As the country starts to reopen, a lot of patients are asking themselves: “When is it safe for me to consider leaving isolation?” I can imagine that question brings about a significant amount of fear and anxiety. Thankfully, the CDC has provided a great deal of guidance on who should still be taking extra precautions at this time. These are the top 7 conditions that put you at risk for developing COVID-19, and I want to discuss those in detail with you today.

1. Age

It’s well known that our immune systems steadily decline as we age, but the rate of decline is variable for everyone. The CDC considers anyone over the age of 65 to be higher risk for COVID-19 and recommends extra safety precautions for this entire age group. Nursing home and assisted living residents are at much higher risk because of their close proximity to others. I have made several house calls to nursing homes during the pandemic. In my experience, I have found that they are taking appropriate precautions before letting anyone in, including hand and shoe sanitizing, mask regulations, and screening people for symptoms upon entry.

2. Organ failure

When your organs are not functioning properly, your body cannot mount a coordinated defense against infections. Some organ failures are worse than others. For example, liver failure, kidney failure and heart failure put you at incredibly high risk for COVID-19 and complications thereof. Patients with cirrhosis (chronic scarring) of the liver are at high risk for all infections, including bacterial, viral, and fungal. Mild kidney disease is not very concerning, but if you have end stage kidney disease requiring regular dialysis, then you are at high risk. Having heart failure that causes you to retain fluid is just as risky.

3. Medications

We prescribe so many medications that lower the body’s immune system, either as a goal of therapy or as a side effect. Chemotherapy for cancer will lower the immune system. However, if you are taking maintenance therapy for breast cancer with tamoxifen or therapy for prostate cancer with lupron, then these medications do not lower your immune system. Taking a steroid like prednisone greater than 7.5mg daily for a prolonged period increases your risk. If you have had an organ transplant in the past, then the anti- transplant rejection medications you take lower your immune response and increase your risk. While some medications for autoimmune disease are being studied to treat multi-organ failure and cytokine release syndrome, they are generally listed as placing patients at risk for COVID-19.

If you would like to learn more about autoimmune diseases, then take a look at the book Rheumatology Secrets on the Patient Resources page.

4. Obesity

CDC guidelines say that anyone with a BMI of 40 or greater is at high risk for COVID-19. Morbid obesity places patients higher risk for hospitalization and ICU care with mechanical ventilation. Due to extra pounds, morbidly obese patients are more difficult to ventilate. Additionally, fat releases inflammatory messages, which may play a role in poor outcomes. For more information about BMI and obesity, take a look at my article Staying Trim Around the Holidays.

5. Diabetes

Diabetes is a disorder that causes you to have high levels of blood sugar in your body. These high blood sugar levels lower your immune system in 2 ways: 1) Bacteria, fungus, and viruses all thrive in high blood sugar environments because they feed off of that high sugar level and replicate aggressively. 2) high blood sugar levels actually impair your white blood cells (immune system cells) from organizing an effective response against infections. These two factors make diabetes a very dangerous condition if you are exposed to infection.

The good news is that we can control diabetes if treated properly. A person who has pre-diabetes or a low grade diabetes is not at much higher risk. To give you a reference, an A1c is a lab test that we use to measure someone’s diabetes. A level > 6.5% is considered in the diabetic range, and 6.5-9% is considered in the intermediate range. Once your A1c gets above 9%, then I start to worry that your immune system is compromised.

6. Lung disease

COVID-19 is predominantly a respiratory illness, so any kind of lung disease will put you at higher risk for infection and complications. This includes asthma and chronic obstructive pulmonary disease (COPD), which is permanent lung damage from smoking.

7. Immunodeficiency

There are two kinds of immunodeficiency: inherited and acquired. Some people have inherited immunodeficiencies like combined variable immunodeficiency (CVID), or IgA deficiency. One type of acquired immunodeficiency comes from uncontrolled HIV. The treatment for HIV has improved so much that the disease can be controlled by taking only 1 tablet per day. If a patient takes the highly active antiretroviral therapy (HAART) daily and has a normal CD4 cell count, then their risk is really no higher than the rest of the general population.

These 7 conditions put you at higher risk of developing complications from COVID-19. I do not recommend changing your treatment plan, but if you have any of these conditions then I recommend you take extra precautions to protect yourself from coronavirus at this time. As a wise patient, I want you to discuss your risks for coronavirus with your doctor before relaxing your guard.