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Volume 26, Number 9—September 2020

Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States

Roosecelis B. Martines1Comments to Author , Jana M. Ritter1, Eduard Matkovic, Joy Gary, Brigid C. Bollweg, Hannah Bullock, Cynthia S. Goldsmith, Luciana Silva-Flannery, Josilene N. Seixas, Sarah Reagan-Steiner, Timothy Uyeki, Amy Denison, Julu Bhatnagar, Wun-Ju Shieh, Sherif R. Zaki, and COVID-19 Pathology Working Group
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R.B. Martines, J.M. Ritter, E. Matkovic, J. Gary, B.C. Bollweg, C.S. Goldsmith, L. Silva-Flannery, J.N. Seixas, S. Reagan-Steiner, T. Uyeki, A. Denison, J. Bhatnagar, W.-J. Shieh, S.R. Zaki); Synergy America Inc., Atlanta (H. Bullock).

Main Article

Table 1

Selected demographic and clinical characteristics of 8 case-patients with fatal severe acute respiratory syndrome coronavirus 2 infection

Characteristic No. (%)
M 4 (50)
4 (50)
Age group, y
<65 2 (25)
6 (25)
White, non-Hispanic 7 (87.5)
1 (12.5)
Clinical symptoms
Fever 6 (75)
Cough 5 (62.5)
Shortness of breath 5 (62.5)
Malaise 2 (25)
Myalgias 1 (12.5)
1 (12.5)
Underlying health conditions
>1 condition 8 (100)
Hypertension 6 (75)
Chronic kidney disease* 6 (75)
Cardiovascular disease† 6 (75)
Obesity‡ 5 (62.5)
Diabetes mellitus 4 (50)
Chronic lung disease§ 2 (25)
Immunocompromised condition¶ 3 (37.5)
Neurologic disorders 1 (12.5)
Other chronic diseases#
6 (75)
Radiographic findings
Bilateral interstitial infiltrate or opacities 8 (100)
Pleural effusion
2 (25)
Clinical course
Median days from illness onset to death (range) 12.5 (6–15)
Median days of hospitalization (range)
3.5 (1–8)
Mechanical ventilation** 6 (75)

*Chronic kidney disease requiring treatment with hemodialysis was reported in 2 case-patients.
†Number of cases includes patients with history of coronary artery disease, congestive heart failure, valvular heart disease, and/or cerebrovascular accident.
‡Obesity includes reported BMI >30 or mention of obesity or morbid obesity in the submitted medical records. Two patients had morbid obesity listed in the submitted medical records.
§Chronic obstructive pulmonary disease was the only reported underlying condition with chronic lung disease.
¶This includes persons immunosuppressed by solid organ transplant, corticosteroid therapy, or immunosuppressive medication.
#Includes any of the following: hyperlipidemia, thyroid disease, rheumatologic disorder, and obstructive sleep apnea.
**Two patients were transitioned to comfort care and were not intubated.

Main Article

1These authors contributed equally to this article.

2Members of the COVID-19 Pathology Working Group: Rhonda Cole, Amanda Lewis, Pamela Fair, Lindsey Estetter.

Page created: May 21, 2020
Page updated: August 18, 2020
Page reviewed: August 18, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.