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| Coronavirus Threatens Americans With Underlying Conditions | Coronavirus Threatens Americans With Underlying Conditions |
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| The new coronavirus is a serious threat to the elderly, as federal officials have been at pains to note recently. But they have stepped gingerly around advice for another group of Americans also at special risk from the infection: those with chronic health conditions. | The new coronavirus is a serious threat to the elderly, as federal officials have been at pains to note recently. But they have stepped gingerly around advice for another group of Americans also at special risk from the infection: those with chronic health conditions. |
| It is not a small group. An estimated 60 percent of all Americans have at least one chronic health condition, and 40 percent have more than one. (The figures include the elderly.) Heart disease, cancer, diabetes — all of these can exacerbate a coronavirus infection, studies show, increasing the odds of severe disease and death. | It is not a small group. An estimated 60 percent of all Americans have at least one chronic health condition, and 40 percent have more than one. (The figures include the elderly.) Heart disease, cancer, diabetes — all of these can exacerbate a coronavirus infection, studies show, increasing the odds of severe disease and death. |
| Federal health officials have urged those in their 80s and older to sharply curtail their activities to reduce exposing themselves to infection. But beyond general advice to wash hands frequently and to avoid crowds, officials have said little about those who are younger and cope with chronic illnesses. | Federal health officials have urged those in their 80s and older to sharply curtail their activities to reduce exposing themselves to infection. But beyond general advice to wash hands frequently and to avoid crowds, officials have said little about those who are younger and cope with chronic illnesses. |
| Now some experts are encouraging this broader swath of the population to take immediate action to protect themselves. | Now some experts are encouraging this broader swath of the population to take immediate action to protect themselves. |
| “All you folks older than 60 and those who have underlying illnesses, you ought to do personal mitigation starting now,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. | “All you folks older than 60 and those who have underlying illnesses, you ought to do personal mitigation starting now,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. |
| The risk of dying if one contracts the infection begins to rise at a younger age than federal officials have acknowledged, suggesting the coronavirus may cut deeply into the fabric of a society in which many older adults continue to lead active, engaged lives. | The risk of dying if one contracts the infection begins to rise at a younger age than federal officials have acknowledged, suggesting the coronavirus may cut deeply into the fabric of a society in which many older adults continue to lead active, engaged lives. |
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| In the largest study to date, conducted in China, the greatest risk of death from Covid-19, the disease caused by the new coronavirus, was found among patients in their 80s or older, 15 percent of whom died. But while just 1.3 percent of patients in their 50s died, the death rate rose with each additional decade of life, increasing to 3.6 percent for patients in their 60s and to 8 percent for patients in their 70s. | In the largest study to date, conducted in China, the greatest risk of death from Covid-19, the disease caused by the new coronavirus, was found among patients in their 80s or older, 15 percent of whom died. But while just 1.3 percent of patients in their 50s died, the death rate rose with each additional decade of life, increasing to 3.6 percent for patients in their 60s and to 8 percent for patients in their 70s. |
| The virus has killed younger people: Dr. Li Wenliang, the physician who died after raising the alarm about the mysterious new illness, was only 34. But children have been affected in very small numbers, and younger adults have displayed greater resilience. | The virus has killed younger people: Dr. Li Wenliang, the physician who died after raising the alarm about the mysterious new illness, was only 34. But children have been affected in very small numbers, and younger adults have displayed greater resilience. |
| The chronic health conditions that cause complications following infection with the coronavirus are certainly more common in older people. But they are also commonly found in Americans under 65. | The chronic health conditions that cause complications following infection with the coronavirus are certainly more common in older people. But they are also commonly found in Americans under 65. |
| High blood pressure affects nearly one in three adults in the United States, including one-third of adults in their 40s and 50s. More than one in 10 adults have Type 1 or Type 2 diabetes, including 17 percent of adults aged 45 to 64. At least 16 million Americans struggle with chronic obstructive pulmonary disease. | High blood pressure affects nearly one in three adults in the United States, including one-third of adults in their 40s and 50s. More than one in 10 adults have Type 1 or Type 2 diabetes, including 17 percent of adults aged 45 to 64. At least 16 million Americans struggle with chronic obstructive pulmonary disease. |
| A study of 1,590 patients, also in China, found that people infected with the coronavirus who were already coping with a chronic condition were 1.8 times more likely to have a “poor outcome,” such as being put on a ventilator or dying, than those with no underlying conditions. | A study of 1,590 patients, also in China, found that people infected with the coronavirus who were already coping with a chronic condition were 1.8 times more likely to have a “poor outcome,” such as being put on a ventilator or dying, than those with no underlying conditions. |
