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. But others become so sick that they need to stay in the hospital and may eventually need a machine to breathe.

The risk of developing dangerous symptoms of COVID-19 may be increased in people who are older. The risk may also be increased 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 the flu (influenza).

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

Older age

People of any age 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 are 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, providers' 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 near 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. Alzheimer's 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 various chronic lung problems, including:

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

Some medications for these conditions can weaken your immune system. However, it's important to stay on your maintenance medications to keep symptoms as controlled as possible. You may want to talk to your health care provider about getting 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.

Besides 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
• 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:

• Stroke
• Dementia

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 how well a person's immune system works. 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 may 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 are also 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. The FDA has given emergency use authorization to Pfizer-BioNTech COVID-19 vaccines for age 6 months through age 15. The FDA has approved the Moderna vaccine, now called Spikevax, to prevent COVID-19 in people age 18 and older. The FDA has given emergency use authorization to Moderna COVID-19 vaccine for children ages 6 months through age 17. The FDA has given emergency use authorization to the Janssen/Johnson & Johnson vaccine to certain people age 18 and older. The FDA has also authorized the Novavax COVID-19, adjuvanted vaccine for people age 12 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. After you are vaccinated, you can more safely return to many activities that you might not have been able to do because of the pandemic. However, if you are in an area with a high number of people with COVID-19 in the hospital and new COVID-19 cases, the CDC recommends wearing a mask indoors in public, whether or not you're vaccinated. The CDC recommends wearing the most protective mask possible that you'll wear regularly, fits well and is comfortable.

If you have a weakened immune system or have a higher risk of serious illness, wear a mask that provides you with the most protection possible when you're in an area with a high number of people with COVID-19 in the hospital and new COVID-19 cases. Check with your healthcare provider to see if you should wear a mask when you're in an area with a lower number of new COVID-19 cases and people with COVID-19 in the hospital.

An additional dose of a COVID-19 vaccine is recommended for people who are vaccinated and might not have had a strong enough immune response.

In contrast, a booster dose is recommended for people who are vaccinated and whose immune response weakened over time. This includes many people with health conditions that cause them to have a higher risk of serious illness.

People who have a moderately or severely weakened immune system should get an additional primary shot and a booster shot.

There are many steps you can take to reduce your risk of infection from the COVID-19 virus and reduce the risk of spreading it to others. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) recommend following these precautions for avoiding COVID-19:

• Get vaccinated. COVID-19 vaccines reduce the risk of getting and spreading COVID-19.
• Avoid close contact with others. Avoid anyone who is sick.
• Keep distance between yourself and others if COVID-19 when you're in indoor public spaces if you're not fully vaccinated. This is especially important 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 if you're in an area with a high number of people with COVID-19 in the hospital and new COVID-19 cases, whether or not you're vaccinated.
• 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, regularly.
• 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 the flu and pneumonia. These vaccines won't prevent COVID-19. But becoming ill with the flu or pneumonia may worsen your outcome if you also catch COVID-19.
• Plan an alternate way of communicating with your health care provider in case you need to stay at home for a period of time. Some health care providers are doing appointments via phone or video conference.
• Arrange for delivery or curbside orders of restaurant meals, groceries or medications so you can avoid crowds.
• Call your health care provider 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 health care provider if you have questions about non-critical medical appointments. You'll be advised whether a virtual visit, in-person visit, delaying the appointment or other options are appropriate.