Jonah Patel
The COVID-19 pandemic has disproportionately affected people with underlying health conditions, who are at a higher risk of severe outcomes if infected. While the World Health Organization (WHO) declared in May 2023 that COVID-19 is no longer a public health emergency, vaccination efforts remain crucial for vulnerable individuals. People with underlying health conditions, including those with medical complexities and immunocompromised patients, fall into this category. The definition of an underlying health condition varies by location, with each region determining eligibility and vaccination timing based on infection rates and demographic impacts. While proof of underlying conditions is generally unnecessary, understanding the criteria is essential to ensure efficient vaccine distribution and protect those most at risk.
| Characteristics | Values |
|---|---|
| Age | Risk increases in people aged 50 and older, with a substantial increase over 60 or 65 |
| Residence | Residents of long-term care facilities are at increased risk |
| Medical History | Unvaccinated or not up-to-date with COVID-19 vaccines, including boosters |
| Medical History | Neurological, genetic, metabolic disorders, or congenital heart disease |
| Ethnicity | American Indian or Alaska Native, Asian, Black or African-American, Hispanic/Latino |
| Occupation | Healthcare workers |
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What You'll Learn
Age as a risk factor
Age is a critical factor when considering the risk of severe illness from COVID-19. Data from the US National Vital Statistics System (NVSS) shows that compared to the 18-29 age group, the risk of death increases significantly with age. For individuals aged 50-64, the risk is 25 times higher, rising to 60 times higher for those aged 65-74. The risk further increases to 140 times for those aged 75-84 and a staggering 340 times higher for people aged 85 and above. This data underscores the critical importance of age as a risk factor, with older adults facing a markedly elevated risk of severe outcomes from COVID-19.
The European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have consistently emphasized that older individuals are at higher risk of severe COVID-19 outcomes. In line with this, the ECDC recommends prioritizing vaccination efforts for people over 60 and other vulnerable groups, irrespective of age, with underlying comorbidities or immunocompromised states. This strategy aims to protect those most vulnerable to severe disease and reduce the burden on healthcare systems.
The safety and effectiveness of COVID-19 vaccines in older adults have been well-established. Global regulatory authorities have confirmed the good safety profile of these vaccines in all age groups, including older adults. The vaccines have been shown to offer strong protection against severe COVID-19 outcomes, hospitalization, ICU admission, and death. This is particularly crucial for older individuals, who are more susceptible to the severe consequences of the disease.
Additionally, research has revealed a concerning link between COVID-19 infection in older adults and an increased risk of Alzheimer's disease. A study of over 6 million patients aged 65 and older found that those who contracted COVID-19 had a 50-80% higher risk of developing Alzheimer's within a year compared to a control group. The highest risk was observed in women aged 85 and older, with their risk of Alzheimer's nearly doubling. While the exact mechanism is unclear, the findings underscore the potential long-term neurological impacts of COVID-19 on older individuals.
The confidence in vaccine safety among older adults is also notable. According to a KFF survey, more than two-thirds of older adults expressed confidence in the safety of the COVID-19 vaccine. This trust in vaccine safety is essential in encouraging vaccination uptake among this high-risk population, contributing to their protection against severe illness and potential long-term complications.
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Comorbidities and immunocompromise
COVID-19 vaccines are safe and effective in preventing severe disease and death. They are particularly important for those at higher risk of severe disease and mortality, including older adults, people with comorbidities, immunocompromised individuals, and pregnant people.
Comorbidities refer to the presence of one or more additional conditions co-occurring with a primary condition. In the context of COVID-19, individuals with comorbidities are at an increased risk of severe disease progression and adverse outcomes. This vulnerable group should be prioritised for vaccination to reduce the risk of infection, hospitalisation, and death.
Certain underlying illnesses, such as chronic obstructive pulmonary disease (COPD), diabetes, and hypertension, have been associated with a higher risk of severe COVID-19 infection. Patients with comorbidities have experienced rapid and severe progression of the disease, resulting in higher mortality rates. Therefore, it is crucial to prioritise the vaccination of individuals with comorbidities to decrease infection rates and improve overall health outcomes.
Immunocompromised individuals have a weakened immune system due to medical conditions or treatments that suppress their immune response. This population is at a higher risk of severe illness from COVID-19 and, therefore, vaccination is of utmost importance. The CDC recommends COVID-19 vaccines for most adults aged 18 and older, while parents of children aged 6 months to 17 years should consult healthcare providers to discuss the benefits of vaccination for their children.
While most COVID-19 vaccine trials excluded immunocompromised individuals, the Pfizer and BioNTech BNT162b2 vaccine trials included patients with comorbidities and showed a favourable safety profile with high efficacy in adults aged 65 and above. However, more inclusive trials are needed to definitively establish vaccine efficacy in this vulnerable population.
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Medical complexity in children
Children with medical complexity (CMC) represent less than 1% of children in the U.S. but account for more than one-third of total paediatric healthcare costs. CMC is a subset of children and youth with special healthcare needs (CYSHCN) who have multiple significant chronic health problems, functional limitations, and high healthcare and resource needs. These children often have medical and/or behavioural conditions that impact two or more body systems and require technological assistance or dependence.
