Comorbidities and COVID-19

One of the cruelties of COVID-19 is the danger it poses to the most vulnerable populations. Even as we’re still learning more about how the coronavirus is spread and how it affects long-lasting populations, its lethality among seniors and those with pre-existing conditions is coming into clear focus.

According to a large federal study of COVID-19, people older than 65 years of age and with underlying conditions are up to twelve times more likely to die and six times more likely to be hospitalized after infection with coronavirus than healthier patients. According to the most recent figures, the most common comorbidities found among patients who were hospitalized or died from COVID-19 included:

  • Cardiovascular disease (32%)
  • Diabetes (30%)
  • Chronic lung disease (18%)[1]

In part because they are more likely to have these conditions—and because they often live communally in nursing homes and care centers—this puts American’s elderly at serious risk. In fact, the incidence of COVID-19 between late January and late May in the United States was highest among people over 80 years old. This is the same group with the highest mortality rate.

The virus’s tendency to target older, sicker people has profound implications for how the healthcare system will confront the disease in the future, including the type of patient education that can be used to help patients reduce their risk of infection and serious complications.

First and most importantly, healthcare facilities including residential nursing homes, skilled nursing facilities, rehab units, and others should practice strict infection control. According to a study in the Journal of the American Geriatrics Society (2020):

  • There are 1.5 million vulnerable residents in skilled nursing facilities
  • Infection and mortality rates in these facilities approach 25%
  • Fear of COVID-19 and active infections are impacting care delivery for other chronic conditions[2]

The challenge of dealing with COVID-19 in these settings is complicated by a lack of PPE and testing, the risk of the virus spreading among staff, and the virus’s persistence despite excellent infection control. While there are concrete steps facilities can take—limited physical contact, meticulous hand-washing, strict cohorting practices—steps should also be taken to help residents and patients continue to treat their underlying conditions. This can be accomplished with regular education on the importance of self-care and monitoring of things like medication adherence, personal infection control, and symptom recognition and management.

No one knows when the coronavirus pandemic will end, but even after the immediate threat subsides, it’s likely that the delivery of medical care to these vulnerable populations will remain fundamentally changed. Patient education can play an important role going forward in helping these patients protect themselves.


References

[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. ePub: 15 June 2020.

[2] D’Adamo H, Yoshikawa T, Ouslander JG. Coronavirus Disease 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19. J Am Geriatr Soc. 2020;68(5):912-917.