Which patients are at high risk for COVID-19 (Coronavirus Disease 2019)?

High Risk Patients for COVID-19

Older adults (over 65 years of age) and patients with serious chronic underlying medical conditions, particularly cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease, and hypertension are at highest risk for severe COVID-19 disease and complications. 1

Key High-Risk Groups

Age-Related Risk

• Older adults (≥65 years): Significantly higher risk of severe disease and mortality 1
• Advanced age (>80 years): Even higher risk compared to those <50 years 2
• Male gender: Associated with more severe forms of the disease 1, 2

Medical Comorbidities

1. Cardiovascular Disease

   • Hypertension 1
   • Heart failure 1
   • Coronary artery disease 1

2. Respiratory Conditions

   • Chronic obstructive pulmonary disease (COPD) 1
   • Chronic respiratory disease 1

3. Metabolic Disorders

   • Diabetes mellitus 1
   • Obesity 1

4. Cancer

   • Active malignancy 1
   • Especially lung cancer 1
   • Cancer patients on treatment within previous 14 days (HR=4.08) 1

5. Other Conditions

   • Chronic kidney disease 1
   • Immunocompromised status 1
   • History of smoking 1

Risk Stratification by Severity

Highest Risk Patients

• Multiple comorbidities: Patients with ≥2 chronic conditions 1, 3
• Advanced age with comorbidities: Particularly those >65 years with underlying conditions 1, 4
• Cancer patients: Especially those with:
  • Active disease
  • Recent treatment (within 14 days)
  • Age >60 years
  • Lung cancer 1
• Hematological malignancies: Particularly acute myeloid leukemia and myelodysplastic syndrome 1
• Adult congenital heart disease: Especially those with poor physiological stage (C or D), concomitant heart failure, or pulmonary hypertension 1

Occupational Risk Factors

• Healthcare workers with pre-existing risk factors (age, chronic respiratory disease) 1
• Essential workers with high exposure risk and underlying conditions 1

Clinical Implications

Disease Presentation in High-Risk Groups

• Higher rates of hospitalization (71-78% in those with underlying conditions vs. 27% in those without) 3
• Greater need for ICU admission 3
• More rapid deterioration (median age 66 in deteriorating patients vs. 37 in stable patients) 1
• Higher mortality rates (up to 23-fold greater risk in those >65 compared to <65) 4

Special Considerations

• Immunocompromised patients: May present with atypical findings 1
• Elderly: May have atypical presentations without classic symptoms 4
• Obesity: Associated with higher risk of ICU admission, particularly in younger patients 1
• Poorly controlled conditions: Patients with uncontrolled hypertension or diabetes at higher risk than those with well-controlled disease 1

Clinical Management Implications

• Early identification of high-risk patients is critical for appropriate monitoring and intervention
• Consider baseline imaging for high-risk patients to establish a comparison point for disease progression 1
• High-risk patients may benefit from earlier therapeutic interventions like remdesivir 5
• For non-hospitalized high-risk patients, treatment should be initiated within 7 days of symptom onset 5

Pitfalls and Caveats

• Risk assessment should consider both the number and severity of comorbidities
• Not all patients within a high-risk category have equal risk - severity of underlying condition matters
• Well-controlled chronic conditions may pose less risk than poorly controlled ones 1
• Children with COVID-19 generally have lower risk, but those with underlying conditions (especially hematological malignancies) remain at increased risk 1
• Risk factors may have additive or synergistic effects when multiple conditions are present

By identifying patients at highest risk for severe COVID-19, healthcare providers can implement appropriate preventive measures, monitoring strategies, and early interventions to reduce morbidity and mortality.