COVID-19: Who’s at higher risk of serious symptoms?

Coronavirus disease 2019 (COVID-19) symptoms can vary widely. Some people have no symptoms at all, while others become so sick that they need to stay in the hospital and may eventually need a ventilator to breathe.

The risk of developing dangerous symptoms of COVID-19 may be increased in people who are older and also in people of any age who have other serious health problems — such as heart or lung conditions, weakened immune systems, obesity, or diabetes. This is similar to what is seen with other respiratory illnesses, such as influenza.

While each of these factors can increase the risk of severe COVID-19 symptoms, people who have several of these other health problems are at even higher risk.

Older age

People of any age, even children, can catch COVID-19. But it most commonly affects middle-aged and older adults. The risk of developing dangerous symptoms increases with age, with those who are age 85 and older at the highest risk of serious symptoms. In the U.S., about 81% of deaths from the disease have been in people age 65 and older. Risks are even higher for older people when they have other health conditions.

Take all your medications as prescribed. Consider developing a care plan that includes information about your medical conditions, medications, doctors’ names and emergency contacts.

Nursing home residents are at high risk because they often have multiple health problems, combined with advanced age. And germs can spread very easily between people who live in close proximity to each other. If you live in a nursing home, follow the guidelines to prevent infection. Ask about protection measures for residents and visitor restrictions. Let staff know if you feel ill.

Older people are also more likely to have Alzheimer’s disease, which can make it more difficult for them to remember the precautions recommended to prevent infection.

Lung problems, including asthma

COVID-19 targets the lungs, so you’re more likely to develop severe symptoms if you already have lung problems, such as:

• Chronic obstructive pulmonary disease (COPD)
• Lung cancer
• Cystic fibrosis
• Pulmonary fibrosis
• Moderate to severe asthma

While some medications for these conditions can weaken your immune system, it’s important to stay on your maintenance medications to keep symptoms as controlled as possible. You may want to talk to your doctor about obtaining an emergency supply of prescription medications, such as asthma inhalers.

It may also help to avoid the things that make your asthma worse. These asthma triggers can vary from person to person. Examples include pollen, dust mites, tobacco smoke and cold air. Strong emotions and stress can trigger asthma attacks in some people. Others are bothered by strong odors, so make sure the disinfectant you’re using isn’t an asthma trigger for you.

In addition to being an asthma trigger, smoking or vaping can harm your lungs and inhibit your immune system, which increases the risk of serious complications with COVID-19.

Heart disease

Many types of heart disease can make you more likely to develop severe COVID-19 symptoms. These include:

• Cardiomyopathy
• Pulmonary hypertension
• Congenital heart disease
• Heart failure
• Coronary artery disease

Continue to take your medications exactly as prescribed. If you have high blood pressure, your risk may be higher if you don’t control your blood pressure and take your medications as directed.

Brain and nervous system conditions

Some conditions that affect the brain or nervous system can increase your risk of developing severe COVID-19 symptoms.

These include:

Diabetes and obesity

Type 1 or type 2 diabetes can increase your risk of serious COVID-19 symptoms. Having a higher body mass index that’s considered overweight, obese or severely obese also increases this risk.

Diabetes and obesity both reduce the efficiency of a person’s immune system. Diabetes increases the risk of infections in general. This risk can be reduced by keeping blood sugar levels controlled and continuing your diabetes medications and insulin. If you are overweight or obese, aim to lose weight by eating a healthy diet and getting regular physical activity.

Cancer and certain blood disorders

People who currently have cancer are at higher risk of developing more severe illness from COVID-19. This risk can vary, depending on the type of cancer and the kind of treatment you’re receiving.

Sickle cell anemia is another condition that increases the risk of severe COVID-19 symptoms. This inherited disorder causes your red blood cells to become hard, sticky and shaped like the letter “C.” These deformed red blood cells die early, so oxygen can’t be transported around your body as well. It also causes painful blockages in small blood vessels.

Another inherited blood disorder, called thalassemia, might also make you more likely to have serious COVID-19 symptoms. In thalassemia, the body doesn’t produce enough hemoglobin and this affects how well the red blood cells can carry oxygen.

Weakened immune system

A healthy immune system fights the germs that cause disease. But many conditions and treatments can weaken your immune system, including:

• Organ transplants
• Cancer treatments
• Bone marrow transplant
• HIV/AIDS
• Long-term use of prednisone or similar drugs that weaken your immune system

If you have a weakened immune system, you may need to take extra precautions to avoid the virus that causes COVID-19. Routine doctor appointments may be delayed or happen via phone or video conference. You may want to have your medications mailed to you, so you don’t have to go to the pharmacy.

