If you are at higher risk

How to reduce risk of infection and what to do if you get sick

If you are at increased risk for serious illness from COVID-19, you need to be especially careful to avoid infection. You may have questions about your particular condition or treatment, how it impacts your risk of infection and illness, and what you need to do if you become ill. Your doctor is best equipped to provide individual advice, but we provide some general guidelines, below.

Who is at highest risk for getting very sick from COVID-19?

The risk of serious illness from COVID-19 increases steadily with age, especially for those with underlying medical problems like chronic bronchitis, emphysema, cardiovascular disease, serious heart conditions, obesity, or diabetes. According to a recent study published in the CDC's Morbidity and Mortality Weekly Report, certain underlying medical conditions may increase the risk of serious COVID-19 for individuals of any age.

The strongest evidence supporting increased risk of serious COVID-19 illness applies to the following conditions:

  • chronic kidney disease
  • COPD (chronic bronchitis or emphysema)
  • obesity (body mass index [BMI] of 30 or higher)
  • immunocompromised state (weakened immune system) from solid organ transplant
  • pregnancy
  • serious heart conditions, including coronary artery disease, heart failure, and other diseases of the heart muscle
  • sickle cell disease
  • type 2 diabetes.

Conditions that might increase risk of severe COVID-19 illness include:

  • moderate to severe asthma
  • cerebrovascular disease such as stroke
  • cystic fibrosis
  • high blood pressure
  • weakened immune response due to blood or bone marrow transplant, immune deficiencies, HIV or AIDS, use of corticosteroids, or use of other immune-weakening medications
  • any condition or treatment that weakens the immune response (cancer, cancer treatment, organ or bone marrow transplant, immunosuppressant medications, HIV or AIDS)
  • neurologic conditions, such as dementia
  • liver disease
  • pulmonary fibrosis (damaged or scarred lung tissue)
  • smoking
  • thalassemia (a blood disorder)
  • type 1 diabetes.

According to the CDC, hospitalizations have been six times higher and deaths 12 times higher among those with reported underlying conditions compared with those who did not have underlying health conditions.

In addition, among COVID-19 cases with known race and ethnicity, 33% were Hispanic, 22% were black, and 1.3% were non-Hispanic American Indian or Alaska Native. These findings suggest that these groups, who account for 18%, 13%, and 0.7% of the US population, respectively, are disproportionately affected by the COVID-19 pandemic.

Everything we are learning underscores the importance of maintaining health-promoting behaviors, even as restrictions begin to ease, especially if you have an underlying medical condition. To reduce your risk of getting sick, continue to stay home when possible, wear a mask and maintain a physical distance of at least six feet when you're around other people, and wash your hands often.

I'm older and have a chronic medical condition, which puts me at higher risk for getting seriously ill, or even dying from COVID-19. What can I do to reduce my risk of exposure to the virus?

The risk of serious illness or death from COVID-19 increases steadily with age. This is true whether or not you also have an underlying medical condition, although the sickest individuals and most of the deaths have been among people who were both older and had chronic medical conditions, such as heart disease, lung problems, or diabetes.

The CDC suggests the following measures for those who are at higher risk:

  • Obtain several weeks of medications and supplies in case you need to stay home for prolonged periods of time.
  • Take everyday precautions to keep space between yourself and others.
  • When you go out in public, keep away from others who are sick, limit close contact, and wash your hands often.
  • Avoid crowds.
  • Avoid cruise travel and nonessential air travel.
  • During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.

I have a chronic medical condition that puts me at increased risk for severe illness from COVID-19, even though I'm only in my 30s. What can I do to reduce my risk?

You can take steps to lower your risk of getting infected in the first place:

  • As much as possible, limit contact with people outside your family.
  • Maintain enough distance (six feet or more) between yourself and anyone outside your family.
  • Wash your hands often with soap and warm water for 20 to 30 seconds.
  • As best you can, avoid touching your eyes, nose, or mouth.
  • Stay away from people who are sick.
  • During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.
  • Clean and disinfect high-touch surfaces in your home, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day.

In addition, do your best to keep your condition well-controlled. That means following your doctor's recommendations including taking medications as directed. If possible, get a 90-day supply of your prescription medications and request that they be mailed to you so you don't have to go to the pharmacy to pick them up.

Call your doctor for additional advice specific to your condition.

How does obesity increase risk of COVID-19?

According to a recent review and meta-analysis that looked at 75 international studies on the subject, obesity is a significant risk factor for illness and death due to COVID-19.

