People with Certain Medical Conditions

People with Certain Medical Conditions
Updated Dec. 29, 2020
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Summary of Recent Changes

Revisions were made on December 23, 2020 to reflect recent data supporting increased risk of severe illness among persons with Down syndrome from the virus that causes COVID-19. Revisions also include addition of sickle cell disease and chronic kidney disease to the conditions that might increase the risk of severe illness among children.

We are learning more about COVID-19 every day. The below list of underlying medical conditions is not exhaustive and only includes conditions with sufficient evidence to draw conclusions; it is a living document that may be updated at any time, subject to potentially rapid change as the science evolves. This list is meant to inform clinicians to help them provide the best care possible for patients, and to inform individuals about their level of risk so they can make individual decisions about illness prevention. Notably, the list may not include every condition that might increase one’s risk for developing severe illness from COVID-19, such as those for which evidence may be limited (e.g., rare conditions). Individuals with any underlying medical condition (including those conditions that are NOT on the current list) should consult with their healthcare providers about personal risk factors and circumstances to determine whether extra precautions are warranted.

Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.

Adults of any age with the following conditions are at increased risk of severe illness from the virus that causes COVID-19:

COVID-19 is a new disease. Currently there are limited data and information about the impact of many underlying medical conditions on the risk for severe illness from COVID-19. Based on what we know at this time, adults of any age with the following conditions might be at an increased risk for severe illness from the virus that causes COVID-19:

Want to see the evidence behind these lists?

While children have been less affected by COVID-19 compared to adults, children can be infected with the virus that causes COVID-19 and some children develop severe illness. Children with underlying medical conditions are at increased risk for severe illness compared to children without underlying medical conditions. Current evidence on which underlying medical conditions in children are associated with increased risk is limited. Children with the following conditions might be at increased risk for severe illness: obesity, medical complexity, severe genetic disorders, severe neurologic disorders, inherited metabolic disorders, sickle cell disease, congenital (since birth) heart disease, diabetes, chronic kidney disease, asthma and other chronic lung disease, and immunosuppression due to malignancy or immune-weakening medications.

We do not yet know who is at increased risk for developing the rare but serious complication associated with COVID-19 in children called Multisystem Inflammatory Syndrome in Children (MIS-C), nor do we know what causes MIS-C. Learn about MIS-C.

Reduce your risk of getting COVID-19

It is especially important for people at increased risk of severe illness from COVID-19, and those who live with them, to protect themselves from getting COVID-19.

The best way to protect yourself and to help reduce the spread of the virus that causes COVID-19 is to:

If you start feeling sick and think you may have COVID-19, get in touch with your healthcare provider within 24 hours.  If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

What to consider before being around other people

There is no way to ensure you have zero risk of infection, so it is important to understand the risks and know how to be as safe as possible if or when you do resume some activities, run errands, or attend events and gatherings.

People at increased risk of severe illness from COVID-19, and those who live with them, should consider their level of risk before deciding to go out and ensure they are taking steps to protect themselves. Consider avoiding activities where taking protective measures may be difficult, such as activities where social distancing can’t be maintained. Everyone should take steps to prevent getting and spreading COVID-19 to protect themselves, their communities, and people who are at increased risk of severe illness.

In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher your risk of getting and spreading COVID-19.

  • If you decide to engage in public activities, continue to protect yourself by practicing everyday preventive actions.
  • Keep these items on hand and use them when venturing out: a mask, tissues, and a hand sanitizer with at least 60% alcohol, if possible.
  • If possible, avoid others who are not wearing masks or ask others around you to wear masks.

Are you considering in-person visits with family and friends? Here are some things to consider to help make personal and social activities as safe as possible:

When to delay or cancel a visit

In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher the risk of COVID-19 spread. So, think about:

  • How many people will you interact with?
  • Can you keep at least 6 feet of space between you and others?
  • Will you be outdoors or indoors?
  • What’s the length of time that you will be interacting with people?

Encourage social distancing

  • Limit the number of people you interact with and ensure you keep safe distances (at least 6 feet) between you when possible and if not in the same household.
  • Visit with your friends and family outdoors, when possible. If this is not feasible, make sure the room or space is well-ventilated (for example, open windows or doors) and large enough to accommodate social distancing.
  • Arrange tables and chairs to allow for social distancing. People from the same household can be in groups together and don’t need to be 6 feet apart from each other.
  • Consider activities where social distancing can be maintained, like sidewalk chalk art or yard games.
  • Try to avoid close contact with your visitors. For example, don’t shake hands, elbow bump, or hug. Instead wave and verbally greet them.
  • If possible, avoid others who are not wearing masks or ask others around you to wear masks.
  • Consider keeping a list of people you visited or who visited you and when the visit occurred. This will help with contact tracing if someone becomes sick.
  • Limit the time you have close contact with visitors to less than 15-20 minutes as much as possible.

