Underlying conditions among people at any age increase risk for severe COVID-19 infection, although varying levels of evidence exist for different conditions, the agency said on Thursday.
Previously, CDC stated adults over age 65 were at higher risk of severe disease, but on a call with reporters, officials advised thinking of age as a “continuum.” They further noted that people of any age with certain underlying medical conditions are at increased risk of severe disease. The agency classified these categories based on strength of evidence.
Populations at risk of severe illness based on the strongest evidence now include those with cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, obesity (BMI over 30), any immunosuppressive condition, a history of organ transplant, and type 2 diabetes.
Most substantial changes were among the conditions included in the category of “might increase risk,” where the evidence is weaker. Specifically, hypertension was included, after having been touted as a substantial risk factor for severe disease since the beginning of the outbreak.
When asked by a reporter why hypertension was moved, Jay Butler, MD, CDC’s deputy director for infectious diseases, said the agency was “talking about strength of evidence rather than upgrading or downgrading risk.”
He added that data have mainly pointed to manifestations of hypertension, such as heart disease and chronic kidney disease, rather than “hypertension alone driving increased risk.”
Butler added the same was true of obesity, where early on, Butler said severe illness was “the most obvious among people with severe obesity,” or a BMI over 40. But new evidence now suggests a BMI over 30 may also increase risk.
Evidence indicated certain populations “might be at an increased risk” of severe COVID-19 infection, including those with lung diseases such as moderate to severe asthma and cystic fibrosis, cerebrovascular disease, neurologic conditions such as dementia, and pregnancy.
CDC Director Robert Redfield, MD, also took time to address media coverage on the growing number of infections among people younger than age 50, adding that at the beginning of the outbreak, these infections often went undiagnosed.
“We didn’t directly pursue diagnostics in young, asymptomatic people,” he said. “We’re in a different situation today than in March and April” when the majority of infections were diagnosed “in older individuals with significant comorbidities.”
Redfield estimated for every one infection diagnosed, there were 10 other infections that went undiagnosed. He referred to reports of a national serosurvey that found 6% of the population had been infected with COVID-19, estimating 5%-8% of the American public has likely experienced infection.
“The traditional approach of looking for symptomatic illness and diagnosing it underestimated the total amount of infections,” Redfield said.
‘Good News, Bad News’ for Pregnant Women
CDC also released new data on characteristics of pregnant women with COVID-19 in an early edition of the Morbidity and Mortality Weekly Report. They found that while about a third of pregnant women with COVID-19 were hospitalized compared to only 6% of non-pregnant women, death rates were similar compared to non-pregnant women (0.2% apiece).
After adjusting for age, underlying conditions and race/ethnicity, researchers found that pregnant women were 5.4 times more likely to be hospitalized, 1.5 times more likely to be admitted to the intensive care unit, and 1.7 times more likely to receive mechanical ventilation versus non-pregnant women. However, there was no increased risk of death, and the observed differences may be explained by closer medical surveillance of pregnant women.
CDC officials characterized the findings as a “good news, bad news picture,” though they noted there is not yet data on how COVID-19 infection ultimately affects the baby.
“Other infections increase the risk for preterm birth, I wouldn’t be surprised if that’s a risk factor here,” said Dana Meaney-Delman, MD, of the CDC, on the call with reporters.
The authors examined data from 8,207 pregnant women and 83,205 non-pregnant women ages 15 to 44 from January 22 to June 7, all of whom had laboratory-confirmed COVID-19 infections. The researchers noted the composition of their sample of pregnant women, where 46% were Hispanic, 23% were non-Hispanic white, and 22% were non-Hispanic Black. By contrast, among women with reported race/ethnicity data who gave birth in 2019, 24% were Hispanic, 15% were Black, and 51% were white.
“Although data on race/ethnicity were missing for 20% of pregnant women in this study, these findings suggest that pregnant women who are Hispanic and [Black] might be disproportionately affected by SARS-CoV-2 infection during pregnancy,” the authors wrote.
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