Blog Post

Insight: Who’s At Risk for COVID-19?

By: Laura Summers

Note: The opinions expressed are those of the author alone and do not reflect an institutional position of the Gardner Institute. We hope the opinions shared contribute to the marketplace of ideas and help people as they formulate their own INFORMED DECISIONS™.

Aug 28, 2020 – Our world has been struggling with COVID-19 for about six months now. And while it feels like forever, there is still a lot we don’t know about the disease. For example, how much of the virus do you need to come into contact with to get infected? Will there be long-term health effects for those who are asymptomatic? How long do antibodies last? When will this all end?

There are a few things that are clear, however; one of them being that individuals with pre-existing chronic conditions are more susceptible to experiencing symptoms and severe complications from the disease. The Centers for Disease Control and Prevention (CDC) notes that people with the following conditions, of any age, are at increased risk of severe illness from COVID-19.[i]

  • Cancer
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Obesity (body mass index [BMI] of 30 or higher)
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes mellitus

In addition, people with the following conditions might be at an increased risk for severe illness:

  • Asthma (moderate to severe)
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Pregnancy
  • Pulmonary fibrosis (having damaged or scarred lung tissues)
  • Smoking
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

And while Utah is known as a healthy state—we typically rank high on healthy indicators compared with other states―it is important to acknowledge that many individuals in Utah have the pre-existing chronic conditions that place them at risk for more severe complications from COVID-19.

For example, data collected by the state show that 22.4% of individuals who have contracted COVID-19 in Utah have a known pre-existing condition. The top three most common conditions are chronic pulmonary conditions (uncontrolled asthma or chronic obstructive pulmonary disease, COPD), being a former smoker, and diabetes.

The top three pre-existing conditions among individuals hospitalized for COVID-19 are diabetes, cardiovascular disease, and chronic pulmonary conditions. For more information see: https://coronavirus-dashboard.utah.gov/#risk-factors.

Comparing these data with the prevalence of pre-existing conditions among Utah’s adult population shows that the percent of COVID-19 cases with pre-existing conditions is lower than the prevalence in the adult population; however, the rate among those hospitalized is higher (see Figure 1). This helps confirm what many already know, that individuals with pre-existing conditions are not at higher risk for contracting COVID-19, but they are more likely to become severely ill if they contract COVID-19―even in our healthy state.

Figure 1: Percent of Pre-Existing Conditions among Utah’s COVID-19 Cases, Hospitalizations, and Adult Population

Note: COVID-19 data were pulled August 24, 2020. Population-level data are from 2018 and age-adjusted.

Source: Utah Department of Health Coronavirus Dashboard; Utah Behavioral Risk Factor Surveillance System, Utah Department of Health; Alzheimer’s Association

 

While interesting, this quick comparison has its flaws. For example, COVID-19 case counts and hospitalizations include individuals younger than age 18. Public data on the prevalence of pre-existing conditions among Utah’s adult population were not available for all pre-existing conditions, and the datasets used to compare COVID-19 conditions to conditions among Utah’s adult population use different definitions to measure the various pre-existing conditions. Finally, the percent of pre-existing conditions among reported COVID-19 cases may not be representative of all COVID-19 cases, given limited testing at the beginning of the outbreak. While testing has improved, it is likely that many individuals who are asymptomatic or who have mild symptoms are not being tested, which may skew the pre-existing condition case count upward.

That said, it is notable to see how much more prevalent pre-existing conditions are in individuals hospitalized for COVID-19. This in turn underscores the need for continued chronic disease prevention and management, as those with chronic conditions are especially vulnerable to severe illness from the virus.

Laura Summers is the senior health care analyst at the Kem C. Gardner Policy Institute.

[i] Coronavirus Disease 2019 (COVID-19). (2020 April 17). Groups at Higher Risk for Severe Illness. Centers for Disease Control and Prevention. Available from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html#diabetes.