Wear masks

Masks prevent people from getting and spreading the virus, especially those who may not know they have it.

  • Masks should be worn over the nose and mouth. Masks are especially important to help protect each other when it is difficult to stay at least 6 feet apart from others or when people are indoors.
  • Masks prevent people from getting and spreading the virus.
  • CDC recognizes that wearing masks may not be possible in every situation or for some people such as children. Some older adults with cognitive, sensory, or behavioral issues might find wearing a mask difficult. Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a mask or to reduce the risk of spreading COVID-19 if it is not possible to wear one. These adults need to take extra precautions when interacting with others. Additionally, some people may rely on reading lips or facial expressions during social interactions. This can be difficult when others are wearing masks that cover large portions of their face.
  • Who should NOT use masks: Children under age 2 or anyone who has trouble breathing, is unconscious, or is incapacitated or otherwise unable to remove the mask without assistance.

Wash hands often

  • Everyone should wash their hands with soap and water for at least 20 seconds at the beginning and end of the visit and whenever you think your hands may have become contaminated.
  • If soap and water are not readily available, such as with outdoor visits or activities, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Remind guests to wash or sanitize their hands before serving or eating food.
  • Use single-use hand towels or paper towels for drying hands so visitors do not share towels. Have a no-touch trash can available for guests to use.

Limit contact with commonly touched surfaces or shared items

  • Encourage your visitors to bring their own food and drinks.
  • Clean and disinfect commonly touched surfaces and any shared items between use.
  • If you choose to use any shared items that are reusable (e.g., seating covers, tablecloths, linen napkins), wash, clean, and sanitize them after the event.

If you are thinking about participating in an event or gathering:

If you are at increased risk for severe illness, consider avoiding high-risk gatherings. Here are things to consider for personal and social activities.

Stay healthy during the COVID-19 pandemic

Staying healthy during the pandemic is important. Talk to your healthcare provider about whether your vaccinations and other preventive services are up to date to help prevent you from becoming ill with other diseases.

  • It is particularly important for those at increased risk of severe illness, including older adults, to receive recommended vaccinations against influenza and pneumococcal disease.
  • Talk with your healthcare provider about maintaining preventive services like cancer screenings during the pandemic.
  • Remember the importance of staying physically active and practicing healthy habits to cope with stress.
  • Ask your healthcare provider about telemedicine or remote healthcare visits, and know when to go to the emergency department.
  • If you have a medical emergency, do not delay seeking emergency care.

 If you have an underlying medical condition, you should continue to follow your treatment plan:

  • Continue your medicines and do not change your treatment plan without talking to your healthcare provider.
  • Have at least a 30-day supply of prescription and non-prescription medicines. Talk to a healthcare provider, insurer, and pharmacist about getting an extra supply (i.e., more than 30 days) of prescription medicines, if possible, to reduce your trips to the pharmacy.
  • Do not delay getting emergency care for your underlying medical condition because of COVID-19. Emergency departments have contingency infection prevention plans to protect you from getting COVID-19 if you need care.
  • Call your healthcare provider if you have any concerns about your underlying medical conditions or if you get sick and think that you may have COVID-19. If you need emergency help, call 911 right away.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
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Protect Your Health This Flu Season

Getting a flu vaccine during 2020-2021 is more important than ever because of the ongoing COVID-19 pandemic. Flu vaccination is especially important for people who are at high risk from flu; many of whom are also at high risk for COVID-19 or serious outcomes.

Actions you can take based on your medical conditions and other risk factors

Asthma (moderate-to-severe)

Having moderate-to-severe asthma might increase your risk for severe illness from COVID-19.

Actions to take

  • Keep your asthma under control by following your Asthma Action Plan.
  • Continue your current medicines, including any inhalers with steroids in them (“steroids” is another word for corticosteroids). Know how to use your inhaler.  Avoid your asthma triggers.
  • Make sure that you have at least a 30-day supply of your medicines.
    • Call your healthcare provider or care team if you have concerns about your condition, your treatment, think you may have been exposed to COVID-19, have any new signs or symptoms of illness or any other questions.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Call your healthcare provider if you have concerns about your condition or feel sick. If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Have another member of your household who doesn’t have asthma clean and disinfect your house for you. When they use cleaning and disinfecting products, have them:
    • Make sure that people with asthma are not in the room.
    • Avoid using disinfectants known to trigger asthma attacks.
    • Open windows or doors and use a fan that blows air outdoors.
    • Always follow the instructions on the product label.
    • To minimize cleaners from spreading in the air, spray pour spray products onto a cleaning cloth or paper towel instead of spraying the product directly onto the cleaning surface (if the product label allows).

