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High Mortality among Older Patients Hospitalized with COVID-19 during the First Pandemic Wave

Background: Understanding the local epidemiology, including mortality, of COVID-19 is important for guiding optimal mitigation strategies such as vaccine implementation, need for study of more effective treatment, and redoubling of focused infection control measures. Methods: A retrospective observational cohort study design was utilized. We included adult patients diagnosed in the hospital or emergency department with COVID-19 from March 8, 2020 through May 17, 2020 at Grady Memorial Hospital (Atlanta, GA). Medical chart data abstraction was performed to collect clinical, laboratory and outcome data. Death, defined as inpatient mortality or discharge to hospice, was the primary outcome. Results: Among 360 persons with laboratory-confirmed COVID-19, 50% were [≥] 60 years, and most (80%) were Black and had a BMI [≥]25 kg/m2 (64%). A total of 53 patients (15%) had an outcome of death with the majority (n=46, 88%) occurring in persons [≥] 60 years. Persons [≥] 60 years were less likely to have typical COVID-19 symptoms while more likely to have multiple comorbidities, multifocal pneumonia, and to be admitted to intensive care. The death rate was 27% among persons [≥]60 years versus 4% in those <60 years (p<.01). Furthermore, most deaths (n=40, 75%) occurred among residents of long-term care facilities (LCFs). Conclusions: We describe early COVID-19 cases among predominantly Black and older patients from a single center safety net hospital. COVID-19 related mortality occurred predominantly among older patients from LCFs highlighting the need for improved preparedness and supporting prioritization of vaccination efforts in such settings.