COVID-19 risk factors: Difference between revisions

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'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>


{{CMG}} ; {{AE}} {{sab}} {{SaraH}} {{Aisha}}
{{CMG}} ; {{AE}} {{SaraH}} {{sab}} {{Aisha}}


==Overview==
==Overview==


Similar to all [[Viral disease|viral illnesses]], exposure is considered the most significant [[risk factor]] for [[infection]] with Coronavirus disease 2019 (COVID-19). Individuals at risk for the severe form of the [[disease]] include [[Old age|elderly]] (those aged 60+), [[cardiovascular disease]] [[Patient|patients]], [[Diabetic|diabetics]], [[Chronic (medical)|chronic]] [[respiratory disease]] [[Patient|patients]], [[Hypertension|hypertensive]] [[Patient|patients]], [[Cancer patient|cancer patients]], and individuals in long term care facilities.
Front-line [[health-care workers]] are at increased [[risk]] of having a positive Coronavirus disease 2019 ([[COVID-19]]) test.
Similar to all [[Viral disease|viral illnesses]], exposure is considered the most significant [[risk factor]] for [[infection]] with [[SARS-CoV-2]] that causes [[COVID-19]]. [[Racial]] and [[ethnic]] minority groups are at increased risk of the infection.
The most common risk factors associated with a severe form of the [[disease]] include [[Old age|elderly]] (those aged 60+), male sex, [[cardiovascular disease]], [[Diabetic|diabetes mellitus]], [[Chronic (medical)|chronic]] [[kidney disease]], [[COPD]], [[Hypertension|hypertension]], [[Cancer]], [[Solid organ]] [[transplantation]], [[Sickle cell disease]], and [[Obesity]] ([[BMI]] > 30).
 
==Risk Factors==
==Risk Factors==
A recent study showed that front-line health-care workers were at increased risk of having a positive [[COVID-19]] test (adjusted [[HR]] 3·40, 95% CI 3·37–3·43). Adequacy of [[PPE]], clinical setting, and ethnic background were important factors for a higher positive test result in this group.<ref name="NguyenDrew2020">{{cite journal|last1=Nguyen|first1=Long H|last2=Drew|first2=David A|last3=Graham|first3=Mark S|last4=Joshi|first4=Amit D|last5=Guo|first5=Chuan-Guo|last6=Ma|first6=Wenjie|last7=Mehta|first7=Raaj S|last8=Warner|first8=Erica T|last9=Sikavi|first9=Daniel R|last10=Lo|first10=Chun-Han|last11=Kwon|first11=Sohee|last12=Song|first12=Mingyang|last13=Mucci|first13=Lorelei A|last14=Stampfer|first14=Meir J|last15=Willett|first15=Walter C|last16=Eliassen|first16=A Heather|last17=Hart|first17=Jaime E|last18=Chavarro|first18=Jorge E|last19=Rich-Edwards|first19=Janet W|last20=Davies|first20=Richard|last21=Capdevila|first21=Joan|last22=Lee|first22=Karla A|last23=Lochlainn|first23=Mary Ni|last24=Varsavsky|first24=Thomas|last25=Sudre|first25=Carole H|last26=Cardoso|first26=M Jorge|last27=Wolf|first27=Jonathan|last28=Spector|first28=Tim D|last29=Ourselin|first29=Sebastien|last30=Steves|first30=Claire J|last31=Chan|first31=Andrew T|last32=Albert|first32=Christine M.|last33=Andreotti|first33=Gabriella|last34=Bala|first34=Bijal|last35=Balasubramanian|first35=Bijal A.|last36=Beane-Freeman|first36=Laura E.|last37=Brownstein|first37=John S.|last38=Bruinsma|first38=Fiona J.|last39=Coresh|first39=Joe|last40=Costa|first40=Rui|last41=Cowan|first41=Annie N.|last42=Deka|first42=Anusila|last43=Deming-Halverson|first43=Sandra L.|last44=Elena Martinez|first44=Maria|last45=Ernst|first45=Michael E.|last46=Figueiredo|first46=Jane C.|last47=Fortuna|first47=Pedro|last48=Franks|first48=Paul W.|last49=Freeman|first49=Laura Beane|last50=Gardner|first50=Christopher D.|last51=Ghobrial|first51=Irene M.|last52=Haiman|first52=Christopher A.|last53=Hall|first53=Janet E.|last54=Kang|first54=Jae H.|last55=Kirpach|first55=Brenda|last56=Koenen|first56=Karestan C.|last57=Kubzansky|first57=Laura D.|last58=Lacey, Jr|first58=James V.|last59=Le Marchand|first59=Loic|last60=Lin|first60=Xihong|last61=Lutsey|first61=Pam|last62=Marinac|first62=Catherine R.|last63=Martinez|first63=Maria Elena|last64=Milne|first64=Roger L.|last65=Murray|first65=Anne M.|last66=Nash|first66=Denis|last67=Palmer|first67=Julie R.|last68=Patel|first68=Alpa V.|last69=Pierce|first69=Eric|last70=Robertson|first70=McKaylee M.|last71=Rosenberg|first71=Lynn|last72=Sandler|first72=Dale P.|last73=Schurman|first73=Shepherd H.|last74=Sewalk|first74=Kara|last75=Sharma|first75=Shreela V.|last76=Sidey-Gibbons|first76=Christopher J.|last77=Slevin|first77=Liz|last78=Smoller|first78=Jordan W..|last79=Steves|first79=Claire J.|last80=Tiirikainen|first80=Maarit I.|last81=Weiss|first81=Scott T.|last82=Wilkens|first82=Lynne R.|last83=Zhang|first83=Feng|title=Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study|journal=The Lancet Public Health|year=2020|issn=24682667|doi=10.1016/S2468-2667(20)30164-X}}</ref>
A recent study showed that front-line health-care workers were at increased risk of having a positive [[COVID-19]] test (adjusted [[HR]] 3·40, 95% CI 3·37–3·43). Adequacy of [[PPE]], clinical setting, and ethnic background were important factors for a higher positive test result in this group.<ref name="NguyenDrew2020">{{cite journal|last1=Nguyen|first1=Long H|last2=Drew|first2=David A|last3=Graham|first3=Mark S|last4=Joshi|first4=Amit D|last5=Guo|first5=Chuan-Guo|last6=Ma|first6=Wenjie|last7=Mehta|first7=Raaj S|last8=Warner|first8=Erica T|last9=Sikavi|first9=Daniel R|last10=Lo|first10=Chun-Han|last11=Kwon|first11=Sohee|last12=Song|first12=Mingyang|last13=Mucci|first13=Lorelei A|last14=Stampfer|first14=Meir J|last15=Willett|first15=Walter C|last16=Eliassen|first16=A Heather|last17=Hart|first17=Jaime E|last18=Chavarro|first18=Jorge E|last19=Rich-Edwards|first19=Janet W|last20=Davies|first20=Richard|last21=Capdevila|first21=Joan|last22=Lee|first22=Karla A|last23=Lochlainn|first23=Mary Ni|last24=Varsavsky|first24=Thomas|last25=Sudre|first25=Carole H|last26=Cardoso|first26=M Jorge|last27=Wolf|first27=Jonathan|last28=Spector|first28=Tim D|last29=Ourselin|first29=Sebastien|last30=Steves|first30=Claire J|last31=Chan|first31=Andrew T|last32=Albert|first32=Christine M.|last33=Andreotti|first33=Gabriella|last34=Bala|first34=Bijal|last35=Balasubramanian|first35=Bijal A.|last36=Beane-Freeman|first36=Laura E.|last37=Brownstein|first37=John S.|last38=Bruinsma|first38=Fiona J.|last39=Coresh|first39=Joe|last40=Costa|first40=Rui|last41=Cowan|first41=Annie N.|last42=Deka|first42=Anusila|last43=Deming-Halverson|first43=Sandra L.|last44=Elena Martinez|first44=Maria|last45=Ernst|first45=Michael E.|last46=Figueiredo|first46=Jane C.|last47=Fortuna|first47=Pedro|last48=Franks|first48=Paul W.|last49=Freeman|first49=Laura Beane|last50=Gardner|first50=Christopher D.|last51=Ghobrial|first51=Irene M.|last52=Haiman|first52=Christopher A.|last53=Hall|first53=Janet E.|last54=Kang|first54=Jae H.|last55=Kirpach|first55=Brenda|last56=Koenen|first56=Karestan C.|last57=Kubzansky|first57=Laura D.|last58=Lacey, Jr|first58=James V.|last59=Le Marchand|first59=Loic|last60=Lin|first60=Xihong|last61=Lutsey|first61=Pam|last62=Marinac|first62=Catherine R.|last63=Martinez|first63=Maria Elena|last64=Milne|first64=Roger L.|last65=Murray|first65=Anne M.|last66=Nash|first66=Denis|last67=Palmer|first67=Julie R.|last68=Patel|first68=Alpa V.|last69=Pierce|first69=Eric|last70=Robertson|first70=McKaylee M.|last71=Rosenberg|first71=Lynn|last72=Sandler|first72=Dale P.|last73=Schurman|first73=Shepherd H.|last74=Sewalk|first74=Kara|last75=Sharma|first75=Shreela V.|last76=Sidey-Gibbons|first76=Christopher J.|last77=Slevin|first77=Liz|last78=Smoller|first78=Jordan W..|last79=Steves|first79=Claire J.|last80=Tiirikainen|first80=Maarit I.|last81=Weiss|first81=Scott T.|last82=Wilkens|first82=Lynne R.|last83=Zhang|first83=Feng|title=Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study|journal=The Lancet Public Health|year=2020|issn=24682667|doi=10.1016/S2468-2667(20)30164-X}}</ref>
===Risk factors associated with increased risk of infection===
===Risk Factors Associated with Increased Risk of Infection===
Similar to all [[Viral disease|viral illnesses]], exposure is considered the most significant [[risk factor]] for [[infection]] with Coronavirus disease 2019 (COVID-19). Racial and ethnic minority groups are at increased risk of getting sick and dying from COVID-19 {{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}
Similar to all [[Viral disease|viral illnesses]], exposure is considered the most significant [[risk factor]] for [[infection]] with Coronavirus disease 2019 ([[COVID-19]]). According to CDC, racial and ethnic minority groups are at increased risk of getting sick and dying from [[COVID-19]] <ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
*[[Discrimination]]: Unfortunately, discrimination exists in systems meant to protect well-being or health. Examples of such systems include health care, housing, education, criminal justice, and finance.
 