Learn more about asthma.

Cancer

Having cancer currently increases your risk of severe illness from COVID-19. At this time, it is not known whether having a history of cancer increases your risk.

Actions to take:

  • Have a conversation with your healthcare provider or care team to discuss your individual level of risk based on your condition, your treatment, and the level of transmission in your community.
  • Do not stop taking your medicines or alter your treatment plan without talking to your healthcare provider.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Do not delay life-saving treatment or emergency care.
  • Call your healthcare provider or care team if you have concerns about your condition, your treatment, think you may have been exposed to COVID-19, have any new signs or symptoms of illness, or any other questions.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • For more information on preventing infections for people with cancer.

Learn more about cancer.

Chronic kidney disease

Having chronic kidney disease of any stage increases your risk for severe illness from COVID-19.

Actions to take

  • Continue your medicines and your diet as directed by your healthcare provider.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Stay in contact with your healthcare team as often as possible, especially if you have any new signs or symptoms of illness. Also reach out to them if you can’t get the medicines or foods you need.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Have shelf-stable food choices to help you follow your kidney diet.
  • If you are on dialysis:
    • Contact your dialysis clinic and your healthcare provider if you feel sick or have concerns.
    • Do NOT miss your treatments.
    • Plan to have enough food on hand to follow the KCER 3-Day Emergency Diet Planexternal icon for dialysis patients in case you are unable to maintain your normal treatment schedule.

Learn more about kidney disease.

Learn how to take care of your kidneys.

COPD, cystic fibrosis, pulmonary fibrosis, and other chronic lung diseases

Having COPD (including emphysema and chronic bronchitis) is known to increase your risk of severe illness from COVID-19. Other chronic lung diseases, such as idiopathic pulmonary fibrosis and cystic fibrosis, might increase your risk of severe illness from COVID-19.

Actions to take

  • Keep taking your current medicines, including those with steroids in them (“steroids” is another word for corticosteroids).
  • Make sure that you have at least a 30-day supply of your medicines.
  • Avoid triggers that make your symptoms worse.
  • Call your healthcare provider or care team if you have concerns about your condition, your treatment, think you may have been exposed to COVID-19, have any new signs or symptoms of illness or any other questions.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn more about COPD.

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Diabetes

Having type 2 diabetes increases your risk of severe illness from COVID-19. Based on what we know at this time, having type 1 or gestational diabetes might increase your risk of severe illness from COVID-19.

Actions to take

  • Continue taking your diabetes pills and insulin as usual.
  • Test your blood sugar and keep track of the results, as directed by your healthcare provider.
  • Make sure that you have at least a 30-day supply of your diabetes medicines, including insulin.
  • Follow your healthcare provider’s instructions if you are feeling ill as well as the sick day tips for people with diabetes.
  • Call your healthcare provider if you have concerns about your condition or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn more about diabetes.

Down syndrome

Having Down syndrome increases your risk of severe illness from COVID-19.

Actions to take

  • Have a conversation with your healthcare provider or care team to discuss your individual level of risk based on your condition, medical history, your treatment, and the level of transmission in your community
  • Do not stop taking your medicines or alter your treatment plan without talking to your healthcare provider.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Do not delay life-saving treatment or emergency care.
  • Call your healthcare provider or care team if you have concerns about your condition, your treatment, think you may have been exposed to COVID-19, have any new signs or symptoms of illness or any other questions.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn more about Down syndrome.

Learn more about data on Down syndrome.

Heart Conditions and Other Cardiovascular and Cerebrovascular Diseases

Having any of the following heart conditions increases your risk of severe illness from COVID-19:

  • Heart failure
  • Coronary artery disease
  • Cardiomyopathies
  • Pulmonary hypertension

Having other cardiovascular or cerebrovascular disease, such as hypertension (high blood pressure) or stroke, might increase your risk of severe illness from COVID-19.

Actions to take

  • Take your medicines exactly as prescribed and follow your healthcare provider’s recommendations for diet and exercise while maintaining social distancing precautions.
  • Continue angiotensin converting enzyme inhibitors (ACE-I) or angiotensin-II receptor blockers (ARB) as prescribed by your healthcare provider for indications such as heart failure or high blood pressure.
  • Make sure that you have at least a 30-day supply of your heart disease medicines, including high cholesterol and high blood pressure medicines.
  • Call your healthcare provider if you have concerns about your condition or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Do not delay life-saving treatment or emergency care.

Learn more about serious heart conditions.

Learn more about heart disease.

Learn more about stroke.

Learn more about high blood pressure.

