Who is Most At Risk for a Bad Case of Coronavirus?

 In CHR Blog

Most people know by now that the risk of severe illness from the coronavirus rises with age. But is it only the elderly who are most at risk for a bad case of coronavirus?  No, it’s not. Those with underlying conditions are at serious risk, regardless of age. By serious risk, I mean hospitalized. Not the people with the “I-didn’t-even-know-I-had-it” kind of case of Covid. Rather, those folks who find themselves Covid-positive, and after fighting at home for a few days or a week, admit they have to seek serious medical support in the Emergency Room.

A bad case of coronavirus[i] will land a person of any age in the hospital, often struggling to breathe. No matter the age, a COVID-19 patient wants to hold on and come out alive, surviving an illness that, so far, has no surefire cure. Remdesivir and Dexamethasone aside, healthcare workers in the ICU know that helping Covid patients beat back the disease is no easy matter. We need to start talking about what puts younger people at risk too, while still protecting our seniors.

 

Four Underlying Conditions Affecting Many Young People

It is critical to understand that NEARLY EVERY HOSPITALIZED Covid patient had an underlying condition. Only 9%[ii] had no known condition. CDC[iii] Director Robert Redfield, MD gave some sobering statistics in his Senate testimony last week. He noted that people with underlying conditions were 6 times more likely to be hospitalized, and 12 times more likely to die from COVID, if they had underlying conditions, compared to those without.

CDC updated its list of underlying conditions on June 25, using available information through the end of May. It vastly expanded the original set of conditions laid out at the beginning of the pandemic. These underlying conditions add risk for severe COVID-19 disease. For example, it is no longer just those with “Morbid Obesity” (BMI of 40 or higher). CDC expanded those at higher risk to anyone who has “regular” obesity, a Body Mass Index (BMI) of 30 or higher. There are six additional conditions that CDC is confident increase risk. The evidence is considered strong and consistent.

In addition, CDC thinks people MIGHT BE at higher risk for severe illness, if they have any of 12 additional conditions. This second list either has mixed evidence, or limited evidence. Hypertension is in this second category.

“…people with underlying conditions are 6 times more likely
to be hospitalized than those without”

 

I want to highlight 4 underlying conditions that the general public should know about.

1. Obesity.

Strong evidence is now apparent that obesity puts people at higher risk for a bad case of COVID-19. So much of America is obese – 42% of US adults[iv]. Rates are higher in African American (50%) and Hispanic (45%) populations, contributing to our understanding of racial disparities.

What’s also interesting, and scary, is that younger hospitalized patients are more likely to be obese than the older Covid patients. More than 6 of 10 hospitalized patients ages 18 to 49 had obesity as an underlying condition. It is the most common underlying condition for this age group. It is also an underlying condition for more than half of those patients age 50-64, compared to just over 1/3 of the 65+ year olds.

We have been unwilling to talk about obesity. Perhaps because no one seems to know quite how to tackle it on a mass basis. As a country, we just get bigger and bigger every year. Now all that eating, drinking and screen time is playing out in making us more vulnerable to the novel coronavirus. Working from home may further reduce our walking and daily exercise. Add in the extra stress from the coronavirus pandemic, and we reach for comfort foods. Are we ready to make serious diet and exercise changes at this peculiar time of Covid?

The implication in the near term is that we need to do more physical distancing. Our toolbox of 6-foot spacing, handwashing, masks when we go out in public, avoiding big groups and indoor gatherings, covering our cough, and sanitizing our surfaces, is about all we have.

If you want to know where you fit on the overweight-obesity spectrum, check out the BMI Calculator. In general, a person at 5’9” tips to obesity at 203 lbs. At 5’5”, a weight of 180 will get you there.

2. Hypertension or High Blood Pressure.

Hypertension was the most common underlying condition of all hospitalized Covid patients (through June 27). More than half (54.5%) of hospitalized patients had hypertension. While it’s true, high blood pressure was more common in the older hospital patients – ¾ of those age 65+ and 58% of those aged 50 to 64 had underlying hypertension – a full quarter of the younger patients ages 18 to 49 also had high blood pressure. CDC continues to evaluate evidence as it is produced, but at this point they think that high blood pressure might put people at an increased risk for severe illness.

CDC advises people to take their medicines exactly as prescribed and follow their healthcare provider’s recommendations for diet and exercise while maintaining social distancing precautions.

3. Diabetes.

More than one in five (22%) younger Covid patients who are hospitalized had diabetes as an underlying condition. (For older age groups, it was close to 40%). Like hypertension, people can’t tell if you have it, just by looking. The CDC estimates that 10.5% of the US population has the disease – and about 1/5 don’t know it yet. As with obesity, diabetes rates are worse in minority populations: Blacks, Asians, Hispanics (primarily Mexican Americans and Puerto Ricans), and American Indian/Alaskan Natives. Diabetes is also more prevalent in men, overall.