*[[Healthcare]] access and utilization: People from some [[racial]] and [[ethnic]] minority groups are more likely to be uninsured than non-Hispanic whites.
*[[Discrimination]]: Unfortunately, discrimination exists in systems meant to protect well-being or health. Examples of such systems include health care, housing, education, criminal justice, and finance.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
*Occupation: People from some racial and ethnic minority groups are disproportionately represented in essential work settings such as [[healthcare]] facilities, farms, factories, grocery stores, and public transportation. Chances to be exposed to the [[SARS-CoV-2]] virus.
*[[Healthcare]] access and utilization: People from some [[racial]] and [[ethnic]] minority groups are more likely to be uninsured than non-Hispanic whites.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
*Educational, income, and wealth gaps: People with limited job options likely have less flexibility to leave jobs that may put them at a higher risk of exposure. They often cannot afford to miss work, even if they’re sick.
*Occupation: People from some racial and ethnic minority groups are disproportionately represented in essential work settings such as [[healthcare]] facilities, farms, factories, grocery stores, and public transportation. Chances to be exposed to the [[SARS-CoV-2]] virus.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
*Housing: Some people from racial and ethnic minority groups live in crowded conditions that make it more challenging to follow prevention strategies.
*Educational, income, and wealth gaps: People with limited job options likely have less flexibility to leave jobs that may put them at a higher risk of exposure. They often cannot afford to miss work, even if they’re sick.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
**[[Culture]]: In some cultures, it is common for family members of many generations to live in one household.
*Housing: Some people from racial and ethnic minority groups live in crowded conditions that make it more challenging to follow prevention strategies.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
**unemployment rates for some racial and ethnic minority groups during the [[pandemic]] may lead to a greater risk of eviction and homelessness or sharing of housing.
**[[Culture]]: In some cultures, it is common for family members of many generations to live in one household.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
**unemployment rates for some racial and ethnic minority groups during the [[pandemic]] may lead to a greater risk of eviction and homelessness or sharing of housing.<ref name="CDC">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html |title=Health Equity Considerations and Racial and Ethnic Minority Groups &#124; CDC |format= |work= |accessdate=}}</ref>
 
===Risk Factors Associated with Increased Risk of Mortality and Severity of the Disease===