Hemoglobin disorders such as sickle cell disease and thalassemia

Having sickle cell disease (SCD) increases your risk for severe illness from COVID-19. Having other hemoglobin disorders, like thalassemia, might increase your risk for severe illness from COVID-19.

Actions to take

Learn more about blood disorders.

Immunocompromised state (weakened immune system) from blood, bone marrow, or organ transplant; HIV; use of corticosteroids; or use of other immune weakening medicines

Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. These include: having a solid organ transplant, blood, or bone marrow transplant; immune deficiencies; HIV with a low CD4 cell count or not on HIV treatment; prolonged use of corticosteroids; or use of other immune weakening medicines. Having a weakened immune system might increase your risk of severe illness from COVID-19.

Actions to take

  • Continue any recommended medicines or treatments and follow the advice of your healthcare provider.
  • Do not stop taking your medicines without talking to your healthcare provider.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Do not delay life-saving treatment or emergency care.
  • Call your healthcare provider if you have concerns about your condition or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Information for people living with HIV.

Liver disease

Having chronic liver disease, such as alcohol-related liver disease, nonalcoholic fatty liver disease, and especially cirrhosis (scarring of the liver), might increase your risk for severe illness from COVID-19.

Actions to take

  • Take your medicines exactly as prescribed.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Call your healthcare provider if you have concerns about your condition or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn more about chronic liver disease.

Neurologic conditions such as dementia

Having neurologic conditions such as dementia might increase your risk of severe illness from COVID-19.

Actions to take

  • Take your medicines as prescribed.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Call your healthcare provider if you have concerns about your condition or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn more about dementia.

Learn about caring for people living with dementia during COVID-19.

Learn about amyotrophic lateral sclerosis (ALS).

Overweight, Obesity and Severe Obesity

Having obesity, defined as a body mass index (BMI) between 30 kg/m2 and <40 kg/m2 or severe obesity (BMI of 40 kg/m2 or above), increases your risk of severe illness from COVID-19. Having overweight, defined as a BMI > 25 kg/m2 but less than 30 kg/m2 might increase your risk of severe illness from COVID-19.

 Actions to take

  • Take your prescription medicines for overweight, obesity or severe obesity exactly as prescribed.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Follow your healthcare provider’s recommendations for nutrition and physical activity, while maintaining social distancing precautions.
  • Call your healthcare provider if you have concerns or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn more about obesity in adults.

Learn about obesity in children.

Tips to help children maintain a healthy weight.

Learn more about prescription medications to treat obesity.

Pregnancy

Based on what we know at this time, pregnant people are at increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, there might be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.

Actions to take

  • Do not skip your prenatal care appointments.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Talk to your healthcare provider about how to stay healthy and take care of yourself during the COVID-19 pandemic.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Call your healthcare provider or care team if you have concerns about your condition, your treatment, think you may have been exposed to COVID-19, have any new signs or symptoms of illness or any other questions.
  • Seek care immediately if you have a medical emergency.
  • You may feel increased stress during this pandemic. Fear and anxiety can be overwhelming and cause strong emotions. Learn about stress and coping.

Learn more about pregnancy and COVID-19.

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Smoking

Being a current or former cigarette smoker increases your risk of severe illness from COVID-19.

Actions to take

Learn about smoking and tobacco use.

Learn about the health effects of cigarette smoking.

Children with Certain Underlying Conditions

As noted above, children can be infected with the virus that causes COVID-19 and some children develop severe illness. Children with underlying medical conditions are at increased risk for severe illness compared to children without underlying medical conditions.

Actions to take

  • Give medicines as prescribed for your child’s underlying conditions.
  • Make sure that you have at least a 30-day supply of your child’s medicines.
  • Call your child’s healthcare provider if you have concerns and to discuss your child’s specific conditions and risk for severe illness from COVID-19.
  • Well-child visits and vaccines are still important during the COVID-19 pandemic. Stay in contact with your child’s healthcare provider and make sure your child is up to date with vaccines to prevent other diseases. Learn more about how to protect yourself and your family during the COVID-19 pandemic.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.

Learn about preventing illness in your children.

Learn more about congenital heart disease and specific genetic and neurologic disorders in children.

People with Multiple Underlying Conditions

The more underlying medical conditions someone has, the greater their risk is for severe illness from COVID-19.

Actions to take

  • Continue your medicines and treatment plans as directed by your healthcare provider.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Call your healthcare provider if you have any concerns or feel sick.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Do not delay emergency care.
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COVID-19 Hospitalization and Death by Age
COVID-19 Hospitalization and Death by Age
COVID-19 Hospitalization and Death by Race/Ethnicitypdf icon
COVID-19 Hospitalization and Death by Race/Ethnicity

Last Updated Dec. 29, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases