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ACEP COVID-19 Field Guide

Table of Contents

Populations at Risk

Risk Stratification and Evaluation

Populations at Risk

  • Age is the strongest risk factor for severe COVID-19 outcomes.
  • Approximately 54.1 million people aged 65 years or older reside in the United States; in 2020, this age group accounted for 81% of U.S. COVID-19 related deaths. 
  • As of February 7, 2022 (CDC COVID Data Tracker), the number of deaths in this group was more than 97 times the number of deaths in those aged 18–29.
  • In 2020, residents of long-term care facilities made up less than 1% of the U.S. population but accounted for more than 35% of all COVID-19 deaths.
  • Additionally, people ages 18 years and older with certain underlying medical conditions are at increased risk for severe illness from COVID-19.
  • Studies have shown that some people with certain disabilities are more likely to get COVID-19 and have worse outcomes.
  • Data have also shown that compared to non-Hispanic White people, people from racial and ethnic minority groups are more likely to die from COVID-19 at younger ages.
  • In 2020, the largest percentage increases in death occurred among adults aged 25–44 years and among Hispanic or Latino people.

Risk categories:

  • Higher risk for severe COVID-19 outcomes: 
    • An underlying medical condition or risk factor that has a published meta-analysis or systematic review or complete the CDC systematic review process. 
    • The meta-analysis or systematic review demonstrates good or strong evidence, for an increase in risk for at least one severe COVID-19 outcome.
  • Suggestive higher risk for severe COVID-19 outcomes:
    • An underlying medical condition or risk factor that neither has a published meta-analysis or systematic review nor completed the CDC systematic review process. 
    • The evidence is supported by mostly cohort, case-control, or cross-sectional studies. (Systematic reviews are available for some conditions for children with underlying conditions.)
  • Mixed evidence:
    • An underlying medical condition or risk factor that has a published meta-analysis or systematic review or completing the CDC systematic review process. 
    • The meta-analysis or systematic review is inconclusive, either because the aggregated data on the association between an underlying condition and severe COVID-19 outcomes are inconsistent in direction or there are insufficient data (or limited) on the association between an underlying conditions and severe COVID-19 outcomes.

Higher risk for severe COVID-19 outcome

  • Cancer
  • Cerebrovascular disease
  • Chronic kidney disease*
  • Chronic lung diseases limited to:
    • Interstitial lung disease
    • Pulmonary embolism
    • Pulmonary hypertension
    • Bronchiectasis
    • COPD (chronic obstructive pulmonary disease)
  • Chronic liver diseases limited to:
    • Cirrhosis
    • Non-alcoholic fatty liver disease
    • Alcoholic liver disease
    • Autoimmune hepatitis
  • Cystic fibrosis
  • Diabetes mellitus, type 1 and type 2*
  • Disabilities
    • Attention-Deficit/Hyperactivity Disorder (ADHD)
    • Cerebral Palsy
    • Congenital Malformations (Birth Defects)
    • Limitations with self-care or activities of daily living
    • Intellectual and Developmental Disabilities
    • Learning Disabilities
    • Spinal Cord Injuries
  • Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
  • HIV (human immunodeficiency virus)
  • Mental health disorders limited to:
    • Mood disorders, including depression
    • Schizophrenia spectrum disorders
  • Neurologic conditions limited to dementia
  • Obesity (BMI ≥30 kg/m2)*
  • Primary Immunodeficiencies
  • Pregnancy and recent pregnancy
  • Physical inactivity
  • Smoking, current and former
  • Solid organ or hematopoietic cell transplantation
  • Tuberculosis
  • Use of corticosteroids or other immunosuppressive medications

Suggestive higher risk for severe COVID-19 outcomes 

  • Children with certain underlying conditions
  • Overweight (BMI ≥25 kg/m2, but <30 kg/m2)
  • Sickle cell disease
  • Substance use disorders
  • Thalassemia

Mixed evidence:

  • Alpha 1 antitrypsin deficiency
  • Asthma
  • Bronchopulmonary dysplasia
  • Hepatitis B
  • Hepatitis C
  • Hypertension*

* indicates underlying conditions for which there is evidence for pregnant and non-pregnant people

For additional information see CDC’ Guidance on Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals

Risk Stratification and Evaluation

Quarantine and Isolation for Patients

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Treatment

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Treatment

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