COVID-19: Who's at higher risk of serious symptoms?
Underlying health conditions, such as heart or lung disease, can increase your risk of developing dangerous symptoms if you become infected with coronavirus disease 2019 (COVID-19).By Mayo Clinic Staff
Coronavirus disease 2019 (COVID-19) symptoms can vary widely. Some people have no symptoms at all, while others become so sick that they eventually need mechanical assistance 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, severe obesity, or diabetes. This is similar to what is seen with other respiratory illnesses, such as influenza.
While each of these serious health problem increases the risk of severe COVID-19 symptoms, people who have several of these underlying health problems are at even higher risk.
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 80% of deaths from the disease have been in people age 65 and older. Risks are even higher for older people when they have underlying 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 underlying 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.
COVID-19 targets the lungs, so you're more likely to develop severe symptoms if you have preexisting lung problems. Your risk of serious symptoms is higher if you have these conditions:
- Chronic obstructive pulmonary disease (COPD)
- Lung cancer
Some lung conditions may increase your risk of serious illness from COVID-19, including:
- 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, diabetes and obesity
People with several chronic conditions are more likely to experience dangerous symptoms if infected with COVID-19. These include type 2 diabetes, severe obesity and serious heart diseases. High blood pressure and type 1 diabetes may increase your risk of serious COVID-19 symptoms.
Obesity and diabetes both reduce the efficiency of a person's immune system. Diabetes increases the risk of infections in general. The risk of infections, including COVID-19, can be reduced by keeping blood sugar levels controlled and continuing your diabetes medications and insulin.
Your risk of serious illness is higher if you have heart diseases such as cardiomyopathy, pulmonary hypertension, congenital heart disease, heart failure or 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. Keep your high blood pressure controlled and take your medications as directed.
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 can weaken your immune system. Conditions that affect your immune system and increase your risk of serious illness from COVID-19 include:
- Organ transplants
- Cancer treatments
Your risk of serious symptoms from COVID-19 may be increased if you have conditions such as:
- Bone marrow transplant
- 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
If you have chronic kidney disease, you're at higher risk of becoming seriously ill with COVID-19. You may have a higher risk of being ill with serious COVID-19 symptoms if you have chronic liver disease.
If you're on dialysis for chronic kidney disease, go to every dialysis appointment. Let your doctor know if you feel ill. You may have a weakened immune system if you have chronic kidney disease and are having dialysis.
If you have chronic liver disease, your risk of being seriously ill with COVID-19 may be higher because you may have a weakened immune system. Also, having serious COVID-19 symptoms and taking medications to treat the disease may have negative effects on the liver.
Protect yourself; prevent unnecessary risk
The U.S. Food and Drug Administration (FDA) has given emergency use authorization for two COVID-19 vaccines, the Pfizer/BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine. A vaccine might prevent you from getting COVID-19 or prevent you from becoming seriously ill from COVID-19 if you get the COVID-19 virus.
You can take additional 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.
- Cover your face with a cloth face mask in public spaces, such as the grocery store, where it's difficult to avoid close contact with others, especially if you're in an area with ongoing community spread.
- 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:
Dec. 22, 2020
- 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.
See more In-depth
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- McIntosh K. Coronavirus disease 2019 (COVID-19). https://www.uptodate.com/contents/search. Accessed March 31, 2020.
- Lung Health & COVID-19. American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/covid-19/faq. Accessed April 3, 2020.
- What heart patients should know about coronavirus. American Heart Association. https://www.heart.org/en/news/2020/02/27/what-heart-patients-should-know-about-coronavirus. Accessed March 31, 2020.
- Muniyappa R, et al. COVID-19 pandemic, coronavirus, and diabetes mellitus. American Journal of Physiology, Endocrinology, Metabolism and Gastrointestinal Physiology. 2020; doi:10.1152/ajpendo.00124.2020.
- Gupta R, et al. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020; doi:10.1016/j.dsx.2020.03.002.
- Frydrych LM, et al. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. Journal of Leuckocyte Biology. 2018; doi:10.1002/jlb.5vmr0118-021rr.
- Coronavirus: What people with cancer should know. National Cancer Institute. https://www.cancer.gov/contact/emergency-preparedness/coronavirus. Accessed March 31, 2020.
- Q&A on coronaviruses (COVID-19). World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses. Accessed April 3, 2020.
- AskMayoExpert. COVID-19: Outpatient testing, management, and treatment; 2020.
- Robilotti EV, et al. Determinants of COVID-19 disease severity in patients with cancer. Nature Medicine. 2020; doi:10.1038/s41591-020-0979-0.
- Sickle cell disease (SCD). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/sicklecell/facts.html. Accessed Aug. 19, 2020.
- Panepinto JA, et al. Coronavirus disease among people with sickle cell disease, United States, March 20-May 21, 2020. Emerging Infectious Disease. 2020; doi: 10.3201/eid2610.202792.
- Thalassemia. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/thalassemia/facts.html. Accessed Aug. 19, 2020.
- COVID-19 associated hospitalization related to underlying medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-underlying-medical-conditions.html. Accessed Aug. 19, 2020.
- Vaccines and related biological products advisory committee meeting. U.S. Food and Drug Administration. https://www.fda.gov/media/144245/download. Accessed Dec. 9, 2020.
- Emergency use authorization. U.S. Food & Drug Administration. https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization#coviddrugs. Accessed Dec. 21, 2020.