CDC Expands List of Those With Higher COVID-19 Risks: What to Know
By Moira McCarthy
The Centers for Disease Control and Prevention (CDC) has updated its list of underlying conditions that may lead to more severe outcomes from a COVID-19 diagnosis.
The agency is warning that people with type 2 diabetes, kidney disease, whole organ transplants, and women who are pregnant could experience more severe outcomes if they contract COVID-19.
The updated guidelines also remove 65 as the age when more severe outcomes may occur. Instead, it is suggesting as people age, the chance of severe outcomes increases.
What does this mean to the public?
By removing a set age cut off, the updated guidelines give notice to people with underlying conditions of all ages that they are more likely to end up in an intensive care unit (ICU) if they contract the virus.
The guidelines do not suggest that people with these underlying conditions are more susceptible to developing COVID-19.
What should the public do?
Experts say the key is to stay in the know and practice safe habits such as masking, physical distancing, and, when needed, isolation.
A Close Look at the New Conditions
Here's a look at some of the underlying conditions added to the CDC list.
"Pregnancy is a situation with all kinds of hormonal changes in the mix," said Dr. Alan Fishman, medical director for Obstetrix Medical Group in San Jose, California, and board certified in obstetrics and gynecology and maternal-fetal medicine. "Pregnancy is a stress on a healthy woman's body."
That's why, he said, a pregnant woman who contracts COVID-19 may face more severe outcomes.
"It appears that pregnant women [who contract COVID-19] are 5.5 times more likely to be hospitalized than a non-pregnant woman," Fishman told Healthline. "That's pretty significant."
"There is zero evidence that women who are pregnant are more likely to get COVID-19," he added.
But the risks mean his office is carefully counseling those considering pregnancy.
"I counsel them to think about this information and how it sits with them," he said. "They have to remember that it is not a good idea to skip a medical appointment or space them out more."
While some pregnancy appointments can be done virtually, many must be done in person.
So what should a pregnant woman do?
"Common sense still holds," Fishman said.
Wear a mask, wash your hands, keep a physical distance, and isolate when needed is still the key, along with not missing any medical appointments.
"Clearly these types of modifications are going to be with us for a long time," he said.
There's been some confusion around COVID-19 in the diabetes community.
First, there's no evidence yet that people with diabetes are more likely to contract the novel coronavirus.
"The CDC has not come out and said that type 1 or type 2 diabetes makes you more susceptible [to COVID-19]," said Dr. Joshua Miller, the medical director of diabetes care for Stony Brook Medicine and an assistant professor of endocrinology and metabolism at the facility's New York Campus, told Healthline.
However, there is research that concludes people with diabetes can develop more serious cases of COVID-19.
"What we are absolutely seeing are that people who carry a comorbidity struggle more when they contract this," Miller told Healthline.
Figuring out what is going on with those with diabetes who contract COVID-19 is a challenge for healthcare providers.
"It's challenging looking at the numbers and statistics because the way in which we [track diabetes] in the medical world is a challenge," Miller said.
Even in medical reports, he said, type 1 can be mixed up with type 2.
Miller is working with the National Institutes of Health (NIH) to gather and assess data around COVID-19 patients with diabetes. But he points out that mixed information makes it harder to rely on the data.
Right now, the CDC has listed people with type 2 diabetes as being "at increased risk" of more severe outcomes if they contract COVID-19, and people with type 1 diabetes as "might be at an increased risk."
Miller, who has had type 1 diabetes for 21 years, knows one thing for sure.
"When [a person with diabetes] is in the hospital for this, their insulin needs go way up," he said.
Even those with type 2 diabetes who take medication may need injected insulin during treatment, he added.
His advice for those with any kind of diabetes?
"The big lesson we are learning here is simply this," he said. "The healthier our patients are, the better they do with COVID-19. Focus in earnest more than ever on your health. Across the board, the best outcomes come from this."
"While the area you live in has confirmed community spread, your risk is higher than not," he added. "Stay at home if you can. And always, wear the mask, wash your hands, keep that distance. Be smart, be safe."
The Aging Population
The CDC has moved away from a specific age cutoff for heightened concern to a more general statement on aging.
The CDC now says, "People in their 50s are at higher risk for severe illness than people in their 40s. Similarly, people in their 60s or 70s are, in general, at higher risk for severe illness than people in their 50s. The greatest risk for severe illness from COVID-19 is among those aged 85 or older.
That, say aging experts, is an important change.
"I have to give credit to the CDC for really clarifying that," Dr. Ronald Caplan, author of "The Care of the Older Person" and "Long Life Strategy," told Healthline. "Prior to this we were saying 65 and beyond, like the Cinderella phenomenon. At midnight (in this case 65 years of age) your coach just turns into a pumpkin? This is not the way medicine and real life works."
Caplan says that when you consider that 60 percent of Americans have some kind of underlying health condition, that 40 percent of adults are obese, and that many aging Americans have heart health issues, it just makes sense that as a person ages, a COVID-19 battle gets more challenging.
What should older people do?
"The more you know, the safer you can make yourself and the less anxious you will be," Caplan said. "We are all getting more familiar with this. We can see [the disease] attacks major organ systems, so knowing how to treat any [comorbidities] you have now will help you later."
His best tips for older adults?
"Older people should not neglect seeing their healthcare providers, now more than ever," Caplan said. "And get your vaccinations [for] flu and whatever else you need."
The older population should also be careful about self-isolating when there is community spread, but they should do so with support.
