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1 Question, 5 Answers: What Should People With Underlying Conditions Do to Stay Safe?

Kelsey Tyler

Coronavirus information changes quickly, so please note the publication date on this story. You can find current recommendations and national outbreak data on the CDC website. Or, if you want local coronavirus updates, check out the department of health website for your state or your city. Enjoy reading and stay safe. 


Right now, flattening the curve is a priority. To curb the spread of infection, we’re disinfecting door knobs, choosing “contact-less” delivery and seeing friends on Zoom. While social distancing measures are recommended for everyone, the Centers for Disease Control and Prevention urges extra precautions for members of “higher-risk groups.” That means people over 65 years old, as well as those with compromised immune systems or various underlying illnesses, including diabetes and lung disease.

We asked five doctors what people deemed “higher risk” should do to minimize their risk of coronavirus exposure. Here’s what they had to say. 


Dr. Reuben Elovitz, MD

Internist and CEO at Private Health Dallas
Dallas

Based upon the history of other viral infections, those with underlying conditions are likely at increased risk of “catching” COVID-19, and at increased risk of severe illness and even death if they catch it. Several precautions will apply for people age 65 and older, and those with preexisting and/or high risk conditions, such as: Stay home as much as possible, call your [healthcare provider] if you develop any symptoms and request a 90 day supply of prescription medications.

People who live in a nursing home or long-term care facility should isolate themselves from visitors, volunteers and nonessential healthcare personnel, and avoid group activities and communal dining. People with chronic lung disease or moderate to severe asthma are particularly vulnerable to COVID-19 and should have a 90-day supply of inhalers, nebulizers and other medical equipment, and follow their asthma action plan. This includes aggressively treating allergies to prevent asthma flares.

People who have serious heart conditions should monitor vitals including weight, blood pressure and heart rate. Most importantly, do not stop blood pressure medications based upon news reports, or self-treat and adjust medications without consulting with a doctor. People who are immunocompromised, including HIV and cancer patients, should consult their doctor to find out if the pandemic will alter treatment or follow-up appointments. 

Anyone of any age with severe obesity (body mass index [BMI] greater than 40) or certain underlying medical conditions, particularly if not well-controlled, such as diabetes, renal failure or liver disease, might also be at risk. It’s crucial to get any preexisting medical conditions under better control where possible.


Dr. Shon Chakrabarti, MD, MPH

Interventional cardiologist and medical director at Abiomed
Boston

While new data is emerging each day, we believe that older adults and people with serious underlying medical conditions are at higher risk of severe illness from COVID-19. People with health conditions should take the same social-distancing precautions that are recommended for all individuals. In addition, patients should ensure they have a regular supply of their chronic medications, including refills through at least 90 days, given the strain on the healthcare system this pandemic is creating. It’s important to keep in mind that regular office visits may be more difficult to conduct for many healthcare providers, who are just now gearing up for effective telehealth visits

Make sure you are closely monitoring any health or symptom changes. Patients who are immunocompromised or [who] have heart or chronic lung disease may be more likely to contract illness and have a higher likelihood of severe disease once infected, which is noted by the American College of Cardiology

Continue cardiovascular exercise where possible. If you can no longer access a gym due to the latest restrictions and guidelines, you should consider walks or jogs outside. Keeping social distancing in mind, it’s best to do this by yourself, avoiding areas that may have large groups of people.

I would urge everyone to support our healthcare providers by abiding by the social distancing guidelines set forth, including staying home! While at home, maintaining physical and mental health is a challenge, but adapting until this pandemic is past us will save lives.


Dr. Brandon Colby, MD

Founder of Sequencing.com, author of Outsmart Your Genes
Los Angeles

For the past month, I’ve been focused on the coronavirus pandemic and identifying ways to better assess risk of severity of COVID-19 progressing to a more severe illness and how to personalize prevention. Patients with health issues that affect the lungs, heart, brain or immune system are at higher risk of COVID-19 turning into a severe, life-threatening illness. There are a wide range of conditions that impact the immune system, such as cancer, autoimmune diseases and even sleep abnormalities. 

All patients with any preexisting health issue should consider themselves at higher risk. For example, high blood sugar [conditions], such as prediabetes, may not require any medication and may not be thought of as a health issue. However, high blood sugar negatively impacts the immune system. So even a health issue that may seem harmless can still increase risk of COVID-19 turning into a severe illness. Because of this, it’s prudent for anyone with a health issue to focus on getting their condition as under control as possible right now. Now is the time to follow your doctor’s recommendations.

