David and Goliath, MJ and Scottie, the Blues Brothers, Frodo and Sam, salt and pepper, and grits and eggs rank as top duos in religion, sport, comedy, film, cuisine, and culture. St. Louis is a baseball town. Many fans will recall arguably the best double play duo in baseball history—the Big Red machine’s Joe Morgan and Dave Concepcion. And St. Louis’s own Ozzie Smith and Tommy Herr as a duo represent one of the more formidable infield combos in the game’s history.
All of these pairings were intended to offer life lessons, enjoyment, or opportunities for friendly debate as they remind us of our humanity. However, not all pairings generate a positive response. If you think Bonnie and Clyde, robbery and death come to mind. Today, we face a pandemic associated with a novel coronavirus and the disease it causes, COVID-19. This disease robs us of our health. And if paired with an underlying health condition, this duo has proved to be fatal.
What is an underlying health condition? Another pair helps to describe the term—chronic and immunocompromised.
Chronic conditions include long-term diseases such as hypertension (treated and untreated), diabetes, asthma, chronic bronchitis, cancer, liver disease, chronic obstructive pulmonary disease, heart disease, and cancer. Immunocompromised encompasses all conditions that weaken the immune system. Lupus, HIV/AIDs and pneumonia affect the immune system. Chemotherapy or steroids suppress the immune system.
Currently, the relationship between COVID-19 and underlying health is being monitored by public health officials in the United States. So far, there is a large gap in data available in regards to patients with underlying health conditions and other known risk factors. As of March 28, according to the Center for Disease Control’s (CDC) Morbidity and Mortality Weekly Report, only 7,162 cases, or 5.8%, of the total number of COVID-19 cases in the U.S. have data available on these conditions and risks. Of these 7,162 cases, 2,692 (37.6%) of the patients reported having one or more underlying condition or risk, while 4,470 (62.4%) reported having none.
Patients with at least one underlying health condition were admitted to the intensive care unit (ICU) or required hospitalization without ICU admissions at higher rates than those with no reported conditions or risks. Additionally, of the 7,162 cases, 184 deaths occurred, 173 of which (94%) were among patients with at least one underlying condition. All of the deaths occurred in patients over 19 years old.
Some of the more common underlying conditions reported include diabetes mellitus, chronic lung disease, and cardiovascular disease. These findings suggest that people with underlying health conditions are at higher risk for severe outcomes with COVID-19 compared to those without them.
This data was collected from all 50 states and four U.S. territories, and Washington D.C. (Repatriated cases from Wuhan, China, and the Diamond Princess Cruise Ship were not included in the data analysis.) Public health departments collected data on underlying health conditions through a report form that asks if a patient has any of the following conditions: chronic lung disease, diabetes mellitus, cardiovascular disease, chronic renal disease, chronic liver disease, immunocompromised condition, neurologic disorder, neurodevelopment or intellectual disability, pregnancy, current or former smoking status, or other chronic disease.
Because of the small amount of reported data regarding underlying health conditions, this report is preliminary. However, two conditions suggest the findings warrant action.
First, the findings align with reports from China and Italy that suggested risk factors for severe disease include the presence of one underlying health condition. The second factor is the prevalence of these underlying health conditions in the United States.
Let’s take hypertension. The CDC reported that nearly one-third of the adult population in the United States have been diagnosed with hypertension and/or are being treated with hypertension medication. This fact indicates a large percentage of the United States population has elevated risk.
Demographic differences in hypertension prevalence rates offer even more insight into the risk of severe outcomes with COVID-19. In relative terms, middle-aged and older blacks experience hypertension at higher rates than non-Hispanic Whites. Blacks develop hypertension earlier than whites, and the disparities in rates of hypertension persist across life course.
Other underlying conditions present in disparate fashion. The CDC reports that diabetes is 17% more prevalent in rural areas than in urban areas. Many rural communities lack the ICU equipment required for supporting the most severe reactions to COVID-19. American Indian/Native American (15.1%), Hispanic (12.7%), and black, non-Hispanic (12.1%) have the highest percentages of U.S. adults age 18 or older with diagnosed diabetes. Many of these demographic groups live in concentrated fashion in urban and rural communities.
Furthermore, millions may face the challenge of being underserved. According to Kaiser Health News, 18 million people reside in counties with hospitals that lack an ICU. Almost 11 million more residents live in counties without a hospital. In both cases, nearly one-fourth of the residents are 60 or older. Older adults face greater risk of severe outcomes if they experience COVID-19 due to their age. Many older adults live with one or more underlying conditions.
Disparity rates associated with underlying conditions provide insight into the groups with elevated risk of severe outcomes. These rates are not an excuse for poor prevention practices or for less robust intervention. Prevention measures include hand washing, disinfecting high-touch surfaces, social distancing, as well as avoiding large groups, traveling, and contact with persons experiencing illness.
The CDC recommended that individuals living with underlying health conditions maintain at least a 30-day supply of medication, 2-week supply of food, and knowledge of the COVID-19 symptoms. If you have underlying conditions and experience symptoms of COVID-19, including fever, cough, or shortness of breath, please contact your health care provider.
The CDC recommended that people who are sick should stay home with the sole exception of accessing medical care, especially those who work or interact with people with underlying health conditions and other at-risk persons. For individuals without underlying conditions, it is important to practice social distancing. Not only does this protect you, it protects our neighbors at higher risk of experiencing severe outcomes from COVID-19.
Our community members need to know we have their back. To put it in the words of the iconic pair Sonny and Cher, “I got you.”
William F. Tate IV is dean and vice provost for Graduate Education; Edward Mallinckrodt Distinguished Professor in Arts & Sciences; and faculty scholar, Institute for Public Health, at Washington University in St. Louis. Find him on Twitter @WFTate4.
Kally Xu is a John B. Ervin Scholar and Gephardt Institute Civic Scholar at Washington University in St. Louis, where she is a candidate in the 3-2 Masters of Public Health in the George Warren Brown School of Social Work and the A.B. program in International and Area Studies and Asian American Studies.