"Suicide among older people is a non-talked about thing, but it is a thing," Caplan said. "You lose a spouse, a friend or friends and all of a sudden you are alone, and then this virus comes along. It can be overwhelming."
He suggests for those who must isolate making a small trusted bubble of friends or family who visit and check on you.
He also repeats the suggestions to wear masks, maintain distancing, and wash hands.
"All those common sense measures that the CDC is giving us all go back to when I was a kid, before vaccinations," Caplan said. "This is what we did. And now, the answer is we need an effective vaccination. We're going to have to wait for that, though, and do the right thing in the meantime."
Expect additions, subtractions, and other changes to this list as the pandemic continues, experts say.
"It's a fascinating virus," Dr. Mary Dale Peterson, MSHCA, FACHE, FASA, president of the American Society of Anesthesiologists, told Healthline. "It has a propensity to attack organs, but we are still very much learning as we go along."
Some of what medical professionals are seeing makes historic sense, she added, such as people with obesity having more difficulty recovering and pregnancy taxing the heart and lungs.
As one who sees the impact of comorbidity on COVID-19 recovery first hand, Peterson has suggestions.
"The way I look at it is this: We all have our own set of risk factors," she said. "So look at what are in your spheres of control."
"I can make sure I take care of my chronic disease. I can eat a good diet. I can get up and actually not be a couch potato as tempting as it is to be one right now," she explained.
"Physical activity is actually a treatment we use in the hospital on COVID-19 patients," she added. "Double down on your healthy habits. It will only help."
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For centuries, the delicate silver dove has been a symbol of love and fidelity.
Biodiversity and Habitat Loss<p>Their near extinction is a symbol of the <a href="https://www.dw.com/en/global-biodiversity-outlook-targets-extinction-summit-new-york-pledge/a-54932895" target="_blank">biodiversity crisis</a> in the UK, largely driven by habitat destruction. Britain is now one of the countries with the most <a href="https://www.wwf.org.uk/future-of-UK-nature#:~:text=The%20UK%20is%20one%20of,than%20half%20are%20in%20decline" target="_blank">depleted nature</a> in the world according to the World Wildlife Fund. Half its plant and animal species are in decline and more than <a href="https://www.rspb.org.uk/about-the-rspb/about-us/media-centre/press-releases/let-nature-sing-wales/#:~:text=a%20natural%20tragedy.-,Over%2040%20million%20birds%20have%20vanished%20from%20UK%20skies%20in,unaware%20of%20the%20impending%20danger" target="_blank">40 million birds</a> have vanished in just half a century.</p><p>"[Turtle doves] are the canary in the [coal] mine because there are all these other species before it and after it," said Tree. "It's an umbrella for all the other species that are heading that way."</p><p>Turtle doves migrate south through Europe to sub-Saharan Africa between July and September, ending up in dry woodland and farmland areas of countries like Mali and Senegal for winter. </p><p>Droughts in West Africa and the Sahel region are believed to have contributed to the fall in turtle dove species recorded in northern Europe, with low rainfall reducing supplies of the seeds and insects the birds rely on for energy for the long journey home.</p>
Conservation and Farming<p><a href="https://www.operationturtledove.org/" target="_blank" rel="noopener noreferrer">Operation Turtle Dove,</a> a partnership project of charities including the Essex Wildlife trust, works with landowners and farmers to actively build turtle dove habitat.</p><p>Outten works with <a href="https://www.ebws.org.uk/birdsites/blue-house-farm-ewt-north-fambridge" target="_blank">Blue House Farm</a>, a 660-acre nature reserve in the UK county of Essex, where they have replicated weedy fallow plots. </p><p>"We work on it every year to make sure it's in the condition it needs to be with plants such as clovers and black medic," Outten said. "These plants are native to the landscape and produce the seed the birds feed on." </p><p>The birds eat a wide range of seeds from various plants that would have been abundant 50 or 100 years ago, added Guy Anderson, program manager for species recovery with The Royal Society for the Protection of Birds (RSPB). </p><p>"But it's simply true that with the gradual process of <a href="https://www.dw.com/en/farming-without-pesticides-how-can-we-make-agriculture-greener/a-52216796" target="_blank" rel="noopener noreferrer">intensifying our agricultural production</a>, the availability of those seeds has dropped and dropped," said Anderson.</p><p>Part of the project includes supplementary feeding — providing sources of food in the form of seed or grain. Under the Countryside Stewardship Scheme in England, farmers can receive financial support to create a turtle dove habitat. </p><p>Though they haven't recorded an increase in doves across the sites in the four years of working on the project, Outten said they are seeing improvements in how landowners and farmers manage habitat for the birds. </p>
A Turtle Dove Haven<p>The 3,500-acre Knepp Estate in West Sussex is another project taking a different approach and one of the few places where turtle dove numbers are increasing.</p><p>Isabella Tree and her husband Charlie Burrell converted their intensively farmed land into a rewilding project almost 20 years ago. They have let the land return to nature.</p><p>Just one year after they'd finished <a href="https://www.dw.com/en/uks-most-talented-architects-are-not-human/a-35952128" target="_blank">rewilding</a> the southern part of their property, they heard turtle doves for the first time. It's now a breeding hotspot for the birds with an estimated 19 pairs. Knepp is also home to <a href="https://www.rewildingbritain.org.uk/rewilding/rewilding-projects/knepp-estate" target="_blank" rel="noopener noreferrer">2% of the UK's population</a> of nightingales. </p><p>Tree is critical of supplementary feeding schemes that, in her view, are short term. She questions the chances of turtle doves getting to feed on scattered seeds before other mammals eat them first.</p>
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