Identifying CMC at the individual level is a subjective distinction based on a person's experiences and perceptions of the child's medical complexity. However, identifying CMC at a population level is challenging due to varying perspectives among parents, clinicians, and researchers, the rarity and diversity of their underlying conditions, and the lack of a consensus-based definition of CMC.
The AAP and other organizations have developed resources and guidelines to support pediatricians and healthcare professionals working with CMC. These resources aim to improve the quality of healthcare, better support families, and increase cost-effectiveness. The Catalyst Center, for example, promotes universal, continuous, and affordable coverage for CYSHCN, closing benefit and financing gaps, and building sustainable financing capacity.
The definition of CMC should consistently identify children whose health and quality of life depend on integrating healthcare from multiple loci of care, including primary care, tertiary care services, transitional care facilities, rehabilitation units, schools, and community-based settings. This definition must also consider the periodicity of assessments as the complexity of care needs may change over time.
While the focus is on CMC, it is important to note that the COVID-19 vaccines have been deemed safe for children and people with underlying medical conditions. The World Health Organization (WHO) and national authorities play a crucial role in identifying high-risk groups and determining vaccination campaigns.
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Impact on minority groups
The COVID-19 pandemic has had a disproportionate impact on minority groups in terms of infection, hospitalisation, and mortality rates. Black, Latinx, and American Indian persons have been consistently hospitalised and have died at a higher rate than White persons. This trend is also observed in children, with Black, Latinx, and American Indian children experiencing higher hospitalisation and mortality rates than White children.
Several factors have contributed to the disproportionate impact on minority groups. Firstly, systemic racism and long-standing social determinants of health, such as gaps in wealth, employment, housing, and access to healthcare, have played a significant role. The pandemic has likely exacerbated these disparities, making it more challenging for minority groups to cope with the disease's impact. Additionally, school closures will have long-lasting consequences, widening the achievement gaps between minority and White students.
Vaccine hesitancy, misinformation, and barriers to access have also contributed to the lower vaccination rates among Black and Latinx persons in the earlier phases of the vaccination rollout. However, it is important to note that vaccine hesitancy rates among these minority groups have decreased and are now comparable to those of White persons. The aggregated data for Asian Americans, a diverse group with significant disparities, makes it challenging to determine the precise impact of COVID-19 on this community.
The effectiveness of mitigation efforts has been compromised by communication gaps between communities and health authorities. However, employing community health workers (CHWs) and utilising simple technology have proven beneficial in bridging these gaps and enhancing information flow between diverse communities and public health authorities. These strategies have improved adherence to COVID-19 guidelines, reducing infection spread while addressing mental health and resource needs within the communities.
Moving forward, it is crucial to address systemic racism, engage with the communities being served, and promote health equity to better prepare for future pandemics and create a more just healthcare system. Dismantling the barriers that minority groups face in accessing healthcare and improving health literacy can help reduce the disproportionate impact of public health crises on these communities.
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Antiviral treatments
People aged 50 and above, especially those over 65, are generally considered to be at higher risk of severe illness from COVID-19 and may benefit from antiviral treatment. Additionally, individuals with certain underlying medical conditions are also more vulnerable to severe COVID-19, regardless of their age. These conditions include a weakened immune system, heart disease, obesity, diabetes, and chronic lung disease.
Several antiviral treatments are available for COVID-19, including Paxlovid (nirmatrelvir/ritonavir), Veklury (remdesivir), and Lagevrio (molnupiravir). Paxlovid, an antiviral pill, can be taken orally at home and must be started within five days of the onset of symptoms. However, it is more likely to interact with other medications, so healthcare providers may adjust or pause other medications while a patient takes Paxlovid. For individuals who cannot take Paxlovid due to medication interactions, Veklury and Lagevrio may be suitable alternatives with fewer drug interactions.
It is important to consult a healthcare provider to determine the most appropriate antiviral treatment based on individual circumstances, including current medications, severity of symptoms, and hospitalisation status. Antiviral treatments may be prescribed to high-risk individuals who have tested positive for COVID-19 or had a known exposure, even before the onset of symptoms or the receipt of test results.
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Frequently asked questions
The CDC provides a list of underlying health conditions that increase the risk of severe COVID-19, including neurological, genetic, metabolic disorders, and congenital heart disease. The list is non-exhaustive and updated as new data is obtained.
No, proof of your underlying health condition or disability is not required to get the COVID vaccine. However, healthcare providers should consider a patient's age, presence of underlying conditions, and other risk factors when determining the risk of severe COVID-19 outcomes.
Yes, COVID-19 vaccines have been confirmed to be safe for people with underlying health conditions. The International Coalition of Medicines Regulatory Authorities (ICMRA) concluded in July 2023 that the vaccines have a very good safety profile in all age groups, including those with underlying medical conditions, immunocompromised patients, and pregnant women.
Yes, the ECDC recommends that vaccination efforts prioritize people at high risk of severe disease, including those over 60 years old and vulnerable individuals of any age with underlying comorbidities or immunocompromised states.
Eligibility for the COVID-19 vaccine varies by location. Each district or country may have specific registration plans and eligibility criteria. It is recommended to refer to local health authorities or take a survey to determine your eligibility.