| But those with two chronic conditions were at 2.6 greater risk, compared to individuals with none. Nearly 20 percent of the patients who had at least one chronic condition had a poor outcome, compared with 4.5 percent of those without any chronic ailments, the study found. | But those with two chronic conditions were at 2.6 greater risk, compared to individuals with none. Nearly 20 percent of the patients who had at least one chronic condition had a poor outcome, compared with 4.5 percent of those without any chronic ailments, the study found. |
| Dr. Schaffner and other public health experts outlined a series of steps individuals can take to minimize their risk of exposure. | Dr. Schaffner and other public health experts outlined a series of steps individuals can take to minimize their risk of exposure. |
| “It’s imperative that the population understand that now is the time to get serious about avoiding group events, and to become a bit of a hermit,” Dr. Schaffner said. | “It’s imperative that the population understand that now is the time to get serious about avoiding group events, and to become a bit of a hermit,” Dr. Schaffner said. |
| “If I’m older, and have underlying illnesses, then I’m the kind of person that this virus makes more seriously and even gravely ill.” | “If I’m older, and have underlying illnesses, then I’m the kind of person that this virus makes more seriously and even gravely ill.” |
| Among the recommendations were: refraining from recreational group activities and face-to-face work meetings. Canceling travel. Staying home from religious services and other social and celebratory events — even family get-togethers — that bring together large groups. | Among the recommendations were: refraining from recreational group activities and face-to-face work meetings. Canceling travel. Staying home from religious services and other social and celebratory events — even family get-togethers — that bring together large groups. |
| Go shopping at off hours, when stores are less frequented, Dr. Schaffner suggested. Watch the game on TV, not live. And no hugging. | Go shopping at off hours, when stores are less frequented, Dr. Schaffner suggested. Watch the game on TV, not live. And no hugging. |
| “I’m not trying to put everyone in a plastic enclosure, but to reduce the risk,” Dr. Schaffner said. “And every little thing you can do to reduce the risk helps.” | “I’m not trying to put everyone in a plastic enclosure, but to reduce the risk,” Dr. Schaffner said. “And every little thing you can do to reduce the risk helps.” |
| Smoking An estimated 34 million Americans smoke, and 16 million live with a disease caused by smoking. | Smoking An estimated 34 million Americans smoke, and 16 million live with a disease caused by smoking. |
| Covid-19 is a respiratory ailment. Longtime smokers with damaged lungs will be more vulnerable and should quit now, said Marc Lipsitch, an epidemiologist at Harvard University. | Covid-19 is a respiratory ailment. Longtime smokers with damaged lungs will be more vulnerable and should quit now, said Marc Lipsitch, an epidemiologist at Harvard University. |
| Diabetes If you have Type 1 or Type 2 diabetes, exercising very strict control over blood sugar levels can help boost immunity, said Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists. | Diabetes If you have Type 1 or Type 2 diabetes, exercising very strict control over blood sugar levels can help boost immunity, said Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists. |
| “We know that if you do not have good glucose control, you’re at high risk for infection, including viruses and presumably this one as well,” Dr. Weber said. | “We know that if you do not have good glucose control, you’re at high risk for infection, including viruses and presumably this one as well,” Dr. Weber said. |
| Even improving glucose control over the next one to two weeks “would put you in a situation where you would have better immune function,” she said. | Even improving glucose control over the next one to two weeks “would put you in a situation where you would have better immune function,” she said. |
| People with Type 1 diabetes are more likely to have severe disease if they become infected. When they experience viral symptoms like nausea, diarrhea and vomiting, they are more likely to develop a serious complication called life-threatening ketoacidosis. | People with Type 1 diabetes are more likely to have severe disease if they become infected. When they experience viral symptoms like nausea, diarrhea and vomiting, they are more likely to develop a serious complication called life-threatening ketoacidosis. |
| Lung disease Dr. Albert Rizzo, chief medical officer of the American Lung Association, urged patients with chronic lung conditions like asthma or C.O.P.D. to talk to their doctors — by phone — and to “think twice” about going anywhere that might expose them to the virus. | Lung disease Dr. Albert Rizzo, chief medical officer of the American Lung Association, urged patients with chronic lung conditions like asthma or C.O.P.D. to talk to their doctors — by phone — and to “think twice” about going anywhere that might expose them to the virus. |
| Heart disease A respiratory illness like Covid-19 is risky for anyone who has heart disease, because it increases metabolic demand, forcing the heart to work harder to pump blood, said Orly Vardeny, who studies influenza and heart disease at the University of Minnesota. | Heart disease A respiratory illness like Covid-19 is risky for anyone who has heart disease, because it increases metabolic demand, forcing the heart to work harder to pump blood, said Orly Vardeny, who studies influenza and heart disease at the University of Minnesota. |
