Table of ContentsView AllTable of ContentsAdults 65 and OverChronic Lung DiseaseImmunocompromised PeopleHeart DiseaseDiabetesLiver DiseaseChronic Kidney DiseaseObesityNeurological Disorders
Table of ContentsView All
View All
Table of Contents
Adults 65 and Over
Chronic Lung Disease
Immunocompromised People
Heart Disease
Diabetes
Liver Disease
Chronic Kidney Disease
Obesity
Neurological Disorders
By the time the very first cases ofCOVID-19were identified in the United States in January 2020,it was already clear that certain groups were at greater risk of serious illness, and possibly death, than others. In an effort to protect vulnerable populations, the Centers for Disease Control and Prevention (CDC) published a list of pre-existing health conditions that place certain groups at an increased risk of severe illness and death.
Babies, for example, were not included in the CDC’s list, even though they are considered to be at high risk of severe illness from the flu. Variations like this led to some confusion in the public about the nature of the virus and why it causes serious illness in some but not in others.
It is important to understand that having one or more risk factors for COVID-19 does not mean that you are destined to fall seriously ill if infected. On the other hand, having none doesn’t mean that you are inherently “safe.”
Verywell / Ellen Lindner
According to the CDC, the risk for severe illness with COVID-19 increases with age, with older adults at highest risk.
As of June 2, 2022, 74% of COVID-19 related deaths were in adults ages 65 or older.
There are several reasons for this, some of which are interrelated:
Due to the underlying health risks, the CDC strongly advises that people 65 and over get vaccinated for COVID-19, limit in-person interactions (especially indoors), maintain social distance, and wash hands often.
What Older Adults Need to Know About COVID-19
COVID-19 is a respiratory virus that attaches to cells via proteins known as ACE2 receptors. ACE2 receptors occur in high density in the esophagus (windpipe) and nasal passages, where the virus can causeupper respiratory symptoms.
But, in some people, the virus can move deeper into the lungs to thealveoliwhere ACE2 receptors also proliferate, causing severe and potentially life-threateningacute respiratory distress syndrome (ARDS).
People with chronic lung diseases are considered to be at a significantly increased risk for experiencing ARDS if infected with COVID-19. These include respiratory conditions like:
Despite these vulnerabilities, there remains debate on how “at-risk” people with some of these diseases truly are.
A 2021 review of 37 studies found an association between COPD and hospitalization, admission to intensive care units, and death from COVID-19. The same review did not find an association between asthma with negative COVID-19-related outcomes.However, other research on asthma is mixed or inconclusive. According to the CDC, those with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized with COVID-19.
A 2021 review of 37 studies found an association between COPD and hospitalization, admission to intensive care units, and death from COVID-19. The same review did not find an association between asthma with negative COVID-19-related outcomes.
However, other research on asthma is mixed or inconclusive. According to the CDC, those with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized with COVID-19.
With that said, it is important to understand that risk from a statistical standpoint is not the same as the risk from an individual standpoint. People with advanced or poorly controlled lung disease, particularly those who smoke, are more likely than not to have compromised immune systems.
It is in this group of people that an uncomplicated upper respiratory infection can suddenly move into the lungs and turn severe.
Immunocompromisedpeople are those whose immune systems are weak, making them less able to fight infection. The loss of immune strength not only increases the risk of infection but also increases the likelihood of severe disease. Immune suppression characteristically affects:
A study from the World Health Organization that included data from 24 countries, found that HIV was associated with an increased risk of severe COVID-19.
A study in the United States conducted in New York also found that people with HIV and COVID-19 had higher rates of hospitalization and death and that risks may be highest for those with HIV whoseCD4 countsare below 350 cells per microliter.
Researchers have also concluded that organ transplant recipients (most especially kidney recipients) and people undergoing chemotherapy are far more likely to get COVID-19 and develop ARDS than the general population.
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In people with pre-existing cardiovascular disease, the added stress on the heart not only increases the severity ofhigh blood pressurebut also the likelihood of a heart attack or stroke.
