The Centers for Disease Control and Prevention (CDC) recently updated and expanded the list of who is at increased risk of getting severely ill from COVID-19. (1) This information is important for registered dietitians to know on both a personal and professional level.

Severe illness from COVID-19 refers to hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.

Risk increases with age statement updated

• Previously, the CDC said that people over age 65 are at higher risk for severe illness from COVID-19. This warning has changed to reflect the fact that adults under age 65 may also be at higher risk.
• The CDC now states that among adults, the risk increases steadily with age. That is, those in their 50s are at higher risk than people in their 40s. People in their 60s or 70s are at higher risk than those in their 50s. (2)
• People age 85 and older continue to be at greatest risk for severe illness due to COVID-19.

Underlying medical conditions are updatedAfter reviewing evidence, the CDC made some changes to its list of underlying medical conditions that put people of all ages at increased risk for severe COVID-19 illness.For the public, the CDC publishes two lists: medical conditions that do increase risk for severe illness and medical conditions that might increase risk. (3) If you’re interested, there’s also a table that separates underlying conditions into categories by level of evidence: strong/most consistent evidence, mixed evidence, and limited evidence. (4)Having more than one underlying medical condition further increases the risk of severe COVID-19 illness.Here are updates to the list of underlying medical conditions that do increase risk for severe illness (there is strong/consistent evidence for each):Changes from the previous list:

• Obesity (BMI of 30 or higher) – previously listed as “severe obesity (BMI of 40 or higher)”
• Chronic kidney disease – previously listed as “chronic kidney disease requiring dialysis”
• Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies – previously listed as “serious heart conditions”

Added to the list: Immunocompromised state from solid organ transplantNo change:

• Sickle cell disease
• Type 2 diabetes
• COPD

Obesity & COVID-19With obesity, as opposed to severe obesity, now considered an underlying health condition that increases the risk for severe COVID-19 illness, this means that more Americans are in danger of becoming very sick if they get COVID-19. About 42 percent of U.S. adults have obesity, while about 9 percent have severe obesity. (5)Here are updates to the list of underlying conditions that might increase the risk for severe illness:Added to the list:

• Cerebrovascular disease
• Hypertension
• Pregnancy

No change:

• Asthma
• Cystic fibrosis
• Immunocompromised state from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
• Liver disease
• Neurologic conditions, such as dementia
• Pulmonary fibrosis
• Smoking
• Thalassemia
• Type 1 diabetes

Pregnancy & COVID-19Information about COVID-19 and pregnancy has been and continues to be limited; however, the CDC points to data from a June 26 Morbidity and Mortality Weekly Report showing that pregnant women with COVID-19 were more likely to be hospitalized and to require a ventilator when compared to nonpregnant women. Pregnant women do not appear to be at higher risk of death from COVID-19. (6)Bottom lineThe CDC notes that more is being learned about COVID-19 every day. Registered dietitians need to stay informed so they can provide accurate information to clients and employees who are at higher risk of severe COVID-19 illness. Also keep in mind populations, including racial and ethnic minority groups, that should take extra precautions. According to a new study in the Lancet about 22% of the world’s population has at least one underlying condition to put them at risk of serious illness from the COVID-19 virus.(7)By Hollis Bass, MEd, RDSources:

1. https://www.cdc.gov/media/releases/2020/p0625-update-expands-covid-19.html
2. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html
3. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html
4. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html
5. https://www.cdc.gov/obesity/data/adult.html
6. https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm
7. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30264-3/fulltext#

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