vaccination are rare. These data underscore the need for complete vaccination in older, immunosuppressed, high risk individuals.