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. 2021 Apr 12;21(1):706.
doi: 10.1186/s12889-021-10611-4.

Age-dependence of healthcare interventions for COVID-19 in Ontario, Canada

Irena Papst  1 , Michael Li  2   3 , David Champredon  4 , Benjamin M Bolker  2   5   6 , Jonathan Dushoff  2   3   5 , David J D Earn  5   6   7
Affiliations

Age-dependence of healthcare interventions for COVID-19 in Ontario, Canada

Irena Papst et al. BMC Public Health. .

Abstract

Background: Patient age is one of the most salient clinical indicators of risk from COVID-19. Age-specific distributions of known SARS-CoV-2 infections and COVID-19-related deaths are available for many regions. Less attention has been given to the age distributions of serious medical interventions administered to COVID-19 patients, which could reveal sources of potential pressure on the healthcare system should SARS-CoV-2 prevalence increase, and could inform mass vaccination strategies. The aim of this study is to quantify the relationship between COVID-19 patient age and serious outcomes of the disease, beyond fatalities alone.

Methods: We analysed 277,555 known SARS-CoV-2 infection records for Ontario, Canada, from 23 January 2020 to 16 February 2021 and estimated the age distributions of hospitalizations, Intensive Care Unit admissions, intubations, and ventilations. We quantified the probability of hospitalization given known SARS-CoV-2 infection, and of survival given COVID-19-related hospitalization.

Results: The distribution of hospitalizations peaks with a wide plateau covering ages 60-90, whereas deaths are concentrated in ages 80+. The estimated probability of hospitalization given known infection reaches a maximum of 27.8% at age 80 (95% CI 26.0%-29.7%). The probability of survival given hospitalization is nearly 100% for adults younger than 40, but declines substantially after this age; for example, a hospitalized 54-year-old patient has a 91.7% chance of surviving COVID-19 (95% CI 88.3%-94.4%).

Conclusions: Our study demonstrates a significant need for hospitalization in middle-aged individuals and young seniors. This need is not captured by the distribution of deaths, which is heavily concentrated in very old ages. The probability of survival given hospitalization for COVID-19 is lower than is generally perceived for patients over 40. If acute care capacity is exceeded due to an increase in COVID-19 prevalence, the distribution of deaths could expand toward younger ages. These results suggest that vaccine programs should aim to prevent infection not only in old seniors, but also in young seniors and middle-aged individuals, to protect them from serious illness and to limit stress on the healthcare system.

Keywords: Age distribution; COVID-19; Epidemiology; Hospitalization; Infectious disease; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Known infections (KIs) over time in Ontario. Counts are split by whether or not the KI was resolved (marked as “resolved” or “fatal” in the Case and Contact Management database) by 16 February 2021 (see “Methods” section). Dashed vertical lines mark important dates for the outbreak in the province. Shaded regions indicate roughly when the most populous regions were in each reopening stage (reopening efforts have not been uniform across public health units). Larger stage numbers correspond to looser public health restrictions. Detailed descriptions of each reopening stage, recent shutdowns, and the newer zoned reopening framework can be found on the official Ontario COVID-19 website [, , –28]
Fig. 2
Fig. 2
Age distribution of known infections (KIs) in Ontario. The distribution of ages for resolved KIs (panel a), Ontario population projections for 2020 (panel b), resolved KIs per 10,000 population (panel c), positive and total SARS-CoV-2 infection tests per 10,000 population (panel d), and test positivity rate (panel e). The test positivity rate is the proportion of tests administered that were positive. The y-axes in panels c and d are on a logarithmic scale
Fig. 3
Fig. 3
COVID-19 outcomes by age in Ontario. The distribution of ages for hospital interventions (panel a), and deaths (panel b). Hospital outcomes are nested and tallied by the most intensive medical intervention used for each patient (ventilator use is the most intensive, followed by intubation, ICU admission, and hospitalization). Deaths are split by whether or not the patient also had a record of hospitalization for COVID-19 treatment
Fig. 4
Fig. 4
Age-dependent COVID-19 hospitalization probability for known SARS-CoV-2 infection (panel a) and survival probability for hospitalized patients (panel b) in Ontario. We give age-by-age estimates of each probability (points; 95% exact binomial confidence intervals given by vertical lines), where point area is proportional to age-specific sample size. We additionally provide more precise estimates of these probabilities under stricter assumptions, modelling the hospitalization probability using a generalized additive model and the survival probability using a generalized linear model (curves; 95% confidence bands given by shaded regions). See “Methods” section for details
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