Unreported young adult population uniquely vulnerable to COVID-19

Just two months ago, the world was convinced of millennials’ invulnerability to coronavirus. So how do we now assimilate reports on their hospitalizations, ICU admissions, and fatalities?

It would help if we knew how many are healthy young adults — or vulnerable ones with chronic conditions. 

COVID-19 is known to be dangerous for people with underlying medical conditions, but few are aware that this includes 20 million young adults who struggle to find doctors trained to treat their age group. Society doesn’t see or understand these young people. They, in turn, are reluctant to open up about their health for fear of being misunderstood. They are invisible to health systems, colleges, workplaces, and government, so there are no supports or services for them. For this reason, they have chosen to call themselves “Young Invisibles.” 

COVID-19 is a game-changer, with data now emerging that should cause our warning lights to blink red. We know from HHS studies that 26 percent of young adults grow up with chronic conditions, such as asthma, lupus, epilepsy, diabetes, and kidney disease. A CDC report shows that 85 percent of 18-49-year-olds with confirmed coronavirus hospitalizations had underlying medical conditions. 

The CDC states explicitly that people of any age with serious medical conditions may be at risk for severe infections. Put all these facts together, and it’s clear that Young Invisibles face an outsized risk. No longer can we overlook this population and pretend they’ll be fine. We must prioritize these young people to protect their health and lives.

The heart of our problem is a medical system that is not designed to care for young adults beyond pediatrics, a failing that is downright dangerous in the face of COVID-19. Young Invisibles are hard-pressed to find a medical team that can provide coordinated care to keep their conditions at bay. I have a millennial daughter who has an uncontrolled medical condition, and, to the extent, there is an action plan for her, I – a physician mom – have had to create it in conjunction with her specialist. COVID-19 guidance instructs people with symptoms to call their doctor, who is supposed to advise on testing and hospitalization. But this is inadequate.

More than ever, we need the medical community to advise them on how to manage their specific conditions. Moreover, we need to take these immediate steps:

First, the leaders we most depend upon — the president, state governors, and medical experts — need to ensure that this population will be a high priority for testing and medical care, along with elderly people who have underlying medical conditions. Second, guidance is needed on the protection, prevention, and development of an action plan if they develop symptoms. Young Invisibles need specific and trustworthy guidance on precautions, particularly since they lack a young adult system of care and advocacy groups like the pediatric community and AARP.

Third, we need to refine our data.

For decades, data on young adults have been buried within the 18-64-year-old segment, preventing a clear understanding of the prevalence of young Invisibles and their conditions. Snippets of data are surfacing about COVID-19 and young adults. 

A Washington Post analysis in early April found a minimum of 235 fatalities in people in their 20s and 30s and noted that the majority had underlying conditions but did not delve further. On June 10, Maryland, it was reported that 33 percent of those tested positive were 20-39 years old: 19497 cases with 48 deaths. A new D.C. Children’s study shows Young Invisibles are at a higher risk of severe COVID-19 infections that require hospitalization and critical care. All of this warrants the need to proactively study Young Invisibles in-depth to learn about their risk, health conditions, clinical features, treatments, and outcomes.

 Without this data, we will continue to treat young adults as low risk and be unprepared to provide the best care for those who are seriously vulnerable. We will miss this unique opportunity to learn critical things about how the virus impacts Young Invisibles: what conditions COVID-19 targets, the risk/benefit of experimental drugs and drug interactions related to different conditions, how COVID-19 progresses in certain conditions, and if and how it exacerbates underlying conditions. 

Ultimately we will have severe medical problems and the loss of young lives, the greatest tragedy of all when those complications and deaths are highly preventable. We know what we have to do to address this threat. What we need now is the will to do it.  

Santi KM Bhagat, MD, MPH, is the founder of Physician-Parent Caregivers, a charitable non-profit that pioneered the Invisible Wave movement.