A March 2020 study published inJAMA Cardiologyreported that nearly 28% of people hospitalized for COVID-19 experienced a coronary event, including a heart attack, while in hospital. Those who did were nearly twice as likely to die compared to those with no heart event (13.3% versus 7.6%, respectively).
Studies suggest that people with pre-existing heart conditions are three times more likely to die as a result of a COVID-19 infection than those with no pre-existing heart condition.
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Type 1andtype 2 diabetescan both cause abnormal increases in blood sugar (hyperglycemia) if not properly controlled. Studies suggest that the inability to control blood sugar is one of the main reasons why certain people are likely to get COVID-19 and experience worse disease.
Acute hyperglycemia can lead to a condition calleddiabetic ketoacidosis, in which acids known as ketones impair the production of defensivewhite blood cells. This can increase a person’s vulnerability to infection. Even if ketoacidosis is not present, people with untreated or controlled diabetes tend to have some level of immune suppression.
According to a March 2020 study published inJAMA,involving 72,314 COVID-infected people in Wuhan, China, diabetes was associated with no less than a three-fold increase in the risk of death compared to people without diabetes.
While other studies have not reported such dramatic findings, blood glucose control does appear to influence the risk of COVID-19 infection in people with diabetes.
A March 2020 study in the journalMetabolismconcluded that people with type 2 diabetes who are able to maintainnormal blood sugarlevels are at a lower risk of infection and severe illness from COVID-19 than those who aren’t.
It is unknown how greatly COVID-19 affects people with liver disease, although most studies suggest that problem is limited to those with advanced or end-stage liver disease.
A March 2020 review of studies in theLancetreported that people hospitalized for COVID-19 are twice as likely to have extreme elevations of aminotransferase. Even so, few of these individuals experienced any liver damage, and any increases in the enzymes were usually short-lived.
Chronic kidney disease (CKD)appears to increase the risk of severe illness and death in people with COVID-19. The risk seems directly tied to the severity of the CKD, with people on dialysis at greatest risk.
People with advanced CKD typically have suppressed immune systems, but other factors can contribute to increased risk. Because the function of the lungs, heart, and kidneys are interrelated, any impairment of one organ will impact the others. If a severe lung infection were to occur, for example, the symptoms of kidney disease would almost invariably be amplified.
According to a March 2020 study inKidney International,the risk of death from COVID-19 is doubled if pre-existing kidney disease is involved. Most deaths occur when a systemic infection causesacute renal failure, typically in critically ill patients with advanced CKD.
Despite the concerns, research published in theAmerican Journal of Nephrologysuggests that acute renal failure is still a relatively uncommon occurrence with COVID-19 and that COVID-19 will not aggravate CKD in most people.
Obesityis a predisposing factor for many of the health conditions on the CDC’s list of pre-existing conditions for COVID-19, including heart disease, type 2 diabetes,fatty liver disease, and kidney disease
Moreover, obesity is associated with impaired immunity, due in large part to the persistent inflammation that “blunts” the activation of the immune system.
While it is unclear how much obesity increases the risk or severity of COVID-19, epidemiologic research suggests that countries with high rates of obesity are generally at greater risk.
According to an April 2020 study inObesity,the mortality rate of COVID-19 in countries like Italy, where obesity rates are high, is far greater than countries like China, where the obesity rate is significantly lower.
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At the same time, many of the drugs used to treat neurological disorders like MS andmyasthenia graviscan actively suppress the immune system, increasing the risk and severity of COVID-19 infections.
Some health authorties warn that combination therapies used to treat these disorders, such as Azasan (azathioprine), CellCept (mycophenolate mofetil) or methotrexate combined with prednisolone, can cause severe immunosuppression.People on such regimens should take extra precautions to limit social interactions and maintain social distancing.
A Word From Verywell
Vaccination, social distancing, frequent hand-washing, and staying at home are the best ways to reduce your risk during the pandemic. Moreover, early treatment at thefirst signs of illnessmay prevent the progression of the disease and the development of ARDs.
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The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.
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