Clients with Acute and Chronic Health Problems:

The dynamic correlation between COVID-19 and chronic diseases

COVID-19 virus can infect individuals across all age groups, but the World Health

Organization (WHO, 2020) has identified two groups with higher risk of severe COVID-19

disease: those who are over 60 years and those with underlying medical conditions such as

cardiovascular disease, diabetes, chronic respiratory disease, and cancer. (Abalos, 2020)

Thousands of people have died as a result of the terrible coronavirus disease 2019 (COVID-19)

epidemic, and millions more are suffering from its effects. According to growing evidence, the

disease manifests itself in a severe form among people who have pre-existing chronic problems

such as cardiovascular disease, diabetes, lung disease, or kidney disease. Adding to the findings

that individuals with pre-existing conditions may be more susceptible to COVID-19, it has also

been shown that COVID-19 can induce chronic diseases in previously healthy patients.

Therefore, understanding the interlinked relationship between COVID-19 and chronic diseases

helps in optimizing the management of susceptible patients. (Shatha K. Alyammahi, 2020)

Developing countries are divided into groups based on their income levels, which are

likely to indicate a country's ability to respond to a pandemic. Even among developing countries,

each country faces its own set of obstacles in dealing with the COVID-19 epidemic. High

population density, for example, is one of the characteristics of the Philippines that increase the

country's sensitivity to COVID-19's detrimental consequences. Adults 65 years and older, as well

as those with underlying medical disorders such as cardiovascular disease, hypertension, and

diabetes, are at a higher risk of getting more significant COVID-19 consequences, according to

Demographics and Social Welfare. (Robert D. Buenaventura, 2020)

Conditions on this list have been shown to be associated with severe illness from COVID-19.

Updates to the conditions below were based on published reports, scientific articles in press,
unviewed pre-prints, and data from CDC-led investigations. Conditions were categorized by the

type of study design:

 Supported by meta-analysis/systematic review: Defined as having a significant

association in at least one meta-analysis or systematic review.

 Supported by mostly cohort, case-control, or cross sectional studies: Defined as having an

association in cohort, case-control or cross sectional studies; may include systematic

review or meta-analysis that represents one condition in a larger group of conditions (for

example, kidney transplant under the category of solid organ or blood stem cell

transplantation).

 Supported by mostly case series, case reports or, if other study design, the sample size is

small (and no systematic review or meta-analysis were available to review): Defined as

having an association in one or more case series studies. If there are cohort or case-

control studies, sample sizes were small. Conditions included may be rare.

 Supported by mixed evidence: Defined as having an association in at least one meta-

analysis or systematic review and additional studies or reviews that reached different

conclusions about risk associated with a condition.

Based on available evidence, conditions could move between evidence categories. Aside from

substance use disorders and Down syndrome, last reviewed in January 2021 and December 2020,

respectively, no additional condition has been added to this list. If strong and consistent evidence

demonstrated no association with severe outcomes, it may be removed from the list. No

conditions were removed from the previous underlying medical conditions list. (CDC, 2021)
TABLE OF EVIDENCE
Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness
from COVID-19
Tier Condition
Supported by meta- Cancer
analysis/systematic review
Cerebrovascular disease
Chronic kidney disease
COPD
Diabetes mellitus, type 1
Diabetes mellitus, type 2
Heart conditions (such as heart
failure, coronary artery disease, or Cohort Study [15, 16]
cardiomyopathies)
Smoking, current and former
Obesity
Pregnancy and Recent Pregnancy
Supported by mostly cohort, case- Children with certain underlying
control, or cross-sectional studies conditions
(if there is a systematic review or
meta-analysis available, it
represents one condition in a Down syndrome
larger category of conditions) HIV
Neurologic conditions
Overweight
Evidence of Impact on COVID-19
Severity [Reference number]
Systematic Review [1, 2]
Cohort Study [3-5]
Case Series [6-8]
Case Control Study [9]
Meta-Analysis [10-13]
Synthesis of Evidence [14]
Cohort Study [15-17]
Meta-Analysis [13, 18]
Cohort Studies [16, 19-40], {41}*
Case Series [42-44]
Meta-Analysis [45-47]
Systematic Review [48, 49]
Meta-Analysis [50]
Case Series [43]
Cohort Study [15, 51-56]
Meta-Analysis [57]
Systematic Review {58}*
Gestational Diabetes Systematic
Review {59}*
Case Series [43]
Longitudinal Study [60]
Cohort Study [50, 54, 60-65]
Meta-Analysis [66-68]
Meta-Analysis [45, 67, 69-76]
Systematic Review {58}*
Cohort [24, 80-88], {41, 89-92}*
Meta-Analysis [77-79]
Systematic Review [58, 59, 93]
Cross Sectional [87]
Case Control [94, 95]
Case Series [96-98]
Cohort Study [99-102]
Systematic Review [103, 104]
Cross-Sectional Study [105-107]
Cohort Study [108-116]
Case Series [117, 118]
Cohort Study [119, 120]
Cohort Study [32, 121-123]
Case Series [124-126]
Review [127]
Cross-Sectional Study [105]
Cohort Study [16, 108]
Cohort Study [83]

