Who's Most at Risk from COVID-19?

By Angela Betsaida B. Laguipo, BSN

The coronavirus disease (COVID-19) has spread across the globe at a rapid speed, infecting hundreds of thousands of people. While older people remain most at risk of dying from severe disease caused by the novel coronavirus, they are far from the only ones susceptible.

Since the advent of the novel coronavirus, now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of cases has skyrocketed, particularly in China, Italy, the United States, Iran, and Spain, among others. Several studies have shown that older people, especially those more than 60 years old, and those with underlying health conditions, are vulnerable to the disease.

There is limited information regarding risk factors for severe disease. Still, based on currently available information, older adults and those with underlying medical conditions might be at higher risk for severe disease from COVID-19. What are all the risk factors of the novel coronavirus illness?

Novel Coronavirus SARS-CoV-2 Colorized scanning electron micrograph of an apoptotic cell (green) heavily infected with SARS-COV-2 virus particles (purple). Credit: NIAID

Older people

COVID-19 was first reported in Wuhan, Hubei Province in China and has subsequently spread to the rest of China. Now, the global pandemic has impacted 177 countries across the globe. Several studies have noted that among the patients in China during the first wave of the pandemic were older adults.

In one study conducted in China, the researchers found that compared to those aged 30 to 59 years old, those 60 and above are 5.1 times more likely to die after developing symptoms of COVID-19. The risk of symptomatic infection increased with age.

Another study, which explored the clinical characteristics linked to the development of acute respiratory distress syndrome (ARDS) and death among patients with COVID-19, has found that the risk of developing ARDS increases with age, likely due to a less vigorous immune response against the pathogen.

Cardiovascular disease

People with cardiovascular disease are at a higher risk of fatal consequences from COVID-19. A study by researchers at the University of Texas Health Science Center at Houston (UTHealth) reports that COVID-19 can affect the heart muscle in people without previous heart disease. Hence, those with heart disease may experience a higher risk of cardiac problems when they contract the virus.

The study further found that the disease is linked to a high inflammatory burden, including vascular inflammation, myocarditis, and cardiac arrhythmias. People with cardiovascular disease, such as heart disease and hypertension, may experience severe symptoms tied to COVID-19.

Experts

Health institutions, such as the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC), recommend that those with underlying medical conditions, such as heart disease, should take extra precautions. They should avoid crowds, self-isolate, and stay away from those who are sick.

The CDC recommends that seniors, especially those who over 65, should stay at home, avoid close contact with people, and call their doctor if they develop symptoms, taking note if they have any underlying health condition.

The CDC also warns that those who are living in nursing homes or long-term care facilities are at a heightened risk of contracting the novel coronavirus. This has prompted institutions to curb the spread of the infection by not allowing visitors to their patients from entering the facilities.

Underlying medical conditions

Aside from age and cardiovascular disease, people with underlying medical conditions are at a higher risk of dying from COVID-19. Based on an analysis by the Chinese Center for Disease Control and Prevention (CCDC) in February 2020, patients with cardiovascular disease had a 10.5 percent overall case fatality rate, compared to just 0.9 percent in people with no existing illness. Those who have diabetes mellitus had a 7 percent fatality rate. People with hypertension, cancer, or chronic respiratory disease had a 6 percent fatality rate each.

Further, patients who are immunocompromised may experience severe disease since their immune systems do not work efficiently in fighting infections. Included are those who are undergoing treatments for cancer and other health conditions that may alter the body’s immune response.

Many conditions may cause immunosuppression, including smoking, bone marrow or organ transplantation, cancer treatment, poorly controlled HIV or AIDS, immune deficiencies, and the prolonged use of immune weakening medicines such as corticosteroids.

Obesity

A report from the Intensive Care National Audit and Research Centre, seven in 10 patients admitted in intensive care units in the United Kingdom affected by the coronavirus, are obese or overweight.

Obesity may predispose people to infections since their immune systems are busy fighting the inflammation in cells, making them overworked. When a severe infection happens, like the COVID-19, they may have severe complications.

Other risk factors

In other studies, smoking is tied to increased risks. For instance, in Italy, there was a higher risk reported in males than in females, possibly due to higher comorbidities and smoking rates.

Further Reading

• All Coronavirus Disease COVID-19 Content
• The COVID-19 Pandemic: What have the experts learned?
• What Mutations of SARS-CoV-2 are Causing Concern?
• What Role has Social Media Played in COVID-19?
• Unlocking our clinical understanding of SARS-CoV-2 infection, Post-Acute COVID Syndrome (PACS), and systemic recovery

References:

• Wu, J.T., Leung, K., Bushman, M. et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat Med (2020). https://doi.org/10.1038/s41591-020-0822-7. https://www.nature.com/articles/s41591-020-0822-7
• U.S. Centers for Disease Control and Prevention (CDC). (2020). People Who Are At Higher Risk: Older Adults. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html
• Wu, C., Chen, X., Cai, Y. et al. (2020). Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Network. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184
• Madjud, M., Safavi-Naeini, P., Solomon, S. et al. (2020). Potential Effects of Coronaviruses on the Cardiovascular System. JAMA Network. https://jamanetwork.com/journals/jamacardiology/fullarticle/2763846
• Guan, W., Ni, .Z., Hu, Y., Liang, W. et al. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
• Intensive Care National Audit and Research Centre. (2020). ICNARC report on COVID-19 in critical care. https://www.icnarc.org/DataServices/Attachments/Download/a9875849-f16c-ea11-9124-00505601089b
• Tobacco and waterpipe use increases the risk of suffering from COVID-19  - http://www.emro.who.int/tfi/know-the-truth/tobacco-and-waterpipe-users-are-at-increased-risk-of-covid-19-infection.html