Why chronically ill, elders at higher risk

Many Americans now have two or more chronic diseases.

The coronavirus is most brutal to the old and the chronically ailing. That is a vast cohort in the U.S. — millions of people — who are not blessed with youth and good health, and who now face an enigmatic pathogen that no human immune system has ever encountered and for which there is no vaccine.

Who is at risk?

Late Monday, the Centers for Disease Control and Prevention released new coronavirus guidelines that attempted to describe who is at higher risk and provide common-sense counsel on how everyone can protect themselves and their families and communities from COVID-19, the flulike disease caused by the coronavirus.

The CDC stated that “older adults” are at higher risk, but did not define the term. It said people suffering from “serious chronic medical conditions” are also at higher risk, and gave three examples: heart disease, diabetes and lung disease.

Few children have been seriously ill from COVID-19 and most adults who get infected will suffer only mild or moderate symptoms, according to infectious disease experts. But more serious outcomes have been seen among people over the age of 60.

Patients of all ages with no underlying chronic conditions had a fatality rate of 1.4%, according to the WHO report. COVID19 patients with cardiovascular disease had a rate of 13.2%; with diabetes, 9.2%; with hypertension, 8.4%; with chronic respiratory disease, 8%; and with cancer, 7.6%.

Why it could be worse in U.S.

The U.S. has its own suite of health challenges. Research shows a rise in death rates among young and middle-aged adults. The U.S. public is remarkably unhealthy compared to people in similarly affluent nations — a phenomenon known as the U.S. health disadvantage. One example: A 2015 CDC study found that 30 million Americans have diabetes.

“When we compare our health to Europeans, we have more disease, more disability,” said Eileen Crimmins, a professor of gerontology at the University of Southern California.

Why they’re at risk

She said the 2016 Health and Retirement Study found that 38% of people between the ages of 50 and 59 had at least one of four diseases: diabetes, cancer, heart disease or lung disease. That percentage increases with each decade, peaking at 70% for people between 80 and 89.

Many Americans now have two or more chronic diseases. According to the CDC, 21% of people between the ages of 45 and 64 had at least two chronic diseases in a survey conducted in 2009-2010, compared to 16% in 1999-2000.

One explanation for the elderly’s higher mortality is that as people age, their immune systems age too, in the same way bones get weaker.

Among cancer patients, people with blood malignancies such as non-Hodgkin’s lymphoma, multiple myeloma and acute lymphoblastic leukemia are at highest risk for coronavirus complications, said Steve Pergam, an infectious disease specialist at Fred Hutchinson Cancer Research Center in Seattle. Those diseases affect the body’s infection-fighting cells.

On top of that, the treatments for those illnesses — such as bone-marrow transplants and chemotherapy — further suppress the immune system, he said.