Other lung disease (including
interstitial lung disease, pulmonary
fibrosis, pulmonary hypertension)
Sickle cell disease
Solid organ or blood stem cell
transplantation
Substance use disorders
Use of corticosteroids or other
immunosuppressive medications
Supported by mostly case series, Cystic fibrosis
case reports or, if other study
design, the sample size is small Thalassemia
(and no systematic review or meta-
analysis available were reviewed)
Supported by mixed evidence Asthma
Hypertension
Liver disease
Immune deficiencies
Evidence used to inform the list of underlying medical conditions that increase a
person’s risk of severe illness from COVID-19.
Case Series [88]
Cohort [128-130], {92}*
Cohort [117, 118, 131, 132]
Case Series [117, 132-147]
Meta-Analysis [86]
Case Series [148-159]
Cohort [160]
Case-Control Study [161-163]
Cohort Study [164, 165]
Cohort Study [166]
Cross Sectional [167]
Case Series [168-170]
Case Series [171-173]
Cohort [174]
Case Series [175-178]
Cross Sectional [179]
Meta-Analysis [180-182]
Review [183]
Case Series [184]
Cohort Study [16, 40, 185-190]
Meta-Analysis [67, 191-194]
Systematic Review [195], {58}*
Cohort Study [15, 16, 19, 187, 196-
202]
Case Series [203]
Meta-Analysis [204-208]
Cohort [19, 28, 42, 209-223]
Case-Control [224-229]
Cross sectional [230]
Case Series [231-233]
Meta-Analysis [234]
Cohort [235-237]
Case Series [148, 149, 157, 238-
241]
 Suspected case of SARS-CoV-2 infection

(WHO, 2020)

Population risk factors for severe disease and mortality in COVID-19: A global systematic
review and meta-analysis
Aim
COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases.
While there are a number of early publications relating to risk factors for COVID-19 infection,
low sample size and heterogeneity in study design impacted consolidation of early findings.
There is a pressing need to identify the factors which predispose patients to severe cases of
COVID-19. For rapid and widespread risk stratification, these factors should be easily
obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill
this knowledge gap by systematically mapping all the available evidence on the association of
various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes
in patients with COVID-19.

Methods
The systematic review was conducted using standardized methodology, searching two electronic
databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020
and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while
reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-
analyses were conducted to estimate risk of each variable.
Results
Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The
studies were highly heterogeneous in terms of the sample under study, outcomes, and risk
measures reported. A large number of risk factors were presented for COVID-19. Commonly
reported variables for adverse outcome from COVID-19 comprised patient characteristics,
including age >75 (OR: 2.65, 95% CI: 1.81–3.90), male sex (OR: 2.05, 95% CI: 1.39–3.04) and
severe obesity (OR: 2.57, 95% CI: 1.31–5.05). Active cancer (OR: 1.46, 95% CI: 1.04–2.04) was
associated with increased risk of severe outcome. A number of common symptoms and vital
measures (respiratory rate and SpO2) also suggested elevated risk profiles.

Conclusions
Based on the findings of this study, a range of easily assessed parameters are valuable to predict
elevated risk of severe illness and mortality as a result of COVID-19, including patient
characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms
and vital measurements. (Adam Booth, 2021)
 REFERENCE
Abalos, J. B. (2020, NOVEMBER 9). Prevalence of chronic diseases associated with increased risk of severe
COVID-19 in the Philippines. Retrieved AUGUST 20, 2021, from niussp:
https://www.niussp.org/health-and-mortality/prevalence-of-chronic-diseases-associated-with-
increased-risk-of-severe-covid-19-in-the-philippines/

Adam Booth, A. B. (2021, march 4). Population risk factors for severe disease and mortality in COVID-19:
A global systematic review and meta-analysis. Retrieved from PLOS ONE:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247461

CDC. (2021, May 12). Evidence for Conditions that Increase Risk of Severe Illness. Retrieved from CDC:
https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/underlying-evidence-
table.html

Robert D. Buenaventura, 1. J. (2020, April 30). COVID-19 and mental health of older adults in the
Philippines: a perspective from a developing country. Retrieved August 21, 2021, from NCBI:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235307/

Shatha K. Alyammahi, a. S. (2020, NOVEMBER 29). The dynamic association between COVID-19 and
chronic disorders: An updated insight into prevalence, mechanisms and therapeutic modalities.
Retrieved AUGUST 20, 2021, from NCBI:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700729/

WHO. (2020, December 16). Public health surveillance for COVID-19. Retrieved from WHO:
https://apps.who.int/iris/bitstream/handle/10665/337897/WHO-2019-nCoV-
SurveillanceGuidance-2020.8-eng.pdf