===Risk factors associated with increased risk of mortality and severity of the disease===
*Individuals at risk for the severe form of the [[disease]] include:<ref>{{Cite web|url=http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LiGuan2020">{{cite journal|last1=Li|first1=Qun|last2=Guan|first2=Xuhua|last3=Wu|first3=Peng|last4=Wang|first4=Xiaoye|last5=Zhou|first5=Lei|last6=Tong|first6=Yeqing|last7=Ren|first7=Ruiqi|last8=Leung|first8=Kathy S.M.|last9=Lau|first9=Eric H.Y.|last10=Wong|first10=Jessica Y.|last11=Xing|first11=Xuesen|last12=Xiang|first12=Nijuan|last13=Wu|first13=Yang|last14=Li|first14=Chao|last15=Chen|first15=Qi|last16=Li|first16=Dan|last17=Liu|first17=Tian|last18=Zhao|first18=Jing|last19=Liu|first19=Man|last20=Tu|first20=Wenxiao|last21=Chen|first21=Chuding|last22=Jin|first22=Lianmei|last23=Yang|first23=Rui|last24=Wang|first24=Qi|last25=Zhou|first25=Suhua|last26=Wang|first26=Rui|last27=Liu|first27=Hui|last28=Luo|first28=Yinbo|last29=Liu|first29=Yuan|last30=Shao|first30=Ge|last31=Li|first31=Huan|last32=Tao|first32=Zhongfa|last33=Yang|first33=Yang|last34=Deng|first34=Zhiqiang|last35=Liu|first35=Boxi|last36=Ma|first36=Zhitao|last37=Zhang|first37=Yanping|last38=Shi|first38=Guoqing|last39=Lam|first39=Tommy T.Y.|last40=Wu|first40=Joseph T.|last41=Gao|first41=George F.|last42=Cowling|first42=Benjamin J.|last43=Yang|first43=Bo|last44=Leung|first44=Gabriel M.|last45=Feng|first45=Zijian|title=Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia|journal=New England Journal of Medicine|year=2020|issn=0028-4793|doi=10.1056/NEJMoa2001316}}</ref><ref name="HeymannShindo2020">{{cite journal|last1=Heymann|first1=David L|last2=Shindo|first2=Nahoko|title=COVID-19: what is next for public health?|journal=The Lancet|volume=395|issue=10224|year=2020|pages=542–545|issn=01406736|doi=10.1016/S0140-6736(20)30374-3}}</ref><ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="HuSong2020">{{cite journal|last1=Hu|first1=Zhiliang|last2=Song|first2=Ci|last3=Xu|first3=Chuanjun|last4=Jin|first4=Guangfu|last5=Chen|first5=Yaling|last6=Xu|first6=Xin|last7=Ma|first7=Hongxia|last8=Chen|first8=Wei|last9=Lin|first9=Yuan|last10=Zheng|first10=Yishan|last11=Wang|first11=Jianming|last12=Hu|first12=Zhibin|last13=Yi|first13=Yongxiang|last14=Shen|first14=Hongbing|title=Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China|journal=Science China Life Sciences|year=2020|issn=1674-7305|doi=10.1007/s11427-020-1661-4}}</ref><ref name="PorchedduSerra2020">{{cite journal|last1=Porcheddu|first1=Rossella|last2=Serra|first2=Caterina|last3=Kelvin|first3=David|last4=Kelvin|first4=Nikki|last5=Rubino|first5=Salvatore|title=Similarity in Case Fatality Rates (CFR) of COVID-19/SARS-COV-2 in Italy and China|journal=The Journal of Infection in Developing Countries|volume=14|issue=02|year=2020|pages=125–128|issn=1972-2680|doi=10.3855/jidc.12600}}</ref><ref name="Wilder-SmithChiew2020">{{cite journal|last1=Wilder-Smith|first1=Annelies|last2=Chiew|first2=Calvin J|last3=Lee|first3=Vernon J|title=Can we contain the COVID-19 outbreak with the same measures as for SARS?|journal=The Lancet Infectious Diseases|year=2020|issn=14733099|doi=10.1016/S1473-3099(20)30129-8}}</ref>
* Individuals at risk for the severe form of the [[disease]] include:<ref>{{Cite web|url=http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LiGuan2020">{{cite journal|last1=Li|first1=Qun|last2=Guan|first2=Xuhua|last3=Wu|first3=Peng|last4=Wang|first4=Xiaoye|last5=Zhou|first5=Lei|last6=Tong|first6=Yeqing|last7=Ren|first7=Ruiqi|last8=Leung|first8=Kathy S.M.|last9=Lau|first9=Eric H.Y.|last10=Wong|first10=Jessica Y.|last11=Xing|first11=Xuesen|last12=Xiang|first12=Nijuan|last13=Wu|first13=Yang|last14=Li|first14=Chao|last15=Chen|first15=Qi|last16=Li|first16=Dan|last17=Liu|first17=Tian|last18=Zhao|first18=Jing|last19=Liu|first19=Man|last20=Tu|first20=Wenxiao|last21=Chen|first21=Chuding|last22=Jin|first22=Lianmei|last23=Yang|first23=Rui|last24=Wang|first24=Qi|last25=Zhou|first25=Suhua|last26=Wang|first26=Rui|last27=Liu|first27=Hui|last28=Luo|first28=Yinbo|last29=Liu|first29=Yuan|last30=Shao|first30=Ge|last31=Li|first31=Huan|last32=Tao|first32=Zhongfa|last33=Yang|first33=Yang|last34=Deng|first34=Zhiqiang|last35=Liu|first35=Boxi|last36=Ma|first36=Zhitao|last37=Zhang|first37=Yanping|last38=Shi|first38=Guoqing|last39=Lam|first39=Tommy T.Y.|last40=Wu|first40=Joseph T.|last41=Gao|first41=George F.|last42=Cowling|first42=Benjamin J.|last43=Yang|first43=Bo|last44=Leung|first44=Gabriel M.|last45=Feng|first45=Zijian|title=Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia|journal=New England Journal of Medicine|year=2020|issn=0028-4793|doi=10.1056/NEJMoa2001316}}</ref><ref name="HeymannShindo2020">{{cite journal|last1=Heymann|first1=David L|last2=Shindo|first2=Nahoko|title=COVID-19: what is next for public health?|journal=The Lancet|volume=395|issue=10224|year=2020|pages=542–545|issn=01406736|doi=10.1016/S0140-6736(20)30374-3}}</ref><ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="HuSong2020">{{cite journal|last1=Hu|first1=Zhiliang|last2=Song|first2=Ci|last3=Xu|first3=Chuanjun|last4=Jin|first4=Guangfu|last5=Chen|first5=Yaling|last6=Xu|first6=Xin|last7=Ma|first7=Hongxia|last8=Chen|first8=Wei|last9=Lin|first9=Yuan|last10=Zheng|first10=Yishan|last11=Wang|first11=Jianming|last12=Hu|first12=Zhibin|last13=Yi|first13=Yongxiang|last14=Shen|first14=Hongbing|title=Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China|journal=Science China Life Sciences|year=2020|issn=1674-7305|doi=10.1007/s11427-020-1661-4}}</ref><ref name="PorchedduSerra2020">{{cite journal|last1=Porcheddu|first1=Rossella|last2=Serra|first2=Caterina|last3=Kelvin|first3=David|last4=Kelvin|first4=Nikki|last5=Rubino|first5=Salvatore|title=Similarity in Case Fatality Rates (CFR) of COVID-19/SARS-COV-2 in Italy and China|journal=The Journal of Infection in Developing Countries|volume=14|issue=02|year=2020|pages=125–128|issn=1972-2680|doi=10.3855/jidc.12600}}</ref><ref name="Wilder-SmithChiew2020">{{cite journal|last1=Wilder-Smith|first1=Annelies|last2=Chiew|first2=Calvin J|last3=Lee|first3=Vernon J|title=Can we contain the COVID-19 outbreak with the same measures as for SARS?|journal=The Lancet Infectious Diseases|year=2020|issn=14733099|doi=10.1016/S1473-3099(20)30129-8}}</ref>