When looking at people with COVID-19, the analysis found that, compared with people who were normal weight or overweight, people who were obese were

  • more than twice as likely to be hospitalized
  • if hospitalized, nearly 75% more likely to be admitted to the intensive care unit (ICU)
  • almost 50% more likely to die of COVID-19.

Obesity may impact COVID risk in several ways. For example, obesity increases the risk of impaired immune function and chronic inflammation, both of which could make it harder for the body to fight the COVID-19 infection. Excess fat can also make it harder for a person to take a deep breath, an important consideration for an illness that impairs lung function.

People who are obese are also more likely to have diabetes and high blood pressure, which are themselves risk factors for severe COVID-19. And obesity is more common in Black, Latinx, and Native Americas, who are more likely to get infected and die from COVID-19 than whites for a variety of reasons.

If you have obesity (defined as a body mass index, or BMI, of 30 or higher), stay vigilant about protecting yourself from infection. That means maintaining physical distance, avoiding crowds when possible, wearing masks, and washing your hands often.

I have asthma. If I get COVID-19, am I more likely to become seriously ill?

Yes, asthma may increase your risk of getting very sick from COVID-19.

However, you can take steps to lower your risk of getting infected in the first place. These include

  • social distancing
  • washing your hands often with soap and warm water for 20 to 30 seconds
  • not touching your eyes, nose or mouth
  • staying away from people who are sick.

In addition, you should continue to take your asthma medicines as prescribed to keep your asthma under control. If you do get sick, follow your asthma action plan and call your doctor.

Do pregnant women face increased risks from COVID-19?

A large study from the CDC has found that pregnant women are at increased risk of severe COVID-19 illness compared to women who are not pregnant.

The study looked at 409,462 women, ages 15 to 44, who had symptomatic COVID-19. Of these women, 23,434 were pregnant. Even after taking age, race, ethnicity, and underlying health conditions into consideration, pregnant women were significantly more likely to need intensive care, to require a ventilator, and to require a heart-lung bypass machine, compared to women who were not pregnant. They were also 70% more likely to die.

It's important to note that the overall risk of these complications was low. For example, 1.5 symptomatic pregnant women out of 1,000 died, compared to 1.2 symptomatic women out of 1,000 who were not pregnant.

The CDC also released a smaller study, which found that women who were infected with the COVID-19 virus during pregnancy were more likely to deliver preterm (earlier than 37 weeks).

If you are pregnant, be vigilant about taking precautions. Wear a mask, physically distance from others, and avoid social gatherings. Do your best to follow the CDC's recommendations to protect yourself if someone in your household becomes infected.

Continue to see your doctor for prenatal visits and get any recommended vaccines. Call your doctor's office to discuss safety precautions if you have concerns.

I am pregnant and plan to eventually breastfeed my baby. Is it safe for me to get a mRNA COVID-19 vaccine?

The CDC, American College of Obstetrics and Gynecology (ACOG), and Society for Maternal-Fetal Medicine agree that the new mRNA COVID-19 vaccines (Pfizer/BioNTech and Moderna) should be offered to pregnant and breastfeeding individuals. However, the World Health Organization (WHO) recommends against use of either mRNA vaccine in pregnant women, unless the benefit to an individual outweighs the potential vaccine risks. There is a lot we still do not know about the safety of the vaccines in these populations. As always, your own doctor is in the best position to advise you based on your personal health risks and preferences.

Here are some factors to consider. First, although the actual risk of severe COVID-19 illness and death among pregnant individuals is very low, it is higher when compared to nonpregnant individuals from the same age group. In addition, research suggests that having COVID-19 might increase risk for premature birth, particularly for those with severe illness. Transmission of the virus from mother to baby during pregnancy is possible, but it appears to be a rare event.

mRNA vaccine trials did not deliberately include pregnant individuals, so our knowledge regarding the safety of mRNA COVID-19 vaccines during pregnancy is limited. In animal studies, mRNA vaccines did not affect fertility or cause any problems with pregnancy. mRNA vaccines do not contain any virus, so they cannot cause COVID-19 in a woman or her baby. And our bodies quickly break down and eliminate mRNA particles used in the vaccine, so they are unlikely to reach or cross the placenta. On the other hand, the immunity that a woman generates from vaccination can cross the placenta, and may help to keep the baby safe after birth.

