This blog is the second part of a two-part series. The first part talked about the various lifestyle risk factors and severity of COVID-19 complications. This post will discuss the underlying medical conditions that might increase the risk of illness from COVID-19 and how everyone can protect themselves and their families and communities from COVID-19.

The coronavirus pandemic has emerged and is relentlessly engulfing the whole globe. It has disrupted human activity and has destabilized the world’s economy. According to the World Health Organization (WHO), the number of confirmed cases worldwide as of November 15, 2020, was 53,766,728 including 1,308,975  confirmed deaths and the numbers are still rising. The US, India, and Brazil are leading the tally of most infected countries. The US accounted for the world’s highest number of cases and deaths at 10,641,431 and 242,542 respectively, according to WHO. The physicians and public health research scientists are working tirelessly to tackle this virus. As the symptoms of the virus are varied, it poses problems before the health agencies. For some people, the virus shows no symptoms at all but still are detected corona positive, while others become so sick that they eventually need mechanical ventilation to breathe. With its growth, the emergence of scientific publications trying to analyze the underlying medical conditions that may increase the severity of COVID-19 complications is also rising. According to the latest report by Italy’s National Institute of Health among 99% of COVID-19 patients who have died, it was found that at least one among them had pre-existing medical conditions (1). The Centers for Disease Control and Prevention has also come out with a report mentioning certain underlying conditions that may increase the severity of COVID-19 complications.

Old-Age and COVID-19

Undoubtedly, people of any age and even children can catch the Coronavirus, but more commonly it is found to affect the elderly. The risk of serious complications from COVID-19 increases steadily with age. According to the CDC, those who are 85 years and older are at the highest risk of getting serious symptoms from COVID-19 (Refer figure 1). Additionally, it is found that in the USA, 80% of deaths have been reported in adults ages 65 and older.  It was also found that certain medical conditions, like diabetes, cardiovascular disease, and lung problems, increase the chances of serious illness or death from COVID-19 in older adults. The CDC has released a report that presents certain medical conditions that are held responsible for increasing the severity of COVID-19 complications, which are regularly being updated by CDC, based on new studies and research. 

Figure 1: Old Age and COVID-19

Source: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html

Certain underlying medical conditions and COVID-19

The CDC has found the strongest and most consistent evidence supporting the augmented risk of serious COVID-19 illness under the following medical/health conditions:

• Cancer;
• Chronic Kidney Disease;
• COPD (Chronic obstructive pulmonary disease, including chronic bronchitis or emphysema);
• Heart conditions (like Heart Failure, Coronary Artery Disease (CAD), etc.);
• Obesity (body mass index (BMI) greater than 30);
• Pregnancy;
• Sickle cell disease (an inherited red blood cell disorder that affects the supply of hemoglobin in the body);
• Smoking;
• The weakened immune system from solid organ transplantation (a treatment undertaken in case of some organ failure like kidney, liver, pancreas, heart, and lungs);
• Type 2 diabetes.

Moderate and mixed evidence has been found for the following conditions:

• Asthma;
• Cerebrovascular disease (a variety of conditions that affect the supply of blood to the brain and can lead to hemorrhages, strokes, etc);
• Hypertension;
• Use of corticosteroids (a drug that lowers inflammation in the body) or other immunosuppressive medications (when the body gets an organ (Kidney) transplant, it treats it as a foreigner and starts rejecting it, the immunosuppressive drugs or medicines lower the body’s ability to reject a transplanted organ).

A small number of studies have also supported the following medical conditions that might increase the risk of severe COVID-19 illness:

• Bone marrow transplantation (a medical procedure undertaken to replace the damaged bone marrow);
• HIV;
• Immune deficiencies;
• Inherited metabolic disorders (genetic conditions that result in metabolism problems such as Gaucher disease, Krabbe disease, etc.);
• Chronic liver disease;
• Neurologic conditions like dementia;
• Other chronic lung diseases;
• Overweight (Body Mass Index greater than 25 but less than 30);
• Thalassemia (a type of blood disorder);
• Type 1 diabetes.

Recommended measures for those who are at higher risk of COVID-19

To date, there is no vaccine available to prevent the deadly Coronavirus infection, but we can take steps to reduce the risk of infection. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have recommended some everyday precautions to be taken to avoid COVID-19:

• Making “wearing a mask” a new normal. The mask should be worn over the nose and mouth.
• Covering the mouth and nose with a cloth/ tissue or bent elbow while coughing or sneezing.
• Encouraging social distancing by
  • Staying at home when and wherever possible. 
  • Limiting the interactions with other people as much as possible. Avoid crowds 
  • When going out in public (if necessary), keeping away from those who are sick, avoiding close contact by not shaking hands and or giving hugs; 
  • Maintaining at least a 1-meter distance between yourself and others. 
• Washing hands often with soap and water, or by using an alcohol-based hand sanitizer. 
• Regularly cleaning and disinfecting the most-touched surfaces. 
• Avoiding touching the eyes, nose, and mouth frequently.
• Avoiding sharing dishes, glasses, and other personal and household items if one is sick.
• Doing some mild in-house exercises to stay healthy and stress-free during COVID-19 times. 

In addition to the everyday precautions, the CDC has recommended the following measures for those who are at higher risk:

• Obtaining several weeks of medications and supplies in case one has to stay home for a longer period. 
• Taking regular influenza and pneumonia vaccine shots. Though they can’t prevent COVID-19, becoming ill with influenza or pneumonia may worsen the outcome if one catches COVID-19.
• Notifying the doctor of one’s medical conditions and COVID-19 or if one is ill. If a medical emergency is required, one should call 911 or their local emergency department.
• Establishing an alternate way of communicating, like a phone or video conference with the doctor if one has to stay at home for a few weeks. 
• Taking everyday precautions as recommended above.

Written by Dr. Shikha Sharma, Reviewed by Dr. Harshi Dhingra