If someone with a health issue has any symptoms of COVID-19, they should contact their doctor or their hospital sooner rather than later. Doctors may prioritize COVID-19 testing, closely monitor the patient, and at the first signs of any deterioration of health, start more aggressive supportive therapies. While more research is needed to definitely determine if patients with pre-existing conditions are more susceptible to coronavirus infection, what is most important is that people with any health conditions take extra precautions to avoid exposure.


Dr. Daniel Vorobiof, MD

Oncologist and chief medical director of Belong.Life
Johannesburg

One of the important findings noticed during the first wave of the COVID-19 infection in China was the fact that patients with cancer represented a high-risk immunocompromised population, together with patients suffering from other chronic medical problems and those over 60 years of age. The known preexisting conditions that are considered to be at high risk of developing COVID-19 are cancer (specifically patients currently receiving or who have recently received anti-cancer treatment), diabetes, heart and vascular diseases, autoimmune disorders, HIV/AIDs, preexisting tuberculosis and patients receiving immunosuppressive medications.  

Strict preventive measures for cancer patients need to be put in place in order to reduce possible contamination, such as home isolation, washing of hands multiple times a day, use of masks and gloves when outside the house (such as for a visit to the doctor or medical center) and social distancing. Patients should be prepared to spend a long period at home and try to follow a daily routine, keep in contact with their family and friends, and remain positive and informed. All patients with preexisting conditions should follow the same precautions.

Because of their immunocompromised status, patients with underlying conditions are at high risk of contracting the infection, and thereafter they will have a more difficult course of the disease. We are in this situation alone and together — alone at home, but still connected with the rest of the world. Make the best of it, keep in touch with family and friends, share good news and a laugh — it is good for those of us who are healthy and those who unfortunately are not.


Dr. Abe Malkin, MD, MBA

Founder and medical director of Concierge MD LA
Los Angeles

We have seen a broad range of symptoms and health outcomes associated with COVID-19. Much of this is related to the patients’ underlying health status and existence of underlying health issues. Those most affected by the COVID-19 virus appear to be patients with underlying respiratory issues such as asthma or COPD, as well as those who have a compromised immune system, such as cancer patients. Others with chronic conditions such as cardiovascular disease, obesity and diabetes have also experienced a worsening impact of the virus with worse health outcomes. 

For those who are likely to experience the most severe complications, it is extremely important to practice rigorous preventive measures, including social distancing, especially from those who may be infected, and general health precautions such as regular hand-washing and wearing protective equipment when appropriate. Additionally, taking measures to bolster the immune system, such as taking over-the-counter vitamins like vitamin C and zinc, avoiding alcohol or tobacco products, and making sure to get plenty of sleep at night. Patients with preexisting conditions are both more likely to catch the virus due to a weakened immune system, as well as more likely to develop complications from the virus, given their compromised health status.

In light of this pandemic and ongoing health concerns, there has been a general focus on practicing good health habits in order to bolster a healthy immune system, such as regular exercise and eating a healthy diet. This should hopefully give us a wake-up call to practice these habits regularly, not just during a crisis, so that we are better prepared to handle the effects of a pandemic such as this in the future.


Dr. Geoffey Mount Varner, MD, MPH

ER physician, former medical director for Washington, DC, and decision-making expert
Washington, DC

Social isolation is key. Six feet apart helps keep you and your family from being six feet under.

COVID-19 has a greater impact on those with underlying medical conditions, such as those living with lung disease, including asthma; people who are immunocompromised; active cancer patients and patients who are HIV-positive, have uncontrolled diabetes, uncontrolled hypertension or are elderly. People who are in the high-risk group are more vulnerable to infections than others.

The high-risk group should be sure to socially isolate from others. Keep in mind that most people who have COVID-19 are most infectious three days prior to showing symptoms. Hence you should assume that anyone you come across is positive for the virus. Studies have shown that over-the-counter vitamin D has helped decrease respiratory bacterial and viral infections. Please discuss with a doctor, especially if you have kidney problems, including stones. Staying well hydrated is important. Your respiratory tract naturally produces mucus which is helpful, but if you are dehydrated, then the mucus becomes too thick.


Responses have been condensed and lightly edited.

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