Experts, including the WHO, believe it is most likely safe to get an mRNA COVID-19 vaccine if you're breastfeeding, although breastfeeding people were not included in the vaccine trials. When a person gets vaccinated while breastfeeding, their immune system develops antibodies that protect against COVID-19. These antibodies can be passed through breast milk to the baby and are likely to help protect against infection.

I'm taking a medication that suppresses my immune system. Should I stop taking it so I have less chance of getting sick from the coronavirus?

If you contract the virus, your response to it will depend on many factors, only one of which is taking medication that suppresses your immune system. In addition, stopping the medication on your own could cause your underlying condition to get worse. Most importantly, don't make this decision on your own. It's always best not to adjust the dose or stop taking a prescription medication without first talking to the doctor who prescribed the medication.

I heard that certain blood pressure medicines might worsen symptoms of COVID-19. Should I stop taking my medication now just in case I do get infected? Should I stop if I develop symptoms of COVID-19?

You are referring to angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), two types of medications used primarily to treat high blood pressure (hypertension) and heart disease. Doctors also prescribe these medicines for people who have protein in their urine, a common problem in people with diabetes.

Here's how this concern got started. Researchers doing animal studies on a different coronavirus (the SARS coronavirus from the early 2000s) found that certain sites on lung cells called ACE-2 receptors appeared to help the SARS virus enter the lungs and cause pneumonia. ACE inhibitor and ARB drugs raised ACE-2 receptor levels in the animals.

But observational studies in humans have found no increased risk of COVID diagnosis, hospitalization, or death in people taking ACE inhibitors or ARBs. A randomized clinical trial published in JAMA in January 2021 further bolstered the evidence for continuing these medications if you get COVID-19. The researchers enrolled adults hospitalized with mild or moderate COVID-19, all of whom were already taking an ACE inhibitor or ARB before hospitalization. About half of the participants were assigned to continue their medication and the others were assigned to discontinue it. The researchers found that people who discontinued their medications did not fare significantly better or worse than those who had continued their medications in terms of likelihood of dying, progression of COVID-19, or time to being released from the hospital.

Another consideration: abruptly stopping your ACE inhibitor or ARB could cause your blood pressure to spike or worsen any underlying heart condition, putting you at greater risk of complications from the infection.

The bottom line: at this time, the American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Failure Society of America (HFSA) strongly recommend continuing to take ACE inhibitor or ARB medications, even if you get sick with COVID-19.

I live with my children and grandchildren. What can I do to reduce the risk of getting sick when caring for my grandchildren?

In a situation where there is no choice — such as if the grandparent lives with the grandchildren — then the family should do everything they can to try to limit the risk of COVID-19. The grandchildren should be isolated as much as possible, as should the parents, so that the overall family risk is as low as possible. Everyone should wash their hands very frequently throughout the day, and surfaces should be wiped clean frequently. Physical contact should be limited to the absolutely necessary; as wonderful as it can be to snuggle with Grandma or Grandpa, now is not the time.

Blog posts


COVID-19 and underlying conditions: Why symptoms may be more severe for people with chronic disease (recorded 5/6/20)

People who have diabetes, a heart condition, cancer, kidney disease or other underlying condition are impacted more severely if they contract the coronavirus. Harvard Medical School endocrinologist Dr. Enrique Caballero explains why. Dr. Caballero is on the staff of Brigham and Women's Hospital in Boston, Massachusetts, and is the director of diabetes education in the post-graduate medical education department at Harvard Medical School.

Entendiendo como afecta la infección por COVID-19 a personas con enfermedades crónicas subyacentes (recorded 5/6/20)

Las personas que tienen diabetes, una afección del corazón o de los riñones u otra enfermedad crónica subyacente se ven afectadas más severamente si contraen el coronavirus. El Dr. Enrique Caballero, endocrinólogo de la Escuela de Medicina de Harvard explica la forma en que estas enfermedades favorecen infecciones severas por COVID-19 y como el coronavirus puede empeorar estas condiciones crónicas. El Dr. Caballero forma parte del personal del Hospital Brigham and Women's y es el director de educación en diabetes en el departamento de educación médica de posgrado de la Facultad de Medicina de Harvard en Boston, Massachusetts.

COVID-19 and the vulnerable: How we can help the sick and the elderly? (recorded 3/17/20)

There's a lot we don't know about the novel coronavirus that's shutting down the world. But we do know this: The sick, the elderly, the immune-compromised are particularly at risk. If you or a loved one fall into this category, there are some things you can do to help keep COVID-19 at bay. As Harvard's Dr. Rob Shmerling points out, it starts with situational awareness.

For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.

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