ACEP COVID-19 Field Guide

Table of Contents

Populations at Risk

Risk Stratification and Evaluation

For information, see MDCALC’s COVID-19 Resource Center.

COVID-19 risk related to age

Moving away from age thresholds, risk related to age increases steadily as you age, and it’s not just those over the age of 65 who are at increased risk for severe illness.

Recent data has shown that the older people are, the higher their risk of severe illness from COVID-19. Age is an independent risk factor for severe illness, but risk in older adults is also in part related to the increased likelihood that older adults also have underlying medical conditions.

COVID-19 risk related to underlying medical conditions

There was consistent evidence (from multiple small studies or a strong association from a large study) that specific conditions increase a person’s risk of severe COVID-19 illness:

  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Obesity (BMI of 30 or higher)
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes

An estimated 60 percent of American adults have at least one chronic medical condition. Obesity is one of the most common underlying conditions that increases one’s risk for severe illness – with about 40 percent of U.S. adults having obesity.  The more underlying medical conditions people have, the higher their risk.

Other conditions that potentially increase risk of severe illness

Currently there are limited data and information about the impact of underlying medical conditions and whether they increase the risk for severe illness from COVID-19. Based on what is known, people with the following conditions might be at an increased risk for severe illness from COVID-19:

  • Asthma (moderate-to-severe)
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Pregnancy
  • Pulmonary fibrosis (having damaged or scarred lung tissues)
  • Smoking
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

For more information on high-risk populations, refer to the CDC’s guidance on “People Who Are at Higher Risk for Severe Illness” and “CDC updates, expands list of people at risk of severe COVID-19 illness”. Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19 can be found on this CDC website

COVID-19 is a new disease, and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions may be at higher risk for severe illness from COVID-19.

Based on what we know now, those at high risk for severe illness from COVID-19 include:

  • People aged 65 years and older;
  • People who live in a nursing home or long-term care facility;
  • People of all ages with underlying medical conditions, particularly if the condition is not well controlled, including:
    • People with chronic lung disease or moderate to severe asthma;
    • People who have serious heart conditions;
    • People who are immunocompromised, such as those with a history of cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications;
    • People with severe obesity (body mass index [BMI] of 40 or higher);
    • People with diabetes;
    • People with chronic kidney disease who are undergoing dialysis; and
    • People with liver disease.

For more information on high-risk populations, refer to the CDC’s guidance on “People Who Are at Higher Risk for Severe Illness.”


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