Our city today surpassed 170 identified COVID-19 cases. Regretfully, 7 patients have died. We continue to see here, and around the country, that certain individuals have a higher risk of severe illness and death from COVID-19. Most of those who have been lost were over the age of 65 and/or had underlying conditions.
In this post, my goal is to help decipher what is meant by “underlying conditions” and why people that have them also have the highest risk for the worst COVID-19 outcomes. My second goal is to call attention to the other underlying conditions that are being overlooked.
Underlying conditions, simply put, refer to other diseases and disorders that are sort of operating in the background, before a person ever becomes infected with coronavirus. [FYI, you may also hear underlying health conditions referred to as co-morbid or co-occurring conditions]. People with underlying health conditions are of generally worse health and are, thus, at a distinct disadvantage when it comes to overcoming COVID-19. Starting behind the eight-ball, so to speak.
In addition to old age (which typically brings underlying health conditions along with it), research out of China and Italy has showed us that some underlying health conditions are independent risk factors (irrespective of age) for severe COVID-19-related outcomes including hospitalization, need for intensive care, and death. Just this week, the Centers for Disease Control released the first US data on the link between underlying conditions and severe COVID-19-associated outcomes.
The CDC looked at a long list of underlying health conditions including lung disease (asthma, COPD, and emphysema), diabetes, cardiovascular disease, kidney disease, liver disease, immuno-compromised conditions, and neurological and developmental disorders, among others. They even took it a step further to include some of the more general risk factors for severe respiratory infections – factors like smoking and even pregnancy (think gestational diabetes). Here are the main findings:
Key Study Findings
71% of hospitalizations and 78% of COVID-19 patients admitted to the ICU had one or more underlying health condition.
By comparison, just 27% of COVID-19 cases who were not hospitalized had an underlying health condition.
In general, cases with underlying health conditions were significantly more likely to be hospitalized and more likely to be admitted to an ICU than those without.
Among the 184 deaths included in this analysis, 94% of deaths were patients with underlying health conditions.
The most commonly reported underlying health conditions were diabetes (10.9%), chronic lung disease (9.2%), and cardiovascular disease (9.0%).
It is important to note that this information may not be telling the whole story. First, of the 122,000+ plus US cases identified at the time of this report, information on underlying health conditions was only available for 7,000 (or 5.8%) of them. These small numbers, and the fact that we are still early in the spread of COVID-19 in the US, limit our ability to generalize these findings to the US as a whole. Only the presence or absence of these conditions was known and not their severity or whether or not they were being treated, both of which may have an impact on COVID-19 outcomes.
Still, the research all seems to agree that people with underlying health conditions are at significantly increased risk of more severe COVID-19 outcomes. Of major concern to us is that so many Americans have health issues that are tied to these underlying conditions. Things like obesity, which is linked to diabetes and cardiovascular disease; and smoking, which is tied to lung disease. Even asthma, which impacts about 8% of Americans, could complicate respiratory infections. These too should also be considered risk factors for severe COVID-19 illness. And this is where we get to the other underlying conditions.
The other underlying conditions
All of the other health problems that we had before COVID-19 didn’t just disappear once COVID-19 showed up. People are still having heart attacks. Still getting cancer. Still struggling with mental health and substance abuse problems. Perhaps even more so than ever. In fact, all of these conditions are likely to be exacerbated by the current COVID-19 pandemic.
Limited access to healthy food options; limited physical activity; increased exposure to poor indoor air quality; psychological stress, anxiety, and depression from the general state of affairs, social isolation, or the loss of a loved one. All can lead to poorer health and all are happening right now. At the same time, we may think twice before leaving the house to see our doctors. Or worse, because of the strains on our healthcare system, there may not be a bed for a heart attack patient or a doctor to mend a broken bone at the hospital.
Health inequities are also being exacerbated with some of our most vulnerable and disadvantaged citizens being impacted the most by this pandemic – by the virus and its economic consequences. These are the underlying conditions of our health and of our society that have been operating in the background since long before we were ever exposed to COVID-19. Now, they may be spreading, even faster than the virus.
Study: Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep. ePub: 31 March 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e2external icon
UPDATE (4/2/20): NYC released a data summary of underlying conditions among COVID-19 deaths to date. Over 98% (994/1012) of all NYC deaths (with confirmed health history) had one or more underlying condition. About 75% (1012/1374) of NYC COVID-19 deaths have confirmed health history (25% still pending).
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