**[[Cardiovascular disease]] [[Patient|patients]]
**[[Cardiovascular disease]] [[Patient|patients]]
**[[Diabetic|Diabetics]]
**[[Diabetic|Diabetics]]
Line 29: Line 34:
**[[Cancer patient|Cancer patients]]
**[[Cancer patient|Cancer patients]]
**Individuals in long term care facilities
**Individuals in long term care facilities
**People from black and minority ethnic (BME) groups
**Males
**Males
***According to a [[systematic review]] and [[Meta-analysis]] males had significantly higher [[mortality]] compared to females ([[OR]] 3.4; 95% [[CI]] 1.2–9.1, P=0.01)<ref name="NasiriHaddadi2020">{{cite journal|last1=Nasiri|first1=Mohammad Javad|last2=Haddadi|first2=Sara|last3=Tahvildari|first3=Azin|last4=Farsi|first4=Yeganeh|last5=Arbabi|first5=Mahta|last6=Hasanzadeh|first6=Saba|last7=Jamshidi|first7=Parnian|last8=Murthi|first8=Mukunthan|last9=Mirsaeidi|first9=Mehdi|title=COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis|journal=Frontiers in Medicine|volume=7|year=2020|issn=2296-858X|doi=10.3389/fmed.2020.00459}}</ref>
***According to a [[systematic review]] and [[Meta-analysis]] males had significantly higher [[mortality]] compared to females ([[OR]] 3.4; 95% [[CI]] 1.2–9.1, P=0.01)<ref name="NasiriHaddadi2020">{{cite journal|last1=Nasiri|first1=Mohammad Javad|last2=Haddadi|first2=Sara|last3=Tahvildari|first3=Azin|last4=Farsi|first4=Yeganeh|last5=Arbabi|first5=Mahta|last6=Hasanzadeh|first6=Saba|last7=Jamshidi|first7=Parnian|last8=Murthi|first8=Mukunthan|last9=Mirsaeidi|first9=Mehdi|title=COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis|journal=Frontiers in Medicine|volume=7|year=2020|issn=2296-858X|doi=10.3389/fmed.2020.00459}}</ref>
Line 35: Line 39:
***In the UK  90% of deaths were reported in people over 60
***In the UK  90% of deaths were reported in people over 60
***Individuals ≥80 years had more than 20-fold increased risk of death compared to the 50-59 year olds age group.<ref name="WilliamsonWalker2020">{{cite journal|last1=Williamson|first1=Elizabeth J.|last2=Walker|first2=Alex J.|last3=Bhaskaran|first3=Krishnan|last4=Bacon|first4=Seb|last5=Bates|first5=Chris|last6=Morton|first6=Caroline E.|last7=Curtis|first7=Helen J.|last8=Mehrkar|first8=Amir|last9=Evans|first9=David|last10=Inglesby|first10=Peter|last11=Cockburn|first11=Jonathan|last12=McDonald|first12=Helen I.|last13=MacKenna|first13=Brian|last14=Tomlinson|first14=Laurie|last15=Douglas|first15=Ian J.|last16=Rentsch|first16=Christopher T.|last17=Mathur|first17=Rohini|last18=Wong|first18=Angel Y. S.|last19=Grieve|first19=Richard|last20=Harrison|first20=David|last21=Forbes|first21=Harriet|last22=Schultze|first22=Anna|last23=Croker|first23=Richard|last24=Parry|first24=John|last25=Hester|first25=Frank|last26=Harper|first26=Sam|last27=Perera|first27=Rafael|last28=Evans|first28=Stephen J. W.|last29=Smeeth|first29=Liam|last30=Goldacre|first30=Ben|title=OpenSAFELY: factors associated with COVID-19 death in 17 million patients|journal=Nature|year=2020|issn=0028-0836|doi=10.1038/s41586-020-2521-4}}</ref>
***Individuals ≥80 years had more than 20-fold increased risk of death compared to the 50-59 year olds age group.<ref name="WilliamsonWalker2020">{{cite journal|last1=Williamson|first1=Elizabeth J.|last2=Walker|first2=Alex J.|last3=Bhaskaran|first3=Krishnan|last4=Bacon|first4=Seb|last5=Bates|first5=Chris|last6=Morton|first6=Caroline E.|last7=Curtis|first7=Helen J.|last8=Mehrkar|first8=Amir|last9=Evans|first9=David|last10=Inglesby|first10=Peter|last11=Cockburn|first11=Jonathan|last12=McDonald|first12=Helen I.|last13=MacKenna|first13=Brian|last14=Tomlinson|first14=Laurie|last15=Douglas|first15=Ian J.|last16=Rentsch|first16=Christopher T.|last17=Mathur|first17=Rohini|last18=Wong|first18=Angel Y. S.|last19=Grieve|first19=Richard|last20=Harrison|first20=David|last21=Forbes|first21=Harriet|last22=Schultze|first22=Anna|last23=Croker|first23=Richard|last24=Parry|first24=John|last25=Hester|first25=Frank|last26=Harper|first26=Sam|last27=Perera|first27=Rafael|last28=Evans|first28=Stephen J. W.|last29=Smeeth|first29=Liam|last30=Goldacre|first30=Ben|title=OpenSAFELY: factors associated with COVID-19 death in 17 million patients|journal=Nature|year=2020|issn=0028-0836|doi=10.1038/s41586-020-2521-4}}</ref>
**People from black and [[minority ethnic]] (BME) groups <ref name="WilliamsonWalker2020">{{cite journal|last1=Williamson|first1=Elizabeth J.|last2=Walker|first2=Alex J.|last3=Bhaskaran|first3=Krishnan|last4=Bacon|first4=Seb|last5=Bates|first5=Chris|last6=Morton|first6=Caroline E.|last7=Curtis|first7=Helen J.|last8=Mehrkar|first8=Amir|last9=Evans|first9=David|last10=Inglesby|first10=Peter|last11=Cockburn|first11=Jonathan|last12=McDonald|first12=Helen I.