Chronic kidney or liver disease

Chronic kidney or liver disease can weaken your immune system, which may increase your risk of being seriously ill with COVID-19. Also, having serious COVID-19 symptoms and taking medications to treat the disease may have negative effects on the liver.

If you’re on dialysis for chronic kidney disease, go to every dialysis appointment. Let your doctor know if you feel ill.

Mental health conditions

People with mental health conditions such as depression and schizophrenia spectrum disorders can be more likely to develop serious COVID-19 symptoms.

Down syndrome

People with Down syndrome are more likely to develop lung infections in general, so they are particularly vulnerable to COVID-19. They also are at higher risk of already having many of the health problems that have been linked to developing severe COVID-19 symptoms — including heart disease, sleep apnea, obesity and diabetes.

Many adults with Down syndrome live in nursing homes, where it can be harder to avoid exposure to germs from other residents and staff. Down syndrome also often affects intellectual abilities, so it may be more difficult for this population to follow prevention measures.

Protect yourself; prevent unnecessary risk

The U.S. Food and Drug Administration (FDA) has given emergency use authorization to some COVID-19 vaccines in the U.S. The FDA has also approved the Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, to prevent COVID-19 in people age 16 and older.

A vaccine can prevent you from getting the COVID-19 virus or prevent you from becoming seriously ill if you get the COVID-19 virus. Also, if you’ve been fully vaccinated, you can start doing many things you may not have been able to do because of the pandemic — including not wearing a mask or social distancing — except where required by a rule or law. However, if you are in an area with a high number of new COVID-19 cases in the last week, the CDC recommends wearing a mask indoors in public and outdoors in crowded areas or when you are in close contact with unvaccinated people. If you are fully vaccinated and have a condition or are taking medications that weaken your immune system, you may need to keep wearing a mask.

An additional dose of a COVID-19 vaccine is recommended for people who are fully vaccinated and might not have had a strong enough immune response. In contrast, a booster dose is recommended for people whose immune response weakened over time. This includes many people with health conditions that cause them to have a higher risk of serious illness.

If you haven’t had the COVID-19 vaccine, you can take many steps to reduce your risk of infection. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) recommend following these precautions for avoiding COVID-19:

• Avoid large events and mass gatherings.
• Avoid close contact (within 6 feet, or about 2 meters) with others. Avoid anyone who is sick.
• Stay home when possible and keep distance between yourself and others if COVID-19 is spreading in your community, especially if you have a higher risk of serious illness.
• Wash your hands often with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Wear a face mask in indoor public spaces and outdoors where there is a high risk of COVID-19 transmission, such as at a crowded event or large gathering. Further mask guidance differs depending on whether you are fully vaccinated or unvaccinated. Surgical masks may be used if available. N95 respirators should be reserved for health care providers.
• Cover your mouth and nose with your elbow or a tissue when you cough or sneeze. Throw away the used tissue. Wash your hands right away.
• Avoid touching your eyes, nose and mouth.
• Avoid sharing dishes, glasses, towels, bedding and other household items if you’re sick.
• Clean and disinfect high-touch surfaces, such as doorknobs, light switches, electronics and counters, daily.
• Stay home from work, school and public areas if you’re sick, unless you’re going to get medical care. Avoid taking public transportation, taxis and ride-sharing if you’re sick.

In addition to these everyday precautions, if you are at higher risk of infection or of developing serious COVID-19 symptoms, you might also want to:

• Make sure you have at least a 30-day supply of your regular prescription and over-the-counter medications.
• Check to see if your vaccinations are up to date, particularly for influenza and pneumonia. These vaccines won’t prevent COVID-19, but becoming ill with influenza or pneumonia may worsen your outcome if you also catch COVID-19.
• Establish an alternate way of communicating with your doctor if you have to stay at home for a few weeks. Some doctors are doing appointments via phone or video conference.
• If possible, arrange for social visits to be held outside with friends and family, while keeping 6 feet (2 meters) apart. Keep the group small to reduce the risk of the COVID-19 virus spreading. The virus is more likely to spread in larger groups, especially when people are close together and for a longer period of time.
• Arrange for delivery orders of restaurant meals, groceries or medications so you don’t have to leave your home.
• Call your doctor if you have questions about your medical conditions and COVID-19 or if you’re ill. If you need emergency care, call your local emergency number or go to your local emergency department.
• Call your doctor if you have questions about non-critical medical appointments. He or she will advise you whether a virtual visit, in-person visit, delaying the appointment or other options are appropriate.