Volume 26, Number 10—October 2020
Dispatch
Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020
, Amanda Brandow, Lana Mucalo, Fouza Yusuf, Ashima Singh, Bradley Taylor, Katherine Woods, Amanda B. Payne, Georgina Peacock, and Laura A. Schieve
Table
Characteristics of COVID-19 cases and cases resulting in death that were reported to the Secure-SCD Registry, United States, March 20–May 21, 2020*
| Characteristic | No. (%) case-patients† | No. (%) deaths† | Case-fatality rate, % |
|---|---|---|---|
| Total |
178 |
13 |
7.3 |
| Sickle cell disease genotype‡ | |||
| HbSS/HbSβ0 | 135 (75.8) | 7 (53.9) | 5.2 |
| HbSC/HbSβ+ |
42 (23.6) |
5 (38.5) |
11.9 |
| Mean (SD) age, y | 28.6 (14.5) | 28.5 (14.6) | NA |
| Median age, y | 26 | 38 | NA |
| Age range, y |
<1–69 |
12–69 |
NA |
| Age group, y | |||
| <19 | 44 (24.7) | 1 (7.7) | 2.3 |
| >19 |
134 (75.3) |
12 (92.3) |
9.0 |
| Sex | |||
| F | 101 (56.7) | 6 (46.2) | 5.9 |
| M |
75 (42.1) |
6 (46.2) |
8.0 |
| Race/ethnicity | |||
| Black or African American (and not Hispanic or Latino) | 142 (79.8) | 13 (100.0) | 9.2 |
| Hispanic or Latino (and not Black of African American) |
21 (11.8) |
0 |
0 |
| SCD health history | |||
| Hospitalized for pain >3 times in past 3 y | 96 (53.9) | 11 (84.6) | 11.5 |
| >1 episodes of acute chest syndrome in past 3 y§ | 57 (32.0) | 3 (23.1) | 5.3 |
| Chronic transfusion | 23 (12.9) | 0 | 0 |
| Pulmonary hypertension |
23 (12.9) |
5 (38.5) |
21.7 |
| Renal disease | |||
| Albuminuria | 27 (15.2) | 1 (7.7) | 3.7 |
| Decreased renal function | 22 (12.4) | 3 (23.1) | 13.6 |
| SCD nephropathy |
17 (9.6) |
2 (15.4) |
11.8 |
| Stroke | |||
| Overt | 22 (12.4) | 4 (30.8) | 18.2 |
| Silent |
10 (5.6) |
0 |
0 |
| COVID-19 case indices | |||
| COVID-19 severity¶ | |||
| Asymptomatic | 11 (6.2) | 0 | 0 |
| Mild | 96 )53.9) | 3 (23.1) | 3.1 |
| Moderate | 32 (18.0) | 2 (15.4) | 6.3 |
| Severe | 30 (16.8) | 1 (7.7) | 3.3 |
| Critical |
9 (5.1) |
7 (53.8) |
77.8 |
| Accessed care through emergency department | 153 (86.0) | 13 (100.0) | 8.5 |
| Hospitalized | 122 (68.5) | 11 (84.6) | 9.0 |
| Admitted to intensive care unit | 19 (10.7) | 6 (46.2) | 31.6 |
| Ventilator use |
10 (5.6) |
7 (53.9) |
70.0 |
| Received transfusion | 68 (38.2) | 8 (61.5) | 11.8 |
| Received exchange transfusion |
16 (9.0) |
3 (23.1) |
18.6 |
| Received dialysis | 4 (2.2) | 3 (23.1) | 75.0 |
*Values are no. (%) unless otherwise indicated. COVID-19, coronavirus disease; Hb, hemoglobin; NA, not applicable; SCD, sickle cell disease.
†Numbers do not always add up to total no. case-patients because of missing data.
‡SCD genotypes are HbSS (homozygous for hemoglobin S, a severe phenotype associated with shortest survival); HbSβ0-thalassemia (compound heterozygous for hemoglobin S and β0-thalassemia, clinically indistinguishable from HbSS); HbSC (heterozygous for hemoglobin S and hemoglobin C, usually moderate clinical severity); HbSβ+-thalassemia (heterozygous for hemoglobin S and reduced amounts of β-globin, usually milder severity).
§Acute chest syndrome is a multicausal pneumonia-like illness.
¶COVID-19 severity level classified as asymptomatic, no clinical signs or symptoms during the positive COVID-19 period; mild, symptoms of acute upper respiratory tract infection, including fever, fatigue, myalgia, cough, sore throat, runny nose, and sneezing or gastrointestinal symptoms or digestive symptoms, such as nausea, vomiting, abdominal pain and diarrhea; moderate, pneumonia, with or without clinical symptoms, no hypoxia; severe, early respiratory symptoms or gastrointestinal symptoms followed by dyspnea and hypoxia (O2 saturations <92%); critical, acute respiratory distress syndrome, respiratory failure, encephalopathy, shock, coagulopathy, and multiorgan impairment (lung, heart, kidney, brain) that might be life threatening.