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.

High risk

Age

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
• Diabetes
• Obesity (BMI >30 kg/m2 or >95th percentile in children)
• Disabilities
• Neurological conditions such as dementia
• Immunocompromising conditions or medications
• Pregnancy and recent pregnancy
• Smoking
• Children who are medically complex (e.g., who have neurologic, genetic, or metabolic disorders or congenital heart disease)

Vaccination status

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).