A Neurologist Speaks Out About Young COVID-19 Patients Having Strokes (2:58)
July 1, 2020 — 6:00 a.m. EST
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Over the past few months, our understanding of coronavirus disease 2019 (COVID-19) has changed a lot. We’ve recognized new symptoms of the virus, we’ve seen some animals get the virus, and possible treatments have been considered and then abandoned. But there’s one message that has stayed pretty consistent from the beginning: Older adults are at higher risk of developing severe disease. However this statement does not mean you’re immune if you’re younger. Young people are getting COVID-19 — that’s why it’s important for all ages to take this virus seriously.
Early information about COVID-19 showed that the majority of deaths occurred in people over the age of 59. And the same has remained true today. Eighty percent of COVID-19-related deaths in the United States have been in adults over the age of 64. And the risk of severe disease increases with increasing age, with adults over 84 being the most vulnerable.
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But there’s been a recent slew of headlines with a new warning: Young adults are making up a bigger proportion of people testing positive for COVID-19 now. Additionally, reports of an inflammatory condition in children with COVID-19 has been in the news. So, what’s going on? Are young people suddenly more at risk? Has the virus changed in some way that’s causing this demographic shift?
Why the Rise?
To be clear, we’ve always known that younger people can get COVID-19. Younger people can also develop severe disease and die from COVID-19; it’s just less likely than it is for older people. So, the fact that adults in their 20s and 30s are testing positive for coronavirus isn’t new or surprising. What is new, at least in the United States, is the percentage of total positive cases younger people make up. For example, in California, only 29% of new cases were in people under the age of 35 in May. Now, people under 35 account for 44% of new cases.
Does Testing Have Something to Do With It?
The short answer is probably. In the beginning of the pandemic, there were testing shortages and stricter criteria regarding who could get a test. This meant only the sickest or highest risk people — who also tended to be older people — got tested.
Now that testing is more widespread, younger people (as well as people with milder symptoms) are getting tested too. This alone could explain the increased percentage. This information closely aligns with what researchers noted in South Korea back in March. In South Korea, people were tested regardless of age or symptoms. What they found was that people in their 20s accounted for the largest percentage of cases compared to any other age group (representing 29.9% of cases, while only 21% of cases were in people over 59).
Turns Out, Behavior May Be the Biggest Culprit
Experts worry that young adults may have a more cavalier attitude with regard to the virus, since they are less likely to be severely affected by it. This could include going back to work earlier and ignoring social distancing and face covering guidelines.
This is bad for two reasons:
- Young adults can still get very sick — particularly if they have certain underlying health conditions like diabetes, asthma, high blood pressure, and more.
- Young adults can act as vectors of disease and spread the virus to other, more vulnerable people.
Although more likely to be asymptomatic or only have mild symptoms, young adults do still get sick from novel coronavirus. Symptoms are similar as in older adults and include: cough, fever, shortness of breath, loss of taste/smell, and more.
Additionally, approximately 2.5% of cases in people under age 50 require hospitalization. This is compared to 12.2% of people ages 65–74, 15.8% of people ages 75–84, and 17.2% of people 85 and over.
What About Children?
COVID-19 rates are low in children, accounting for only 2% of cases in the United States. Of these, only 5% are considered severe and 0.6% considered critical. The symptoms in children are similar to the symptoms in adults, except the CDC also includes poor feeding and poor appetite as symptoms.
Very rarely, children may also develop a condition called multisystem inflammatory syndrome in children (MIS-C). MIS-C is an inflammatory condition that affects the heart, lungs, kidneys, brain, skin, eyes, and intestines. Its exact cause and incidence are unknown, but it can be deadly — so it’s important to seek out medical care immediately if symptoms develop. MIS-C was initially confused with Kawasaki disease, another inflammatory condition that affects children, but it has some differences. Symptoms include: fever, abdominal pain, vomiting, neck pain, difficulty staying awake, and more.
For young adults and children, the risk of ending up in the hospital may be low, but it is not zero. Controlling the pandemic requires the cooperation of everyone — not just the people more likely to get sick.
In addition, there’s an aspect of COVID-19 that perhaps doesn’t get paid enough attention: its psychological impact. Everything going on in the world can have a profound impact on young people in terms of stress, fear, boredom, perception of the world, and uncertainty regarding the future. Missing school, summer camp, vacations, other fun activities, and not seeing friends can represent an abrupt change in the lives of younger people. It’s important the mental health effects of the pandemic are not ignored. To this end, the CDC has a page dedicated to providing support for teens and young adults.