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As the coronavirus pandemic rounds the corner on its first year, doctors and researchers are getting a better handle on which patients are most likely to end up fighting for their lives after getting COVID-19 — and which ones are most likely to recover.
It's well-established that risk increases with age. The U.S. Centers for Disease Control and Prevention (CDC) also lists nearly two dozen health conditions that could put you at higher risk of becoming seriously ill or dying of COVID-19.
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But which conditions are the most dangerous?
AARP asked several physicians on the front lines which health conditions worry them most. Although their responses were varied, three answers came up again and again: diabetes, high blood pressure/underlying heart disease and obesity.
Their experience aligns with the results of one of the largest studies so far on COVID-19 mortality, published in the journal Clinical Infectious Diseases in late December. It analyzed data from nearly 67,000 hospitalized coronavirus patients and found the following health conditions are associated with a higher risk of death:
- Obesity
- Diabetes (with complications such as organ damage)
- High blood pressure (with complications such as heart damage or kidney disease)
All three are inflammatory diseases that are prevalent among American adults, and experts say they are closely linked.
Obesity is a risk factor for diabetes and high blood pressure, and diabetes can contribute to high blood pressure. Meanwhile, both diabetes and high blood pressure can trigger kidney disease and lung disease, two other conditions that make COVID-19 more risky, according to the CDC.
"It's hard from experience to pinpoint one or two diseases because, honestly, it's very rare that someone has just one thing,” said Brian Garibaldi, M.D., a critical care doctor at Johns Hopkins Hospital in Baltimore who developed a model for evaluating COVID-19 patients. “It's worse to have four or five chronic conditions than it is to have only one."
Other dangerous conditions mentioned by the physicians include dementia, chronic kidney disease and chronic obstructive pulmonary disease (COPD). Immunocompromised patients, those who smoke and those with organ transplants also raise concern.
For patients, knowing how much an underlying condition raises your risk can help you make more informed decisions about protecting your health and how comfortable you feel participating in activities that could expose you to the coronavirus — especially now that faster-spreading variants are circulating.
High-risk condition: Obesity
What the numbers say: Obese people diagnosed with COVID-19 are more than twice as likely to be hospitalized and about 50 percent more likely to die compared to patients who are a healthy weight, according to a meta-analysis published in Obesity Reviews. (Obesity is defined as those with a body mass index, or BMI, of 30 or above.)
While obesity is often linked to other health problems, doctors say they have been struck by how hard COVID-19 hits even those obese patients who have no other underlying conditions.
"I think the one [health condition] that has really stuck out is obesity,” said Jakob McSparron, M.D., a critical care doctor at Michigan Medicine in Ann Arbor, Mich. “In particular, it seems as though obesity among younger patients is a notable risk factor."
Why it's dangerous with COVID-19: Obesity can make it harder for a person's lungs to expand, impairing breathing and oxygenation. In addition, extra fat, especially around the belly, is linked to chronic inflammation that can weaken the immune response. Obesity is also believed to increase your risk of blood clots.
What you can do: Because your risk of complications from COVID-19 is directly correlated to your BMI, if you're among the 42 percent of Americans who are obese, even a small amount of weight loss can make a difference, said cardiologist Dariush Mozaffarian, M.D., dean of Tufts Friedman School of Nutrition Science and Policy.
"It takes weeks, not years,” he said. “It's very well documented that even losing five pounds makes a difference in your metabolic health. With a few small lifestyle changes — eat a little healthier, exercise a little more, get more sleep — you could very plausibly lower your risk of severe illness from COVID-19."
High-risk condition: High blood pressure
What the numbers say: When researchers analyzed 22 studies from eight countries last year, they found that high blood pressure was present in 42 percent of hospitalized COVID-19 patients, making it the most prevalent health condition by far. Even more stunning: Those patients had twice the risk of death compared with patients without high blood pressure, said Vikramaditya Samala Venkata, M.D., one of the study's authors and a hospital medicine physician at Cheshire Medical Center in Keene, N.H.
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