| Updated June 22, 2020 | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| “That extra stress leads to worsening of their underlying heart disease,” she said. “It’s not going to be limited to fever, cough, pneumonia — it’s also going to affect whatever their underlying condition is and make it worse.” | “That extra stress leads to worsening of their underlying heart disease,” she said. “It’s not going to be limited to fever, cough, pneumonia — it’s also going to affect whatever their underlying condition is and make it worse.” |
| Immunocompromised People with compromised immune systems are especially vulnerable to respiratory infections. That group includes those who have autoimmune disorders such as lupus and arthritis, those who have had organ transplants, patients undergoing chemotherapy and other cancer treatments, and anyone who is taking steroids as treatment. | Immunocompromised People with compromised immune systems are especially vulnerable to respiratory infections. That group includes those who have autoimmune disorders such as lupus and arthritis, those who have had organ transplants, patients undergoing chemotherapy and other cancer treatments, and anyone who is taking steroids as treatment. |
| People with H.I.V. are not on the list as yet, however. With powerful antiretroviral drugs, many now have immune systems strong enough to stave off infections, said Dr. Monica Gandhi, an infectious disease expert at the University of California, San Francisco. | People with H.I.V. are not on the list as yet, however. With powerful antiretroviral drugs, many now have immune systems strong enough to stave off infections, said Dr. Monica Gandhi, an infectious disease expert at the University of California, San Francisco. |
| There is some very preliminary evidence that certain H.I.V. drugs in wide use may help slow the coronavirus. | There is some very preliminary evidence that certain H.I.V. drugs in wide use may help slow the coronavirus. |
| Cancer Chemotherapy or radiation, two common treatments, weaken the immune system, noted Dr. Cardinale Smith, director of quality for cancer survivors at the Mount Sinai Health System. | Cancer Chemotherapy or radiation, two common treatments, weaken the immune system, noted Dr. Cardinale Smith, director of quality for cancer survivors at the Mount Sinai Health System. |
| Cancer patients who have been in treatment should avoid contact with anyone who is sick and stay indoors as much as possible. “It’s really just erring on the side of caution while we ride this out,” Dr. Smith said. | Cancer patients who have been in treatment should avoid contact with anyone who is sick and stay indoors as much as possible. “It’s really just erring on the side of caution while we ride this out,” Dr. Smith said. |
| Seniors Even healthy older people who are active and vigorous need to take precautions, said Dr. Richard Baron, an internist and geriatrician who heads the American Board of Internal Medicine. | Seniors Even healthy older people who are active and vigorous need to take precautions, said Dr. Richard Baron, an internist and geriatrician who heads the American Board of Internal Medicine. |
| “Our organs have a lot of reserves, but it’s in the nature of getting older that you progressively lose that reserve,” Dr. Baron said. “You can get into trouble really quickly.” | “Our organs have a lot of reserves, but it’s in the nature of getting older that you progressively lose that reserve,” Dr. Baron said. “You can get into trouble really quickly.” |
| Those who don’t get sick often should not feel overly confident. The coronavirus is a new pathogen that won’t be recognized by the immune system, said Dr. Charlotte Yeh, chief medical officer at AARP. The body will not have built up its defenses, she added: “Your prior exposures won’t necessarily help you.” | Those who don’t get sick often should not feel overly confident. The coronavirus is a new pathogen that won’t be recognized by the immune system, said Dr. Charlotte Yeh, chief medical officer at AARP. The body will not have built up its defenses, she added: “Your prior exposures won’t necessarily help you.” |
| Now that the virus is embedded in communities, individuals must act to protect themselves, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. | Now that the virus is embedded in communities, individuals must act to protect themselves, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. |
| At least 1,400 Americans are known to have the coronavirus, though the real prevalence in the United States is unknown, as testing has been scarce. At least 38 have died of the infection. | At least 1,400 Americans are known to have the coronavirus, though the real prevalence in the United States is unknown, as testing has been scarce. At least 38 have died of the infection. |
| “People should understand they need to take control of their own life,” Dr. Osterholm said. | “People should understand they need to take control of their own life,” Dr. Osterholm said. |
| “You can’t assume anymore that people are not capable of infecting you. In many cases they won’t even know they’re infected.” | “You can’t assume anymore that people are not capable of infecting you. In many cases they won’t even know they’re infected.” |
| Those who are older or who have chronic health conditions “have to kind of assume the rest of the world is a coronavirus soup,” he added. “If I don’t want to end up swimming in that bowl, I need to find another place on the plate.” | Those who are older or who have chronic health conditions “have to kind of assume the rest of the world is a coronavirus soup,” he added. “If I don’t want to end up swimming in that bowl, I need to find another place on the plate.” |
| Reporting was contributed by Apoorva Mandavilli. | Reporting was contributed by Apoorva Mandavilli. |