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The majority of patients hospitalized with COVID-19 require mechanical ventilation to help them breathe, according to a study published Tuesday by The Lancet.
The findings also show that nearly 40 percent of those who are hospitalized and become critically ill from the disease caused by the new coronavirus, SARS-CoV-2, ultimately die.
The study describes the progression of the virus in 257 patients in New York City, epicenter of the outbreak in the United States.
"Our study provides in-depth understanding of how COVID-19 may be affecting critically ill patients in U.S. hospitals," Dr. Max O'Donnell, senior author and a pulmonologist at Columbia University Irving Medical Center in New York City, said in a statement.
"Of particular interest is the finding that over three-quarters of critically ill patients required a ventilator and almost one third required renal dialysis support," he added. "This has important implications for resource allocation in hospitals, where access to equipment and specialized staff needed to deliver this level of care is limited."
Through Tuesday afternoon, there have been more than 1.52 million confirmed cases of COVID-19 across the United States, with nearly 200,000 in New York City alone, according to the latest figures from Johns Hopkins University. More than 90,000 Americans have died from the virus, including at least 20,000 in New York.
For the analysis, O'Donnell and colleagues describe cases involving 1,150 adult COVID-19 patients admitted to two hospitals in New York City between March 2 and April 1, and followed for at least 28 days. The most common symptoms reported by the patients were shortness of breath, fever, cough, muscle pain, and diarrhea.
The authors found that 22 percent of the patients they tracked -- 257 of 1,150 -- developed "critical illness," meaning they required treatment in the hospital intensive care unit, or ICU.
Two-thirds of the critically ill patients were men, and more than 80 percent of them had at least one chronic illness. The most common of these were high blood pressure, in 63 percent, and diabetes, in 36 percent, the authors found.
Critical illness was more common in older patients, who had a median age of 62, but roughly one in five patients were under 50, the authors noted. Nearly half of the patients were obese.
Additionally, the researchers report that 62 percent of critically ill patients were Hispanic or Latino, and around one in five were black or African-American, the authors said. And 5 percent were employed as healthcare workers, although it was not possible to determine whether they became infected while working in a clinical setting.
Of the critically ill patients, 79 percent -- 203 of 257 -- required ventilator support, spending an average of 18 days on a ventilator, and some spending as long as 28 days on a ventilator.
Almost one-third of the critically ill patients developed severe kidney damage and required therapy to support kidney function, such as dialysis, the authors said.
As of April 28, 39 percent of the critically ill patients had died and 37 percent remained in the hospital. Only 23 percent had been discharged alive, the researchers reported.
In general, the findings in New York City mirror reports from China, Italy, and Britain, with older age and preexisting conditions being the most prominent risk factors associated with poor outcomes from the virus, the authors said.
"Until now, a detailed understanding of how the virus is affecting critically ill patients in the U.S. has been limited to reports from a small number of cases," said Dr. Natalie Yip, associate director of the ICU at Columbia University Irving Medical Center. "Our study aimed to identify risk factors associated with death in critically ill COVID-19 patients in a U.S. hospital setting."