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How Every State's Population Ranks for Risk of Severe COVID-19 Cases

West Virginia has biggest share of at-risk adults based on age and health; Utah has smallest

A masked woman in quarantine looks out the window of her home.

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En español | A few states that have announced plans to relax restrictions put in place to slow the spread of the coronavirus are among the 15 states with the largest share of adults at risk for severe illness from a coronavirus infection, according to data compiled by the Kaiser Family Foundation (KFF).

Over 41 percent of adults 18 and older in South Carolina and Tennessee — two states that have started the gradual process of returning to life as it once was — face an increased risk of hospitalization, even death, from COVID-19, the illness caused by the new coronavirus, due to age (65 and older) or an underlying health condition. In Florida, where some beaches have reopened to the public, the share of adults at risk for serious complications is just more than 42 percent. The national average is 37.6 percent.

Share of Adults 18 and Older At Higher Risk of Serious Illness If Infected With Coronavirus


"It's a major challenge to figure how to ‘reopen’ and when, but the stakes are high, particularly for people at higher risk of severe disease,” explains Robert H. Shmerling, a rheumatologist at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School in Boston. And easing up on stay-at-home orders and physical distancing guidelines too soon in areas with large high-risk populations could lead to an uptick in infection rates among those who are less able to fight off the disease.

COVID-19 could be bad news for more than 90 million adults

The majority of people who become sick with COVID-19 experience mild symptoms of fever, cough and shortness of breath, and are able to recover at home. Sometimes, however, these symptoms worsen and can become life-threatening. And public health experts say older adults and people with chronic health conditions are more likely to experience severe symptoms from the illness if infected.


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In the U.S., that adds up to 92.6 million people, or more than one-third of the adult population, who are 65 and older or who have a heart disease, diabetes, lung disease, chronic obstructive pulmonary disease (COPD), asthma or obesity.

There isn't one single reason why these health conditions can lead to more severe illness from COVID-19, Shmerling says, but rather a few likely explanations. Older adults, for example, tend to have less physiologic reserve, or the ability to “bounce back from damage caused by a disease the way it used to,” he explains. Eight out of 10 deaths from COVID-19 in the U.S. have been in adults 65 and older, the Centers for Disease Control and Prevention (CDC) reports.

Then there's the increased demand on the body's organs during the illness. The heart, for example, has to work harder when a person has a fever or is dehydrated, Shmerling notes. This can be especially taxing for someone who has pre-existing organ damage.

10 State Populations Most at Risk for Severe COVID-19

  • West Virginia, 49.3 percent
  • Kentucky, 43.6 percent
  • Arkansas, 43.5 percent
  • Alabama, 43.1 percent
  • Maine, 42.5 percent
  • Mississippi, 42.5 percent
  • Florida, 42.1 percent
  • Louisiana, 42.1 percent
  • Tennessee, 41.6 percent
  • South Carolina, 41.4 percent

Percentage of residents 65 and older, or with underlying conditions.

West Virginia has the highest share of adults at increased risk from COVID-19 complications; 49.3 percent of the state's population is more likely to get seriously ill if infected. Kentucky is second with 43.6 percent of its adult population at high risk for severe illness. Utah has the smallest share of high-risk adults at 30 percent.

The count of 92.6 million high-risk adults doesn't include people living in nursing homes, KFF Senior Vice President Tricia Neuman points out. This population is also more vulnerable to worse outcomes from a coronavirus infection, according to the CDC. About 1.3 million Americans live in nursing homes; an additional 800,000 live in residential care communities, according to CDC data.

"So in some ways [the data presented in the KFF report] understates the population at risk, because we know that COVID-19 is moving like a wildfire through nursing home facilities. And once one person gets infected, it's hard for others not to get infected,” Neuman says. An added concern, she says, is that “many of these nursing homes and assisted living facilities still don't have sufficient capacity to do testing or have PPE [personal protective equipment] on-site or even know best practices when it comes to where to move patients and how to move patients when they get sick, or to protect the staff and to protect the other residents.”

It's important to note that people with compromised immune systems, including people undergoing treatment for cancer, also face an increased risk for severe illness from COVID-19.

Advice for people at high risk

Experts stress that it's critical for everyone to wash their hands often, stay home as much as possible and keep at least 6 feet of distance between themselves and others. But for people at high risk for serious illness, “it's also important to take care of the medical conditions you have,” Shmerling says.

If you have diabetes, “now is the time to be even better about not skipping doses of medication and not going off your diet,” Shmerling suggests. Also: Stay in touch with your doctor by phone or video chat, and make sure you have “an ample supply of your medications.” Finally, don't forget to let friends and family know if you're feeling sick or need food or other supplies, he adds.

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