This study evaluates the relative risk of death from COVID-19 in people <65 years old versus older individuals in the general population, provides estimates of absolute risk of death in epicenters of the pandemic, and reports what proportion of COVID-19 deaths occur in people <65 years old with and without underlying diseases. They found that individuals <65 years old have very small risks of COVID-19 death even in the hotbeds of the pandemic and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. The authors recommend pandemic management that focuses specifically on protecting high-risk elderly individuals.

The authors analyzed data from countries and US states or major cities with at least 250 COVID-19 deaths as of 4/4/2020 who had information available on death counts according to age strata. Data were available for Belgium, Germany, Italy, Netherlands, Portugal, Spain, Sweden, and Switzerland, as well as Louisiana, Michigan, Washington states and New York City.

The main outcome was the proportion of COVID-19 deaths among individuals <65 years old.

They found:

• Individuals with age <65 account for 5%-9% of all COVID-19 deaths in the 8 European epicenters, and approach 30% in three US hotbed locations
• People <65 years old had 34- to 73-fold lower risk of death compared to those ≥65 years old in the European countries and 13- to 15-fold lower risk in New York City, Louisiana and Michigan.
• The absolute risk of COVID-19 death ranged from 1.7 per million for people <65 years old in Germany to 79 per million in New York City.
• The absolute risk of COVID-19 death for people ≥80 years old ranged from approximately 1 in 6,000 in Germany to 1 in 420 in Spain.
• The COVID-19 death risk in people <65 years old during the period of fatalities from the epidemic was equivalent to the death risk from driving between 9 miles per day (Germany) and 415 miles per day (New York City).
• People <65 years old and not having any underlying predisposing conditions accounted for only 0.3%, 0.7%, and 1.8% of all COVID-19 deaths in Netherlands, Italy, and New York City.