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Key Messages

• National surveillance data through April 2020 has shown that COVID-19 can lead to severe outcomes in adults with underlying chronic health conditions such as cardiovascular disease, diabetes, and chronic lung disease.[1] Clinicians should make every effort to encourage patients with chronic conditions to: keep their medical appointments; maintain preventive health services (e.g. getting an influenza vaccine, undergoing age appropriate screenings, participating in lifestyle change programs); refill their prescriptions; manage their blood sugar, blood pressure and weight; and quit smoking.
  
• Local public health departments[2] should increase public messaging about the importance of routine care and promote participation in lifestyle programs such as chronic disease self-management.
• Health systems and hospitals should encourage patients with chronic conditions to participate in self-management classes and establish referrals to outpatient management with primary care clinics and/or community based providers.
  
  

Current Status

Individuals with underlying health conditions are at increased risk for severe illness from COVID-19. Underlying health conditions such as hypertension, diabetes, cardiovascular disease, and respiratory diseases increase the risk for a poor prognosis in patients with COVID-19 disease.[3] Studies in patients hospitalized with COVID-19 show that the presence of comorbidities is associated with increased risk for severe disease, complications, and mortality. [4] [5] [6] [7] [8] In the United States, hospitalizations have been reported to be six times higher among patients with underlying health conditions compared to those without underlying health conditions (.4% and 7.6% hospitalized respectively).[9] Furthermore, deaths were reported to be twelve times higher among patients with underlying health conditions compared to those without underlying health conditions.[9]  

Prognosis[A]

As of December 8, 2020, there have been 19,935 COVID-19 related deaths among individuals older than 18 years of age. (California Department of Public Health, COVID-19) Older adults make up a larger proportion of the statewide deaths: while adults aged 18-34 account for only 1.6% of all deaths and adults ages 35-64 account for 24.7% of deaths;adults over the age of 65 account for 73.7% among California adults age 65 and older. California adults 65 and older also report the highest prevalence of chronic conditions (21.7% heart disease, 20.4% diabetes, and 55.2% hypertension) (AskCHIS, 2019). Individuals who delay routine chronic condition care and self-management are at higher risk for severe COVID-19 illness or even death.

Consequences

In 2019, an estimated 17.1% of California adults reported a delay in receiving care from a health care provider (AskCHIS, 2019). During the COVID-19 pandemic, this has increased: national estimates indicate that 41% of United States adults are delaying care. Adults with underlying chronic conditions, African Americans, Hispanics, younger adults, and individuals with disabilities are more likely to delay the care they need. (Czeisler ME, et al. 2020). Additionally, an alarming decline in routine care such as vaccinations has occurred since the COVID-19 pandemic began, partially due difficulties in accessing care and fears of COVID-19 exposure in clinical settings.[B]

Recommendation for Providers

For individuals with chronic conditions please encourage patients to:

• Keep their medical appointments
• Maintain preventive health services (e.g. getting an influenza vaccine, routine dental appointments, undergoing age appropriate screenings, and participation in lifestyle change programs)
• Refill and continue taking their prescriptions as prescribed
• If medically appropriate, measure and manage their blood sugar, blood pressure, and weight
• Get an influenza vaccine
• Maintain a healthy diet
• Maintain a healthy exercise program
• Seek medical assistance when feeling ill
• Seek help with quitting smoking or vaping which is available free from the California Smokers' Helpline
• Follow COVID-19 precautions (e.g., social distancing, face masks, hand washing and staying home when sick)

Recommendations for Local Health Departments

Local public health departments should increase public messaging on the importance of routine preventive care and promote life style programs such as chronic disease management, diabetes self-management, and diabetes prevention programs.

Recommendations for Health Systems/Hospitals

Health systems and hospitals should encourage patients with chronic disease to participate in a self-management class and establish referral systems to outpatient self-management programs with primary care clinics and/or community-based providers.

Messaging to Patients

Individuals with chronic conditions are at high risk for becoming very ill

Older adults and people who have chronic medical conditions like high blood pressure, obesity, heart or lung disease, diabetes or asthma are at higher risk for becoming very ill and dying from COVID-19. If you have one or more of these risk factors, be extra careful to protect yourself from COVID-19:

• Obesity
• Asthma and lung disease
• Chronic kidney disease
• High blood pressure
  
• Heart disease
• Diabetes
• Are a smoker
• A weakened immune system, which might mean your body is less able to fight off infection, for example, due to Human Immunodeficiency Virus infection or treatment for cancer

How you can take care of yourself?

• Keep up with your routine medical appointments.
• Keep your routine dental appointments
• Continue taking your medications as prescribed.
• Make sure you have an adequate supply of refills of all medications, especially if there is a chance that you may need to quarantine after a COVID-19 exposure.
• Make sure your blood pressure and blood sugar are under control.
• Get a flu vaccine!
• Stay at least 6 feet apart from people who don't live with you.
• Wear a face covering when you are around people who don't live with you.
• Wash your hands often with soap and water for at least 20 seconds or use hand sanitizers that contain at least 60% alcohol.
• Maintain a healthy diet of fruits, vegetables, whole grains, and lean proteins.
• Regularly clean objects or surfaces in your home that people touch frequently.
• Create a list of contacts to call on if needed, such as friends, relatives, coworkers, and neighbors.
• Keep a smoke and vape-free home to lower the risk of lung damage.
• Get free help to quit smoking or vaping by calling 1-800-NO-BUTTS, 1-800-45-NO-FUME or 1-844-8-NO-VAPE.

[1] Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765. DOI.
[2] CDPH Listing of Local Health Services and Offices web page
[3] Zeng Z, et al., Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect, 2020.
[4] Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. 
[5] Chen R., et al., Risk factors of fatal outcome in hospitalized subjects with Coronavirus disease 2019 from a nationwide analysis in China. CHEST, 2020. 
[6] Deng G, Yin M, Chen X, Zeng F. Clinical determinants for fatality of 44,672 patients with COVID-19. Critical Care, 2020.
[7] Williamson E., et al., Factors associated with COVID-19-related deaths using OpenSAFELY. Nature, 2020. 
[8] Yang, J. et al., Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Journal of Infectious Diseases, 2020. 
[9] Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765. DOI.
[A] JAMA August 25, 2020 Volume 324, Number 8 page 816.
[B] According to a survey led by the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and Gavi, the Vaccine Alliance. JAMA September 15, 2020 Volume 324, Number 11 page 1025.

Originally Published on December 11, 2020