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Infectious Diseases

24 July 2020

The US has expanded the list of people most at risk of severe Covid-19

People with type 2 diabetes and sickle cell disease, among others, have been included in an updated list for being at high risk of severe Covid-19.

  • The CDC has expanded its list of people at higher risk of severe Covid-19
  • Some of the conditions include type 2 diabetes, SCD, and pregnancy
  • These additions are based on consistent, although various levels of evidence

The number of Covid-19 cases continues to grow worldwide. As of 20 July, we surpassed 14.5 million cases worldwide. Although everyone is at risk for getting Covid-19 (the disease caused by the new coronavirus) when exposed to the virus, some people have a higher risk than others of becoming severely ill.

On 14 July, the Centers for Disease Control and Prevention (CDC) updated and expanded its list of underlying conditions that may cause more severe outcomes if infected with Covid-19, with the newest additions being the following: type 2 diabetes, chronic kidney disease, COPD (chronic obstructive pulmonary disease), whole organ transplants, obesity, sickle cell disease, and pregnant women. 

Why the update?

According to the agency, the list was updated after CDC experts reviewed published reports, pre-print studies and several other data sources. They then determined whether there was clear, mixed or limited evidence that the underlying medical condition increased a person’s risk for severe illness, irrespective of age.

The list therefore now includes the following conditions that put people at an increased risk of severe illness from Covid-19: 

  • 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

Apart from this, the agency also states that, based on the available limited data and information, people with the following conditions, among others, might be at an increased risk for severe illness from Covid-19:

  • Asthma (moderate-to-severe)
  • Hypertension (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
  • Pregnancy
  • Smoking
  • Type 1 diabetes mellitus

The conditions are listed by the level of scientific evidence currently available and include "strongest and most consistent evidence", "mixed evidence", and "limited evidence".

Age also removed

Previously, people over the age of 65 were included in the guideline as being at risk for severe outcomes. However, the agency has since removed this age threshold, noting that as people age, their risk of severe outcomes also increases.

“Recent data, including an MMWR (Morbidity and Mortality Weekly Report), published last week, has shown that the older people are, the higher their risk of severe illness from Covid-19.

“Age is an independent risk factor for severe illness, but risk in older adults is also in part related to the increased likelihood that older adults also have underlying medical conditions,” their website reads.

A deeper look at some of the additions

Pregnancy

Based on current evidence, pregnant women might be at an increased risk for severe illness from Covid-19 compared to non-pregnant women, says the CDC, adding that there may be an increased risk of adverse pregnancy outcomes, such as preterm birth.

Although pregnancy is listed under "mixed evidence" (based on multiple studies that reached different conclusions about the risk associated with a particular condition), CDC experts have advised that women continue their prenatal care appointments, make sure they have at least a 30-day supply of their medicines, and contact their healthcare provider or nearest community health centre about staying healthy during the pandemic, among others.

Type 2 diabetes

Type 2 diabetes was last week included under "strongest and most consistent evidence" on the list, which means that multiple small studies or a strong association from a large study serve as consistent evidence for the condition putting people at risk for severe outcomes.

A recently published French study, reported on by Health24, found that one in 10 older patients with diabetes died within the first week of hospitalisation for Covid-19, and that 20% needed a ventilator to breathe by that point.

If you’re diabetic, take the following precautions to keep healthy and safe: continue taking your diabetes medication and insulin; regularly test your blood sugar; ensure that you have at least a full month’s supply of your medication; and contact your healthcare provider or nearest community health centre if you feel sick.

Sickle cell anaemia 

Sickle cell anaemia (also referred to as sickle cell disease) is a genetic blood disorder that affects red blood cells. Studies from as early as April found a link between this disease and Covid-19. Red blood cells affected by SCD are unable to supply enough oxygen vital to sustain the entire body. 

The lack of oxygen therefore puts your immune system under pressure, which means you are more likely to catch Covid-19 and experience severe outcomes.

The condition has also been included under "strongest and most consistent evidence" on the CDC’s evidence list, and they are therefore encouraging people with SCD to take the following actions to remain protected: ask your healthcare provider or nearest community healthcare centre about telemedicine or remote healthcare visits; know when to go to the emergency department; work with your healthcare provider to manage medicines and therapies for your disorder and any other health condition you may have (such as diabetes or high blood pressure); and let friends and family know about the need for healthy blood donors.