While diabetes is found more often in groups ages 45 and higher, nearly 5 million adults age 18-44 have diabetes. Another 25 to 32 million people in that younger age group have a near-condition known as prediabetes. Most people who have prediabetes could not recall being told by a health professional that they had it. You could have diabetes or prediabetes and not know it. Your health is at risk.

What does CDC suggest to protect diabetics from Covid?  In addition to the usual social distancing measures, it is important to take your diabetes pills and insulin as usual (and as prescribed), track your blood sugar, stay in touch with your healthcare provider and make sure you have a 30-day minimum supply of your medicines on hand.

4. Asthma.

The last condition to bring to the attention of young people is Asthma. In the very early data during the month of March, asthma was the second most common underlying condition for those hospitalized ages 18 to 49. That number has since come down as of the end of June. Still, almost 14% of these younger hospitalized patients have asthma, nearly double the actual prevalence of asthma in the adult population.

CDC advises staying on your medications, keeping your asthma under control, and following your asthma action plan. They advise keeping a 30-day supply of your medications. Avoid your triggers and stay in touch with your healthcare provider. Give yourself the best chance to avoid a severe case of Covid.

 

Risk of COVID-19 and Age

The price paid by seniors – and their families who have been separated from them in these past months – has been extremely high. More than a quarter of seniors hospitalized with Covid have died in hospital[v]. Fortunately, older people have taken the risk to heart. According to COVID-NET, the rate of hospitalization for those ages 65+ has come down[vi] dramatically from its peak in mid-April.

Nursing homes have also received both greater support and greater scrutiny. The CDC notes that 8 out of 10 COVID-19 deaths in the US have been in adults age 65 or older. We’ve known from the early months of the outbreak that nursing home residents have had devastating results when the coronavirus has had its run of the place. Nationally, nursing home deaths represent close to half of the Covid deaths so far.[vii]

The situation regarding age has evolved in recent weeks, though. Many states have reported a rise in cases of younger people. Already, in each of the past three weeks, preliminary COVID-NET data shows more hospitalizations – in terms of raw numbers – in the 18-49 age group than those who are age 65 and up. The 18 to 49-year olds also represent more hospitalizations than the group ages 50 to 64.

“…people are 12 times more likely to die from COVID, if they had
underlying conditions, compared to those without”

Ultimately, the cases in young people will be hard to contain to just such age groups. Inevitably, a sustained rise in young person cases will work its way to a high-risk setting – a workplace, a large apartment building, a nursing home.

Every age group – in 10 year increments – has an increased risk from those ten years younger. The 20-somethings’ risk of a Covid hospitalization is almost 9 times[viii] higher than kids aged 5 to 17. The 30-somethings have almost a double risk of Covid hospitalization compared to those 20-29 years old. Those in their 40s have about a 60% increased risk of hospitalization compared to those in their 30s. Do you see how hospitalization risk increases with each decade of age? It stays in that 55 to 60% range of increase for the upper age groups. At age 85, well, it’s more than pretty serious.

Young people themselves face direct increased risks, due to the widespread reality of underlying conditions, especially obesity. They also cannot accurately size up someone they encounter in the general public, who might have hypertension, diabetes, or asthma. Clearly, there is a moral responsibility to be a good community citizen. If not during a pandemic, then when?

 

Last Thoughts

Almost a million people in the US have recovered so far from COVID-19. Those who have recovered are 7 times the number who have died[ix]. It’s encouraging that the death rate has declined since April. But it’s important to remember the coronavirus is a novel virus that can infect and affect anyone. Younger people with common underlying conditions need to take precautions, along with older age groups.

 

We welcome your thoughts about risk and the coronavirus pandemic. Please leave a comment. (We ask for your email, but do not show it to the public. It will be kept private.)

[i] SARS-CoV-2

[ii] COVID_NET preliminary data for COVID-19 Laboratory-Confirmed Hospitalizations through June 27, 2020, retrieved July 8, 2020.  COVID-NET data comes from 99 counties in 14 states participating in the CDC’s Emerging Infections Program. Participating states include CA, CO, CT, GA, IA, MD, MI, MN, NM, NY, OH, OR, TN, and UT.

[iii] Centers for Disease Control and Prevention

[iv] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018, NCHS Data Brief No. 360, February 2020

[v] CDC COVID-NET data as of June 27, 2020, retrieved July 3, 2020.

[vi] CDC COVID-NET data as of June 27, 2020, retrieved July 3, 2020.

[vii] Kaiser Family Foundation State Reports of Long-Term Care Facility Cases and Deaths Related to COVID-19 (as of June 25, 2020)

[viii] CDC COVID-NET data through June 6, 2020, published June 25, 2020.

[ix] 936,476 recovered in the US compared to 131,857 deaths, as of July 8, 2020, according to the Johns Hopkins COVID-19 Dashboard.

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