What Pre-Existing Conditions for COVID-19 Are Most Risky?

Dr. Don Colbert – Some people are more susceptible to coronavirus infection, and severe symptoms and disease, than others. Who is most at risk? What pre-existing conditions for COVID-19 are most risky? Should you be concerned?

Here’s how and why pre-existing conditions for COVID-19 affect risk and severity, and what to do if you or a loved one has these conditions.

Why Pre-Existing Conditions for Covid-19 Affect Infection Rate and Severity

There are two reasons pre-existing conditions affect COVID-19.

First, if a pre-existing condition affects the immune system and one is not able to fight off the virus before it infects them, they are at higher risk of becoming infected.

Second, once infected, anyone with a weaker immune system may experience a more severe disease as their bodies have a difficult time fighting it. If they have weaker individual systems such as lungs or heart, these specific systems will be more affected by the virus’s actions.

For these two reasons, pre-existing conditions for COVID-19 can affect both the infection rate and severity of disease for individuals who have them. It’s imperative that they are even more diligent with precautions (1).

Pre-Existing Conditions for Covid-19

Advanced Age

Unfortunately, advanced age itself is a pre-existing condition. Why? As we age, our immune systems naturally grow weaker than they were when we were younger.

Of course, a healthy diet and lifestyle can help. But, for most older adults, immunity is still impaired compared to younger populations.

Advanced age can be a risk factor for getting the infection and greater severity in the disease. In fact, 20% of adults in China who contracted COVID-19 experienced severe symptoms compared to just 10% of younger populations. Of the adults, the oldest had the most severe symptoms and the highest mortality (2).

Immunocompromised Individuals Due to Medical Conditions and/or Medications

If you have a compromised immune system for any reason, you are likely at higher risk for infection and severity. Immunocompromised individuals include those who are enduring cancer treatment, those with HIV, those who’ve had a bone marrow or organ transplant, and other medical conditions that affect the immune system.

Other risk factors are smoking, severe obesity (>=40 BMI), older age, very young age (infants), and others.

In addition, some medications affect the immune system. These include prolonged use of corticosteroids, use of immunosuppressants for autoimmune diseases, and many different medications including (3):

• Corticosteroids such as prednisone and budesonide
• Janus kinase inhibitors such as tofacitinib
• Calcineurin inhibitors such as cyclosporine
• mTOR inhibitors such as sirolimus
• IMDH inhibitors such as azathioprine and leflunomide
• Biologics such as abatacept and adalimumab
• Monoclonal antibodies such as basiliximab

This is not an exhaustive list. It’s important to check the information on your individual medications if you suspect they are immunosuppressants. Then, be diligent with precautions to reduce your risk of COVID-19.

Lung Disease and Asthma

Since COVID-19 specifically affects the lungs, those with chronic respiratory diseases, asthma, pulmonary hypertension, and other lung conditions are at higher risk of severe COVID-19 disease if they contract it.

Possible complications of the virus are pneumonia and lung fibrosis. In addition to the precautions below, those with lung disease (and any medication-requiring disease) should have at least a 30-day supply of their medications available. In addition, know where and how to get any needed oxygen and equipment.

Diabetes

Diabetes is a pre-existing condition that increases COVID-19 risk, especially if it is uncontrolled. Why?

First, the immune system is usually compromised in diabetes, which makes it more difficult to fight the infection off in the first place. Then, viruses and infections tend to thrive if blood glucose is high.

Once an infection exists, it can become pneumonia more easily since diabetes is also associated with chronic inflammation.

Diabetes mellitus is also a know risk factor for the development of tuberculosis, has been a risk factor for other viral respiratory infections, and is associated with impaired production of immune cells that fight disease (4).

If you have diabetes, it’s important to do your best to control and monitor your blood sugars and take the extra precautions below.

Cardiovascular Disease

Like diabetes, people with heart disease tend to have more chronic inflammation and weakened immune systems. Typically, they also have other underlying conditions like high blood pressure, elevated cholesterol, diabetes, and lung disease, which weaken the body’s immune system in many ways.

One specific issue for those with heart disease is that COVID-19 typically causes a low-grade fever, which puts additional strain on the body’s metabolic system and heart. Then, if pneumonia develops, a weakened heart and lungs will have a tougher time oxygenating the body’s tissues and systems.

What to Do if You Have Pre-Existing Conditions for Covid-19

Much of the recommendations are the same, but it’s important that you are extremely diligent. Start with this list of Dr. Colbert’s Keys to Avoid COVID-19. Make sure you:

• Wash your hands diligently throughout the day and use 60%+ alcohol hand sanitizer when not able to wash.
• Stay home as much as possible. If you want to go outside for exercise, maintain at least 10 feet between you and others.
• Allow others to do your shopping and errands if possible.
• Make sure you have all needed medications and medical equipment on hand.
• Contact your doctor if you experience any symptoms including long-lasting headache, fever, body aches, diarrhea, or others.

Where to Get Tested if You Have Symptoms

You can start with your local doctor for information about testing. However, some offices are only testing those over 60 years old. If this is the case, call your local health department (usually your city or county health department). Many of them are maintaining information on their websites and social media pages. You can also find information on symptoms and testing on this CDC page. If you display emergency signs of COVID-19, call your emergency department and seek medical attention immediately. These include (5):

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

Bottom Line

Some medical conditions, age, medications, and other factors increase the risk of contracting COVID-19 and experiencing severe symptoms. If you or a love one is high-risk, it’s imporant to be extra-diligent with precautions, have all medications and equipment available, and to have a plan in place for testing and contacting medical help if you become concerned. There’s no need to panic, but being informed and creating a plan is definitely worth your while.

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