The Centers for Disease Control and Prevention (CDC) has updated and expanded the list of who is at increased risk for getting severely ill from COVID-19. The agency is warning that people with type 2 diabetes, kidney disease, whole organ transplants, and women who are pregnant could experience more severe outcomes if they contract COVID-19. The updated guidelines also remove 65 as the age when more severe outcomes may occur. Instead, it is suggesting as people age, the chance of severe outcomes increases. Here’s a look at some of the underlying conditions added to the CDC list:
“Pregnancy is a situation with all kinds of hormonal changes in the mix,” said Dr. Alan Fishman, medical director for Obstetrix Medical Group in San Jose, California, and board certified in obstetrics and gynecology and maternal-fetal medicine. “Pregnancy is a stress on a healthy woman’s body.” That’s why, he said, a pregnant woman who contracts COVID-19 may face more severe outcomes. “It appears that pregnant women [who contract COVID-19] are 5.5 times more likely to be hospitalized than a non-pregnant woman,” Fishman told Healthline. “That’s pretty significant.”
“There is zero evidence that women who are pregnant are more likely to get COVID-19,” he added. But the risks mean his office is carefully counseling those considering pregnancy. “I counsel them to think about this information and how it sits with them,” he said. “They have to remember that it is not a good idea to skip a medical appointment or space them out more.” While some pregnancy appointments can be done virtually, many must be done in person.
“Common sense still holds,” Fishman said. Wear a mask, wash your hands, keep a physical distance, and isolate when needed is still the key, along with not missing any medical appointments. “Clearly these types of modifications are going to be with us for a long time,” he said.
There’s been some confusion around COVID-19 in the diabetes community. First, there’s no evidence yet that people with diabetes are more likely to contract the novel coronavirus. “The CDC has not come out and said that type 1 or type 2 diabetes makes you more susceptible [to COVID-19],” said Dr. Joshua Miller, the medical director of diabetes care for Stony Brook Medicine and an assistant professor of endocrinology and metabolism at the facility’s New York Campus, told Healthline. However, there is research that concludes people with diabetes can develop more serious cases of COVID-19. “What we are absolutely seeing are that people who carry a comorbidity struggle more when they contract this,” Miller told Healthline. Figuring out what is going on with those with diabetes who contract COVID-19 is a challenge for healthcare providers. “It’s challenging looking at the numbers and statistics because the way in which we [track diabetes] in the medical world is a challenge,” Miller said. Even in medical reports, he said, type 1 can be mixed up with type 2. Miller is working with the National Institutes of Health (NIH) to gather and assess data around COVID-19 patients with diabetes. But he points out that mixed information makes it harder to rely on the data. Right now, the CDC has listed people with type 2 diabetes as being “at increased risk” of more severe outcomes if they contract COVID-19, and people with type 1 diabetes as “might be at an increased risk.” Miller, who has had type 1 diabetes for 21 years, knows one thing for sure. “When [a person with diabetes] is in the hospital for this, their insulin needs go way up,” he said. Even those with type 2 diabetes who take medication may need injected insulin during treatment, he added.
“The big lesson we are learning here is simply this,” he said. “The healthier our patients are, the better they do with COVID-19. Focus in earnest more than ever on your health. Across the board, the best outcomes come from this.” “While the area you live in has confirmed community spread, your risk is higher than not,” he added. “Stay at home if you can. And always, wear the mask, wash your hands, keep that distance. Be smart, be safe.”
The aging population
The CDC has moved away from a specific age cutoff for heightened concern to a more general statement on aging. The CDC now says, “People in their 50s are at higher risk for severe illness than people in their 40s. Similarly, people in their 60s or 70s are, in general, are at higher risk for severe illness than people in their 50s. The greatest risk for severe illness from COVID-19 is among those aged 85 or older. That, say aging experts, is an important change. “I have to give credit to the CDC for really clarifying that,” Dr. Ronald Caplan, author of “The Care of the Older Person” and “Long Life Strategy,” told Healthline. “Prior to this we were saying 65 and beyond, like the Cinderella phenomenon. At midnight (in this case 65 years of age) your coach just turns into a pumpkin? This is not the way medicine and real life works.” Caplan says that when you consider that 60 percent of Americans have some kind of underlying health condition, that 40 percent of adults are obese, and that many aging Americans have heart health issues, it just makes sense that as a person ages, a COVID-19 battle gets more challenging.
“Older people should not neglect seeing their healthcare providers, now more than ever,” Caplan said. “And get your vaccinations [for] flu and whatever else you need.” The older population should also be careful about self-isolating when there is community spread, but they should do so with support. “Suicide among older people is a non-talked about thing, but it is a thing,” Caplan said. “You lose a spouse, a friend or friends and all of a sudden you are alone, and then this virus comes along. It can be overwhelming.” He suggests for those who must isolate making a small trusted bubble of friends or family who visit and check on you. He also repeats the suggestions to wear masks, maintain distancing, and wash hands. “All those common sense measures that the CDC is giving us all go back to when I was a kid, before vaccinations,” Caplan said. “This is what we did. And now, the answer is we need an effective vaccination. We’re going to have to wait for that, though, and do the right thing in the meantime.”