COVID-19 risk factors: Difference between revisions

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Revision as of 02:11, 2 August 2020

For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here

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

Overview

Similar to all 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 elderly (those aged 60+), cardiovascular disease patients, diabetics, chronic respiratory disease patients, hypertensive patients, cancer patients, and individuals in long term care facilities.

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).

Risk factors associated with increased risk of mortality and severity of the disease

Individuals at risk for the severe form of the disease include:^[2]^[3]^[4]^[5]^[6]^[7]^[8]
- Cardiovascular disease patients
- Diabetics
- Chronic respiratory disease patients
- Hypertensive patients
- Cancer patients
- Individuals in long term care facilities
- People from black and minority ethnic (BME) groups
- 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)^[9]
- Elderly (those aged 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.^[10]
- Obese Patients (hazard ratios 1.19-1.39 after age and sex correction)^[10]
CDC has proposed the following list of conditions that may increase the risk of a severe disease regardless of the individual's age:^[11]
- Blood disorders
- Chronic kidney disease
- Chronic liver disease
- Compromised immune system (immunosuppression)
- Current or recent pregnancy in the last two weeks
- Endocrine disorders
- Metabolic disorders
- Heart disease
- Lung disease
- Neurological and neurodevelopmental conditions
An Israeli based population study with 7,807 participants was published online on the 23rd of July 2020^[12]. 10.1% (782) of these patients were COVID-19 positive. The study found that low vitamin D levels may be an independent risk factor for COVID-19 infection and hospitalization.

References

↑ 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.
↑ http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Missing or empty |title= (help)
↑ 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.
↑ 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.
↑ https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html. Missing or empty |title= (help)
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ ^10.0 ^10.1 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.
↑ (PDF) https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Missing or empty |title= (help)
↑ "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".

[NguyenDrew2020-1] 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] ttp://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Missing or empty |title= (help)

[LiGuan2020-3] 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.

[HeymannShindo2020-4] 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.

[5] ttps://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html. Missing or empty |title= (help)

[HuSong2020-6] 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.

[PorchedduSerra2020-7] 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.

[Wilder-SmithChiew2020-8] 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.

[NasiriHaddadi2020-9] 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.

[WilliamsonWalker2020-10] 10.0 ^10.1 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.

[11] (PDF) https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Missing or empty |title= (help)

[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-12] "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".

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@@ Line 10: / Line 10: @@
 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.
 ==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>
 ===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).