|last13=MacKenna|first13=Brian|last14=Tomlinson|first14=Laurie|last15=Douglas|first15=Ian J.|last16=Rentsch|first16=Christopher T.|last17=Mathur|first17=Rohini|last18=Wong|first18=Angel Y. S.|last19=Grieve|first19=Richard|last20=Harrison|first20=David|last21=Forbes|first21=Harriet|last22=Schultze|first22=Anna|last23=Croker|first23=Richard|last24=Parry|first24=John|last25=Hester|first25=Frank|last26=Harper|first26=Sam|last27=Perera|first27=Rafael|last28=Evans|first28=Stephen J. W.|last29=Smeeth|first29=Liam|last30=Goldacre|first30=Ben|title=OpenSAFELY: factors associated with COVID-19 death in 17 million patients|journal=Nature|year=2020|issn=0028-0836|doi=10.1038/s41586-020-2521-4}}</ref>
***According to a survey by The Johns Hopkins University and American Community, [[infection rate]] was more than 3-fold higher in predominantly black counties in the US compared to the predominantly white counties and the [[death rate]] for predominantly black counties was 6-fold higher. Although further studies are needed to understand the race disparity, this result indicates that minorities such as black communities are in risk of COVID-19 infection more frequently and dying disproportionately. There could be multiple barriers in [[social distancing]] in these communities that result in higher infection and death rates.<ref name="Yancy2020">{{cite journal|last1=Yancy|first1=Clyde W.|title=COVID-19 and African Americans|journal=JAMA|volume=323|issue=19|year=2020|pages=1891|issn=0098-7484|doi=10.1001/jama.2020.6548}}</ref>
**[[Obese]] Patients ([[hazard ratios]] 1.19-1.39 after age and sex correction)<ref name="WilliamsonWalker2020">{{cite journal|last1=Williamson|first1=Elizabeth J.|last2=Walker|first2=Alex J.|last3=Bhaskaran|first3=Krishnan|last4=Bacon|first4=Seb|last5=Bates|first5=Chris|last6=Morton|first6=Caroline E.|last7=Curtis|first7=Helen J.|last8=Mehrkar|first8=Amir|last9=Evans|first9=David|last10=Inglesby|first10=Peter|last11=Cockburn|first11=Jonathan|last12=McDonald|first12=Helen I.|last13=MacKenna|first13=Brian|last14=Tomlinson|first14=Laurie|last15=Douglas|first15=Ian J.|last16=Rentsch|first16=Christopher T.|last17=Mathur|first17=Rohini|last18=Wong|first18=Angel Y. S.|last19=Grieve|first19=Richard|last20=Harrison|first20=David|last21=Forbes|first21=Harriet|last22=Schultze|first22=Anna|last23=Croker|first23=Richard|last24=Parry|first24=John|last25=Hester|first25=Frank|last26=Harper|first26=Sam|last27=Perera|first27=Rafael|last28=Evans|first28=Stephen J. W.|last29=Smeeth|first29=Liam|last30=Goldacre|first30=Ben|title=OpenSAFELY: factors associated with COVID-19 death in 17 million patients|journal=Nature|year=2020|issn=0028-0836|doi=10.1038/s41586-020-2521-4}}</ref>
**[[Obese]] Patients ([[hazard ratios]] 1.19-1.39 after age and sex correction)<ref name="WilliamsonWalker2020">{{cite journal|last1=Williamson|first1=Elizabeth J.|last2=Walker|first2=Alex J.|last3=Bhaskaran|first3=Krishnan|last4=Bacon|first4=Seb|last5=Bates|first5=Chris|last6=Morton|first6=Caroline E.|last7=Curtis|first7=Helen J.|last8=Mehrkar|first8=Amir|last9=Evans|first9=David|last10=Inglesby|first10=Peter|last11=Cockburn|first11=Jonathan|last12=McDonald|first12=Helen I.|last13=MacKenna|first13=Brian|last14=Tomlinson|first14=Laurie|last15=Douglas|first15=Ian J.|last16=Rentsch|first16=Christopher T.|last17=Mathur|first17=Rohini|last18=Wong|first18=Angel Y. S.|last19=Grieve|first19=Richard|last20=Harrison|first20=David|last21=Forbes|first21=Harriet|last22=Schultze|first22=Anna|last23=Croker|first23=Richard|last24=Parry|first24=John|last25=Hester|first25=Frank|last26=Harper|first26=Sam|last27=Perera|first27=Rafael|last28=Evans|first28=Stephen J. W.|last29=Smeeth|first29=Liam|last30=Goldacre|first30=Ben|title=OpenSAFELY: factors associated with COVID-19 death in 17 million patients|journal=Nature|year=2020|issn=0028-0836|doi=10.1038/s41586-020-2521-4}}</ref>
**[[Vitamin D deficiency historical perspective|Vitamin D deficient individuals.]]
**[[Vitamin D deficiency historical perspective|Vitamin D deficient individuals]]
***An Israeli based population study with 7,807 participants was published online on the 23rd of July 2020<ref name="urlLow plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study - Merzon - - The FEBS Journal - Wiley Online Library">{{cite web |url=https://febs.onlinelibrary.wiley.com/doi/abs/10.1111/febs.15495 |title=Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study - Merzon - - The FEBS Journal - Wiley Online Library |format= |work= |accessdate=}}</ref>. 10.1% (782) of these patients were [[COVID-19]] positive.  
***A study in an Israeli based population showed that low [[vitamin D]] levels could be an independent [[risk factor]] for [[COVID-19]] [OR 1.45; (95% CI 1.08‐1.95, p<0.001)]  and hospitalization [OR; 1.95 (95% CI 0.98‐4.845, p=0.061)] after adjustment for [[confounders]].<ref name="urlLow plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study - Merzon - - The FEBS Journal - Wiley Online Library">{{cite web |url=https://febs.onlinelibrary.wiley.com/doi/abs/10.1111/febs.15495 |title=Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study - Merzon - - The FEBS Journal - Wiley Online Library |format= |work= |accessdate=}}</ref>.
***The study found that low [[vitamin D]] levels may be an independent [[risk factor]] for [[COVID-19 infection]] [OR 1.45; (95% CI 1.08‐1.95, p<0.001)]  and hospitalization [OR; 1.95 (95% CI 0.98‐4.845, p=0.061)] after adjustment for [[confounders]].
 
