Who is at Highest Risk for Complications from SARS-CoV-2 and COVID-19?
Persons considered most at risk for developing complications from COVID-19 include those with cardiovascular disease, hypertension, cerebrovascular disorders, cystic fibrosis, pulmonary fibrosis, liver disease, Downs Syndrome, dementia and neurological disorders, chronic obstructive pulmonary disease (COPD), type 1 and type 2 diabetes mellitus, chronic kidney disease, cancer, sickle cell disease, thalassemia, and those who are immunocompromised due to solid organ transplant, HIV, immune deficiencies, blood or bone marrow transplant, or those taking medications that suppress the immune system1
Persons who are obese (body mass index of 30 or higher), pregnant, smokers, including current and former smokers, and persons with substance use disorders are also considered to be at a higher risk of developing severe illness2
The CDC states that the risk of hospitalization and death increases with age, and that individuals over the age of 85 are at the greatest risk of developing severe illness.3
In the U.S., African Americans have been disproportionally affected by SARS-CoV-2, with higher rates of COVID-19 illness and death reported in comparison to white Americans. However, African Americans have higher rates of underlying chronic illness including diabetes, hypertension, and heart disease, which are known to increase a person’s risk of developing complications from SARS-CoV-2. Many African Americans are also critical front-line workers with jobs considered vital to the community, which may also increase rates of infection within the African American population.4 5
Limited access to health care, lack of health insurance, and distrust of medical personnel are additional factors which contribute to higher rates of severe illness among African Americans. Research has also found that hidden biases exist in health care that prioritizes white Americans over African Americans.6
Additionally, persons of Asian, Hispanic, and Native American descent have also been disproportionally impacted by COVID-19 disease and have experienced higher rates of hospitalizations and deaths in comparison to white Americans. However, the higher rates among racial and ethnic minorities in the U.S. has been attributed to lower socioeconomic status among these populations, rather than a predisposition to the illness. Many Blacks, Hispanics, and persons of Native American descent are more likely to reside in crowded conditions, in multigenerational households, be employed in positions that can’t be performed remotely, and use public transportation. As a result, they are more likely to be exposed to the SARS-CoV-2 virus.7
Ethnic and racial minorities are also known to have less access to health care services and often less likely to have adequate health insurance. As a result, they may not seek prompt treatment for symptoms, which places them at higher risk of hospitalization and death if initial care begins at a later point in the disease process.8
According to the National Academies of Sciences, Engineering, and Medicine:9
“People of color — specifically Black, Hispanic or Latinx, and American Indian and Alaska Native — have been disproportionately impacted by COVID-19 with higher rates of transmission, morbidity, and mortality. Currently there is little evidence that this is biologically mediated, but rather reflects the impact of systemic racism leading to higher rates of co-morbidities that increase the severity of COVID-19 infection and the socioeconomic factors that increase likelihood of acquiring the infection, such as having front line jobs, crowded living conditions, lack of access to personal protective equipment, and inability to work from home.”
Individuals who are not proficient in English, particularly those who lack an understanding of health literacy, have also been noted to have poorer outcomes. Experts report that information provided by public health officials is not adequately communicated and distributed to these populations, placing them at higher risk of severe outcomes.10
IMPORTANT NOTE: NVIC encourages you to become fully informed about covid-19 and the covid-19 vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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1 U.S. Centers for Disease Control and Prevention. COVID-19 - People with Certain Medical Conditions. Mar. 29, 2021.
2 U.S. Centers for Disease Control and Prevention. COVID-19 - People with Certain Medical Conditions. Mar. 29, 2021.
3 U.S. Centers for Disease Control and Prevention. COVID-19 Older Adults. Apr. 16, 2021.
4 Gupta S. Why African-Americans may be especially vulnerable to COVID-19. Science News April 10, 2020.
5 The National Academies of Sciences, Engineering, and Medicine. National Academies Release Draft Framework for Equitable Allocation of a COVID-19 Vaccine, Seek Public Comment. Sept. 1, 2020.
6 Gupta S. Why African-Americans may be especially vulnerable to COVID-19. Science News April 10, 2020.
7 Lopez L 3rd, Hart LH 3rd, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021 Jan 22. doi: 10.1001/jama.2020.26443. Epub ahead of print. PMID: 33480972.
8 Lopez L 3rd, Hart LH 3rd, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021 Jan 22. doi: 10.1001/jama.2020.26443. Epub ahead of print. PMID: 33480972.
9 The National Academies of Sciences, Engineering, and Medicine. National Academies Release Draft Framework for Equitable Allocation of a COVID-19 Vaccine, Seek Public Comment. Sept. 1, 2020.
10 Lopez L 3rd, Hart LH 3rd, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA February 2021; 325(8) pp. 719-720.