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Clinical Recommendations for Patients with Underlying Medical Conditions: COVID-19
Patients who are older, who have one or more underlying medical conditions, or who are not up to date on COVID-19 vaccination are at increased risk of severe outcomes of COVID-19, such as hospitalization or death. Health care providers should consider a patient’s age, presence of underlying conditions, and other risk factors when determining the risk of severe COVID-19 outcomes for their patients.
The risk of severe outcomes from COVID-19 increases in people who are 50 years and older, with the risk increasing substantially at ages older than 65 years. Residents of long-term care facilities are at increased risk of severe outcomes from COVID-19.
Race and ethnicity
People from racial and ethnic minority groups (American Indian or Alaska Native, Asian, Black or African-American, and Hispanic/Latino) have been disproportionately affected by the COVID-19 pandemic. According to CDC data: Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity, compared to non-Hispanic white people, people from these minority groups are more likely to be hospitalized and die from COVID-19 at younger ages.
Underlying medical conditions
Many underlying medical conditions have been associated with increased risk for severe COVID-19. Refer to CDC: Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19 for a more complete list. Key conditions include:
- Chronic heart, lung, kidney, and liver disease
- Obesity (BMI >30 kg/m2 or >95th percentile in children)
- Neurological conditions such as dementia
- Immunocompromising conditions or medications
- Pregnancy and recent pregnancy
- Children who are medically complex (e.g., who have neurologic, genetic, or metabolic disorders or congenital heart disease)
Patients who are unvaccinated or who are not up to date with COVID-19 vaccines, including recommended boosters, are at increased risk for severe COVID-19 illness.
COVID-19 risk continuum
The risk of severe COVID-19 illness increases as the number of comorbid conditions and risk factors increases.
A more detailed discussion of the continuum of risks can be found at: Infectious Diseases Society of America: Understanding Risk for Severe COVID-19.
Actions for health care providers
- Continue to recommend vaccination for COVID-19, including all recommended boosters.
- For clinical guidance and information on where to get vaccinated, refer to COVID-19 Vaccine.
- Consider antiviral therapies for patients with mild to moderate symptoms and underlying risk factors for severe illness.
- Eligibility is based on underlying risk, NOT severity of symptoms. Treatment must be started early to be effective.
- Visit Therapeutic Options for COVID-19 Patients for more information on therapeutic options and prescribing.
- Encourage patients with underlying risk factors for severe illness to continue practicing preventive measures, such as when to wear a high-quality mask, to decrease the risk of infection.
- Patient information is available at Protect Yourself and Others.
- Encourage patients with underlying risk factors to have a COVID-19 plan in place, including testing at the first sign of symptoms and knowing how to access treatment if needed.
- A personal COVID-19 plan for patients to download is available at CDC: COVID-19 Plan (PDF).