*[[Centers for Disease Control and Prevention|CDC]] has proposed the following list of conditions that may increase the risk of a severe [[disease]] regardless of the individual's age:<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*[[Centers for Disease Control and Prevention|CDC]] has published the following [[conditions]] listed in the table below as the risk factors for a severe [[COVID-19]]. These conditions are categorized into the following groups based on the current [[evidence]]:<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref>{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html |title=Scientific Evidence for Conditions that Increase Risk of Severe Illness &#124; COVID-19 &#124; CDC |format= |work= |accessdate=}}</ref>
**[[Blood disorder|Blood disorders]]
 
**[[Chronic kidney disease]]
#'''Strongest and most consistent evidence''': define as consistent evidence from multiple small studies or a strong association from a large study are categorized. They increase the severity of [[COVID-19]] regardless of the individual's age
**[[Chronic liver disease]]
#'''Mixed evidence''': Defined as multiple studies that reached different conclusions about the risk associated with a condition
**[[Immunosuppression|Compromised immune system (immunosuppression)]]
#'''Limited evidence''': Defined as consistent evidence from a small number of studies. Limited evidence: Defined as consistent evidence from a small number of studies.
**Current or recent [[pregnancy]] in the last two weeks
 
**[[Endocrine disorder|Endocrine disorders]]
{| class="wikitable"
**[[Metabolic disorder|Metabolic disorders]]
|+underlying medical conditions that increase a person’s risk of severe illness from COVID-19
**[[Heart disease]]
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Level of Evidence}}
**[[Respiratory disease|Lung disease]]
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Condition}}
**[[Neurological disease|Neurological]] and [[Neurodevelopmental disorders|neurodevelopmental conditions]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Strongest and Most Consistent Evidence]]
|
*Serious [[heart conditions]], such as [[heart failure]], [[coronary artery disease]], or [[cardiomyopathies]]
*[[Cancer]]
*[[Chronic kidney disease]]
*[[COPD]]
*[[Obesity]] ([[BMI]]> 30)
*[[Sickle cell disease]]
*[[Solid organ transplantation]]
*[[Type 2 diabetes mellitus]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Mixed Evidence]]
|
*[[Asthma]]
*[[Cerebrovascular disease]]
*[[Hypertension]]
*[[Pregnancy]]
*[[smoking]]
*Use of [[corticosteroids]] or other [[immunosuppressive medications]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Limited Evidence]]
|
*[[Bone marrow transplantation]]
*[[HIV]]
*[[Immune deficiencies]]
*Inherited [[metabolic disorders]]
*[[Liver disease]]
*[[Neurologic]] conditions
*Other [[chronic lung diseases]]
*[[Pediatrics]]
*[[Thalassemia]]
*[[Type 1 diabetes mellitus]]
|}
This list is a living document that will be periodically updated, and it could rapidly change as the science evolves.


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 15:47, 8 September 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sara Haddadi, M.D.[2] Sabawoon Mirwais, M.B.B.S, M.D.[3] Aisha Adigun, B.Sc., M.D.[4]

Overview

Front-line health-care workers are at increased risk of having a positive Coronavirus disease 2019 (COVID-19) test. Similar to all viral illnesses, exposure is considered the most significant risk factor for infection with SARS-CoV-2 that causes COVID-19. Racial and ethnic minority groups are at increased risk of the infection. The most common risk factors associated with a severe form of the disease include elderly (those aged 60+), male sex, cardiovascular disease, diabetes mellitus, chronic kidney disease, COPD, hypertension, Cancer, Solid organ transplantation, Sickle cell disease, and Obesity (BMI > 30).

Risk Factors

A recent study showed that front-line health-care workers were at increased risk of having a positive COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Adequacy of PPE, clinical setting, and ethnic background were important factors for a higher positive test result in this group.[1]

Risk Factors Associated with Increased Risk of Infection

Similar to all viral illnesses, exposure is considered the most significant risk factor for infection with Coronavirus disease 2019 (COVID-19). According to CDC, racial and ethnic minority groups are at increased risk of getting sick and dying from COVID-19 [2]

  • Discrimination: Unfortunately, discrimination exists in systems meant to protect well-being or health. Examples of such systems include health care, housing, education, criminal justice, and finance.[2]
  • Healthcare access and utilization: People from some racial and ethnic minority groups are more likely to be uninsured than non-Hispanic whites.[2]
  • Occupation: People from some racial and ethnic minority groups are disproportionately represented in essential work settings such as healthcare facilities, farms, factories, grocery stores, and public transportation. Chances to be exposed to the SARS-CoV-2 virus.[2]
  • Educational, income, and wealth gaps: People with limited job options likely have less flexibility to leave jobs that may put them at a higher risk of exposure. They often cannot afford to miss work, even if they’re sick.[2]
  • Housing: Some people from racial and ethnic minority groups live in crowded conditions that make it more challenging to follow prevention strategies.[2]
    • Culture: In some cultures, it is common for family members of many generations to live in one household.[2]
    • unemployment rates for some racial and ethnic minority groups during the pandemic may lead to a greater risk of eviction and homelessness or sharing of housing.[2]

Risk Factors Associated with Increased Risk of Mortality and Severity of the Disease

  • CDC has published the following conditions listed in the table below as the risk factors for a severe COVID-19. These conditions are categorized into the following groups based on the current evidence:[14][15]
  1. Strongest and most consistent evidence: define as consistent evidence from multiple small studies or a strong association from a large study are categorized. They increase the severity of COVID-19 regardless of the individual's age
  2. Mixed evidence: Defined as multiple studies that reached different conclusions about the risk associated with a condition
  3. Limited evidence: Defined as consistent evidence from a small number of studies. Limited evidence: Defined as consistent evidence from a small number of studies.
underlying medical conditions that increase a person’s risk of severe illness from COVID-19
Level of Evidence Condition
Strongest and Most Consistent Evidence
Mixed Evidence
Limited Evidence

This list is a living document that will be periodically updated, and it could rapidly change as the science evolves.

