Coronavirus disease 2019 (COVID-19) Versus Influenza in Hospitalized Adult Patients in the United States: Differences in Demographic and Severity Indicators
H. Keipp Talbot, Emily T. Martin, Manjusha Gaglani, Donald B. Middleton, Shekhar Ghamande, Fernanda P. Silveira, Kempapura Murthy, Richard K. Zimmerman, Christopher Trabue, Samantha M. Olson, Joshua G. Petrie, Jill M. Ferdinands, Manish M. Patel, Arnold S. Monto, HAIVEN Study Investigators, Emily Smith, Kelsey Bounds, Nicole Calhoun, Michael Smith, Andrew Hawrylak, Michael Ladogana, Joseph M. Fernandez, Marc Elieson, James H. Morrison, John Midturi, Tresa McNeal, Alejandro C. Arroliga, Mary Patricia Nowalk, G.K. Balasubramani, Heather Eng, Klancie Dauer, Dayna Wyatt, Yuwei Zhu, Zhouwen Liu, Stephanie Longmire, Kellie Graves, Emily Sedillo, Alina Simion, Karen Speer, Bethany Alicie, Briana Krantz, Donna Carillo, Laura E. Adams, A. M. Drennan, Jan Orga, Lynn M. Peterson, Natasha Halasa, Rendi McHenry, Claudia Guevara Pulido, Lois Lamerato, Anurag N. Malani, Adam S. Lauring, Ryan E. Malosh
Abstract
BACKGROUND: Novel coronavirus disease 2019 (COVID-19) is frequently compared with influenza. The Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) conducts studies on the etiology and characteristics of U.S. hospitalized adults with influenza. It began enrolling patients with COVID-19 hospitalizations in March 2020. Patients with influenza were compared with those with COVID-19 in the first months of the U.S. epidemic. METHODS: Adults aged ≥ 18 years admitted to hospitals in 4 sites with acute respiratory illness were tested by real-time reverse transcription polymerase chain reaction for influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19. Demographic and illness characteristics were collected for influenza illnesses during 3 seasons 2016-2019. Similar data were collected on COVID-19 cases admitted before June 19, 2020. RESULTS: Age groups hospitalized with COVID-19 (n = 914) were similar to those admitted with influenza (n = 1937); 80% of patients with influenza and 75% of patients with COVID-19 were aged ≥50 years. Deaths from COVID-19 that occurred in younger patients were less often related to underlying conditions. White non-Hispanic persons were overrepresented in influenza (64%) compared with COVID-19 hospitalizations (37%). Greater severity and complications occurred with COVID-19 including more ICU admissions (AOR = 15.3 [95% CI: 11.6, 20.3]), ventilator use (AOR = 15.6 [95% CI: 10.7, 22.8]), 7 additional days of hospital stay in those discharged alive, and death during hospitalization (AOR = 19.8 [95% CI: 12.0, 32.7]). CONCLUSIONS: While COVID-19 can cause a respiratory illness like influenza, it is associated with significantly greater severity of illness, longer hospital stays, and higher in-hospital deaths.