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People with chronic medical conditions like diabetes, lung disease and heart disease face an increased chance of being hospitalized with COVID-19 and put into intensive care, according to data released Tuesday by the Centers for Disease Control and Prevention that is consistent with reports from China and Italy.
The new data gives the most sweeping look at the way COVID-19 is causing serious illnesses among people in the U.S. who already face medical challenges. The report reinforces a critically important lesson: Although the disease is typically more severe among older people, people of any age with underlying medical conditions are at increased risk if they contract the virus, for which there is no vaccine or approved drug treatment.
The CDC data is an initial description of how the disease appears to be affecting people who are already dealing with health challenges. The study did not break down the disease demographically, for example by age, sex, race or income. The agency also notes that this is essentially a snapshot and can’t capture the ultimate outcome for people who have been infected with the virus and haven’t yet recovered.
The report shows COVID-19 is thrusting vulnerable people in the U.S. into intensive care units and disproportionately taking the lives of people who already face medical challenges.
The CDC analyzed more than 7,000 confirmed COVID-19 cases across the country in which health officials had a written record about the presence or absence of any underlying medical condition. The preexisting conditions covered in the records include heart and lung diseases, diabetes, chronic renal disease, chronic liver disease, immunocompromised conditions, neurological disorders, neurodevelopmental or intellectual disability, pregnancy, current or former smoker status, and “other chronic disease.”
The CDC found that, of people requiring admission to an intensive care unit, 78% had at least one underlying health condition. Of people hospitalized but not requiring ICU admission, 71% had at least one such condition, compared to just 27% of people who didn’t need to be hospitalized.
Among all the cases analyzed, 10.9% of patients had diabetes mellitus, 9.2% had chronic lung disease and 9% had cardiovascular disease—numbers that roughly parallel the prevalence of these conditions in the U.S. The report did not reach any conclusion about whether the severity of an underlying condition correlated to a more severe COVID-19 illness.
Of the 7,160 patients whose chronic illness status was known through health records, 184 died, and 173 of them had an underlying condition, the CDC said. None of the deaths were among people under the age of 19.
COVID-19 is a respiratory disease. The virus typically infects the upper respiratory tract, but it can also venture deeper into the lungs and in some patients results in pneumonia-like symptoms, requiring hospitalization and sometime intubation on a ventilator. People who smoke or have chronic lung conditions are especially vulnerable.
Diabetes and heart disease are similarly worrisome. Someone already suffering from heart problems—whether they had previous heart attack or required a stent installed because of plaque buildup in their vascular system—may have a heart that cannot take as much strain as the average person, said Amesh Adalja, an infectious disease physician at Johns Hopkins Center for Health Security
When a patient gets infected with something like this coronavirus, the fever causes a spike in the heart rate. Shortness of breath means the patient gets less oxygen. People with limited cardiac capacity can go into arrest.
Diabetes is a metabolic syndrome that involves blood glucose levels and affects how the immune system works, and makes it less effective, Adalja said.
“This is why patients with diabetes are at risk for many infections not just coronavirus,” Adalja said. “They often struggle with infections on their skin and soft tissues, with pneumonia and even more serious conditions.”
The new CDC statistics show those in the high risk group need to be extremely careful.
“If they do become infected, the threshold for them seeking medical attention needs to be much lower. They and their clinicians have to keep this in mind,” Adalja said. “These numbers show us just how crucial that is.”
Wilbur Chen, an infectious-disease physician at the University of Maryland, added that while the virus seems to prey on the elderly and sick, “it does not mean it does not cause severe illness in younger adults or in children—in other words, the risk is not zero among the young.” He said, “We are now documenting a large number of COVID-19 infections across the U.S. and we are now observing more and more of these ‘rare’ events of severe illness and even deaths among the young.”
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It is incorrect that shortness of breath means less oxygen. Please fix this.
In fact, shortness of breath can occur for a variety of reasons and does not necesarily lead to hypoxia. Hypoxia and Sob are 2 different issues. Often times, SOB can lead to hypoxia or even be due to it. But this only happens when SOB is a symptom of hypoxia. Hypoxic patients desat for a variety of reasons- inappropriate blood gas exchange, hemoglobinopathies, etc.
SOB on the other hand is a symptom that can be both due to physiologic issues (hypoxia) AND due to subjective sensation of diminished capacity. This is typically seen in COPDers who have what we call ‘air hunger.’ These patients have chronically poorly inflating lungs (over inflated lungs that have diminished gas exchange)- these patients often feel like they are drowning and begin to take rapid shallow breaths that exchange O2 just fine but due to the sensation of incomplete inflation makes them feel like they are drowning- they then continue to have more and more sob and this leads to decline. I see this a lot in my patients. – from a doctor.