References

  1. ↑ Nguyen, Long H; Drew, David A; Graham, Mark S; Joshi, Amit D; Guo, Chuan-Guo; Ma, Wenjie; Mehta, Raaj S; Warner, Erica T; Sikavi, Daniel R; Lo, Chun-Han; Kwon, Sohee; Song, Mingyang; Mucci, Lorelei A; Stampfer, Meir J; Willett, Walter C; Eliassen, A Heather; Hart, Jaime E; Chavarro, Jorge E; Rich-Edwards, Janet W; Davies, Richard; Capdevila, Joan; Lee, Karla A; Lochlainn, Mary Ni; Varsavsky, Thomas; Sudre, Carole H; Cardoso, M Jorge; Wolf, Jonathan; Spector, Tim D; Ourselin, Sebastien; Steves, Claire J; Chan, Andrew T; Albert, Christine M.; Andreotti, Gabriella; Bala, Bijal; Balasubramanian, Bijal A.; Beane-Freeman, Laura E.; Brownstein, John S.; Bruinsma, Fiona J.; Coresh, Joe; Costa, Rui; Cowan, Annie N.; Deka, Anusila; Deming-Halverson, Sandra L.; Elena Martinez, Maria; Ernst, Michael E.; Figueiredo, Jane C.; Fortuna, Pedro; Franks, Paul W.; Freeman, Laura Beane; Gardner, Christopher D.; Ghobrial, Irene M.; Haiman, Christopher A.; Hall, Janet E.; Kang, Jae H.; Kirpach, Brenda; Koenen, Karestan C.; Kubzansky, Laura D.; Lacey, Jr, James V.; Le Marchand, Loic; Lin, Xihong; Lutsey, Pam; Marinac, Catherine R.; Martinez, Maria Elena; Milne, Roger L.; Murray, Anne M.; Nash, Denis; Palmer, Julie R.; Patel, Alpa V.; Pierce, Eric; Robertson, McKaylee M.; Rosenberg, Lynn; Sandler, Dale P.; Schurman, Shepherd H.; Sewalk, Kara; Sharma, Shreela V.; Sidey-Gibbons, Christopher J.; Slevin, Liz; Smoller, Jordan W..; Steves, Claire J.; Tiirikainen, Maarit I.; Weiss, Scott T.; Wilkens, Lynne R.; Zhang, Feng (2020). "Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study". The Lancet Public Health. doi:10.1016/S2468-2667(20)30164-X. ISSN 2468-2667.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 "Health Equity Considerations and Racial and Ethnic Minority Groups | CDC".
  3. ↑ http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Missing or empty |title= (help)
  4. ↑ Li, Qun; Guan, Xuhua; Wu, Peng; Wang, Xiaoye; Zhou, Lei; Tong, Yeqing; Ren, Ruiqi; Leung, Kathy S.M.; Lau, Eric H.Y.; Wong, Jessica Y.; Xing, Xuesen; Xiang, Nijuan; Wu, Yang; Li, Chao; Chen, Qi; Li, Dan; Liu, Tian; Zhao, Jing; Liu, Man; Tu, Wenxiao; Chen, Chuding; Jin, Lianmei; Yang, Rui; Wang, Qi; Zhou, Suhua; Wang, Rui; Liu, Hui; Luo, Yinbo; Liu, Yuan; Shao, Ge; Li, Huan; Tao, Zhongfa; Yang, Yang; Deng, Zhiqiang; Liu, Boxi; Ma, Zhitao; Zhang, Yanping; Shi, Guoqing; Lam, Tommy T.Y.; Wu, Joseph T.; Gao, George F.; Cowling, Benjamin J.; Yang, Bo; Leung, Gabriel M.; Feng, Zijian (2020). "Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia". New England Journal of Medicine. doi:10.1056/NEJMoa2001316. ISSN 0028-4793.
  5. ↑ Heymann, David L; Shindo, Nahoko (2020). "COVID-19: what is next for public health?". The Lancet. 395 (10224): 542–545. doi:10.1016/S0140-6736(20)30374-3. ISSN 0140-6736.
  6. ↑ https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html. Missing or empty |title= (help)
  7. ↑ Hu, Zhiliang; Song, Ci; Xu, Chuanjun; Jin, Guangfu; Chen, Yaling; Xu, Xin; Ma, Hongxia; Chen, Wei; Lin, Yuan; Zheng, Yishan; Wang, Jianming; Hu, Zhibin; Yi, Yongxiang; Shen, Hongbing (2020). "Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China". Science China Life Sciences. doi:10.1007/s11427-020-1661-4. ISSN 1674-7305.
  8. ↑ Porcheddu, Rossella; Serra, Caterina; Kelvin, David; Kelvin, Nikki; Rubino, Salvatore (2020). "Similarity in Case Fatality Rates (CFR) of COVID-19/SARS-COV-2 in Italy and China". The Journal of Infection in Developing Countries. 14 (02): 125–128. doi:10.3855/jidc.12600. ISSN 1972-2680.
  9. ↑ Wilder-Smith, Annelies; Chiew, Calvin J; Lee, Vernon J (2020). "Can we contain the COVID-19 outbreak with the same measures as for SARS?". The Lancet Infectious Diseases. doi:10.1016/S1473-3099(20)30129-8. ISSN 1473-3099.
  10. ↑ Nasiri, Mohammad Javad; Haddadi, Sara; Tahvildari, Azin; Farsi, Yeganeh; Arbabi, Mahta; Hasanzadeh, Saba; Jamshidi, Parnian; Murthi, Mukunthan; Mirsaeidi, Mehdi (2020). "COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis". Frontiers in Medicine. 7. doi:10.3389/fmed.2020.00459. ISSN 2296-858X.
  11. ↑ 11.0 11.1 11.2 Williamson, Elizabeth J.; Walker, Alex J.; Bhaskaran, Krishnan; Bacon, Seb; Bates, Chris; Morton, Caroline E.; Curtis, Helen J.; Mehrkar, Amir; Evans, David; Inglesby, Peter; Cockburn, Jonathan; McDonald, Helen I.; MacKenna, Brian; Tomlinson, Laurie; Douglas, Ian J.; Rentsch, Christopher T.; Mathur, Rohini; Wong, Angel Y. S.; Grieve, Richard; Harrison, David; Forbes, Harriet; Schultze, Anna; Croker, Richard; Parry, John; Hester, Frank; Harper, Sam; Perera, Rafael; Evans, Stephen J. W.; Smeeth, Liam; Goldacre, Ben (2020). "OpenSAFELY: factors associated with COVID-19 death in 17 million patients". Nature. doi:10.1038/s41586-020-2521-4. ISSN 0028-0836.
  12. ↑ Yancy, Clyde W. (2020). "COVID-19 and African Americans". JAMA. 323 (19): 1891. doi:10.1001/jama.2020.6548. ISSN 0098-7484.
  13. ↑ "Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study - Merzon - - The FEBS Journal - Wiley Online Library".
  14. ↑ (PDF) https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Missing or empty |title= (help)
  15. ↑ "Scientific Evidence for Conditions that Increase Risk of Severe Illness | COVID-19 | CDC".
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