A: The CDC recently updated its list to include older adults as well as people of any age with underlying medical conditions (chronic kidney disease, chronic obstructive pulmonary disease, immunocompromised from organ transplant, obesity, serious heart conditions, sickle cell disease, and type II diabetes).
This is consistent with data from early 2020 and has been updated in light of emerging data.
*Of note, while obesity is listed as a risk factor, it is important to consider that there are many factors (and comorbidities like hypertension) that worsen COVID-19 severity (rather than obesity alone). Most studies are based on correlations and do not indicate that obesity causes worse disease outcomes. Furthermore, in addition to comorbidities, factors such as stigma and delay in care seeking may also play a role in outcomes.
It is also important to be familiar with a few recent articles/studies highlighting particular risk groups.
Pregnant Women:
A recent study suggests that pregnant women with COVID-19 are more likely to be hospitalized and more likely to be intubated (for respiratory distress) than nonpregnant women. Data from the UK suggest higher risk of infection for Black and ethnic minority communities. The UK study also highlights that women in the third trimester are more likely to experience critical illness. Such data are not yet available in the U.S., but will inform future recommendations. Pro Publica Link The bottom line (while we wait for the data): Follow full precautions (good hand hygiene, masking, physical distancing, good cleaning practices, no gatherings, and monitoring for emergence of symptoms). If trying to conceive or if pregnant, avoid high risk situations, particularly in the third trimester. This may prove challenging, particularly for individuals who may not be able to work from home.
Children:
Recent news about multisystem inflammatory syndrome has raised concern about the risk profile of children, however, the data still suggest that risk of infection with COVID-19 is lower among children. Children can, and do, get COVID-19. However, the least affected seem to be those under 10 years of age with rates increasing between 10-20 years of age. Still, overall, children are not considered a high risk group. That does not mean that they cannot infect the adults with whom they live. And therefore, common infection prevention guidance for COVID-19 (masking when appropriate, physical distancing, and good hand hygiene) is recommended.
Individuals with Autoimmune Diseases:
Experts previously suggested that because many individuals with autoimmune disease have suppressed immune systems, they may be more likely to contract COVID-19. Yet, some recent studies, such as this one from Italy, suggest that persons with autoimmune diseases may not be at increased risk of contracting COVID-19. However, a systematic review suggests that autoimmune disease may be associated with an increased risk of severity of disease and mortality (although results were not statistically significant). The bottom line (because it is as clear as mud): People with autoimmune diseases are at higher risk for a number of infections. So, please continue to follow full precautions (take prescribed medications) and consider that this is a high risk group.
Individuals with Asthma:
Recent research suggests that individuals with asthma do not have higher risk of hospitalization for COVID-19 than individuals without asthma. However, the study did find that individuals with non-allergic asthma were more likely to have severe disease course of COVID-19 compared to individuals with allergic asthma. The bottom line: More data is needed. Continue to follow full precautions and continue current medication regimens (including corticosteroids if prescribed). Still consider that this is a high risk group.
Ethnic and racial minorities:
While data suggest that ethnic and racial minority groups are at higher risk of severe illness and death. This is likely due in part to comorbidities, risk factors, and/or structural barriers among other factors, which contribute to worse outcomes. Further data (specifically disaggregated data) is needed to determine location specific risks and context. The bottom line: Ethnic and racial minority groups are at higher risk of disease severity and death, in the US and globally. It is important to acknowledge this risk.
We will continue to monitor risk as it relates to specific groups. When making decisions, it is important to contextualize each person’s specific risks within the risks of your locality and your close contacts.
Stay safe. Stay sane. And stay SMART.
~Aparna
