CDC offers guidance to patients with chronic disease 'living with uncertainty' during COVID-19
Patients with chronic diseases aged older than 65 years, particularly those with cardiovascular disease or diabetes, are at significantly greater risk for acquiring COVID-19 and subsequent mortality from the virus, according to findings presented during a CDC webinar.
“We need to realize that people with existing chronic diseases need to be especially protected from COVID-19, because their risk may be as high as 10-fold higher than the general population,” William Bommer, MD, FACP, FACC, director of noninvasive services at UC Davis Health, said during the “COVID-19 and the Chronic Disease Community” webinar.
The webinar, which was viewed by about 2,100 attendees and supported by 67 participating organizations, also featured presentations from Georgina Peacock, MD, MPH, FAAP, director of the CDC Division of Human Development and Disability, and Vickram Tejwani, MD, from the division of pulmonary/critical care medicine at Johns Hopkins University School of Medicine.
During his presentation, Bonner discussed the continuum of care for high-risk individuals. He began by noting that hypertension, obesity, diabetes, cardiovascular disease and chronic lung diseases not only increase the likelihood for acquiring COVID-19, but also increase risks for hospitalization, admission to the ICU or mortality. “It almost doubles the rate of mortality,” he said.
Protecting patients with chronic diseases begins with social distancing. “If we can separate the virus from susceptible cells, that is the best way to protect ourselves,” Bommer said, noting that six feet is, indeed, the optimal distance of separation.
Bommer stressed that the virus is “easily destroyed” with most household soaps, shampoos and cleaners, and so he also recommended frequent hand washing and sterilization of the home as a key mitigation strategy for those at elevated risk.
Should a high-risk individual begin demonstrating the dry cough, headache, sore throat, dyspnea or myalgias that may come with COVID-19, Bommer suggested monitoring the symptoms closely. “If you have a fever, you need to contact your health care provider,” he added.
Regarding treatment, Bommer said that there is a “variety” of options available, but that few have been rigorously tested. “Protocols are under study at this time,” he said.
When asked when high-risk individuals may consider resuming normal activities, Bommer recommended caution and careful assessment. “That is going to depend on the location where you are,” he said. “We have to be able to track cases and have better testing available.”
Peacock expanded the conversation to a broader range of high-risk individuals, not just the elderly or those with underlying comorbidities. Those who have difficulty accessing health care, those with functional or communication needs, the homeless, racial or ethnic minorities, and those with social or behavioral complications also require more protection.
Of particular concern for Peacock are people with more than one underlying condition. She cited data from the April 8, 2020 Morbidity & Mortality Weekly Report. “Among 178 COVID-19 patients with underlying conditions, 90% had more than one condition,” she said.
Clinicians should also be aware of the role of age in COVID-19 risk for susceptible populations, according to Peacock. She responded to a question about whether children with systemic juvenile idiopathic arthritis are in particular danger. “We do not know if they are at higher risk for getting COVID-19, but we know that they are at higher risk for complications,” she said. “But this particular scenario is in children. Interestingly, we have not seen much serious illness in children.”
With that in mind, clinicians should look at age and severe underlying conditions on a continuum. “If you are older and have serious underlying conditions, you are at more risk,” Peacock said. “However, a child on a biologic [to treat a chronic disease] might not be at as much serious risk as an adult.”
Tejwani zeroed in on three implications for individuals with chronic lung disease in the setting of COVID-19. “One, they are at higher risk for more severe disease or hospitalization,” he said. “Number two, systemic treatment of lung disease can lead to immunosuppression.”
The third challenge is that access to health care can frequently be difficult for people with chronic lung conditions. “Now it is harder due to the resources consumed by COVID,” Tejwani said.
To that point, many pulmonologists are no longer doing routine pulmonary or breathing tests. “Elective surgeries and other procedures are also not being done,” he said.
This underscores a key point Tejwani hoped to convey. “Patients with chronic or underlying conditions should ensure plans with their provider for continued management,” he said. “We need to make sure that care does not fall through the cracks.”
Of particular concern for Tejwani is the proportion of asymptomatic individuals with COVID-19. High-risk individuals venturing out and about in the world are “living with uncertainty,” not knowing if the seemingly healthy people they interact with are carrying the disease. “Absence of symptoms does not equate to being non-infectious,” he said.
As high-risk individuals navigate these uncertainties, and the world anxiously awaits evidence-based treatments or an effective vaccine, Tejwani offered a final recommendation. “Make sure your psychological needs are being addressed, as well,” he said.
Peacock G, et al. National Briefing with CDC: COVID-19 and the Chronic Disease Community; April 29, 2020 (virtual meeting).