- The Washington Times - Thursday, March 12, 2020

The surge in coronavirus infections in countries outside of China, where the COVID-19 outbreak began, led the World Health Organization this week to declare the virus a pandemic.

More than 125,000 cases from 118 countries have been reported globally, and the number of new infections outside of China increased almost 13-fold in the past two weeks, WHO reported Thursday.

The Centers for Disease Control and Prevention has confirmed more than 1,400 cases of the flulike illness in dozens of states and the District, prompting many states to declare states of emergency.

Health experts say those 60 and older and with underlying medical conditions have the biggest risk of developing more serious coronavirus illness.

But others are at risk, too.

Here are more details about who is at risk, the symptoms and severity of COVID-19 and actions people can take to prevent themselves.

Who is at risk, besides the elderly?

According to the CDC, those at higher risk include individuals with the following medical conditions:

• Blood disorders such as sickle cell disease.

• Chronic kidney disease

• Chronic liver disease

• Diabetes and other endocrine disorders

• Metabolic disorders

• Heart disease

• Lung disease

• Neurological and neurodevelopmental conditions

• Compromised immune system caused by cancer, HIV or AIDS, organ or bone marrow transplants

• Women who are pregnant or were pregnant in the last two weeks are also at increased risk for severe COVID-19 disease.

What about asthma and smoking?

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said it would be safe to consider a person with severe asthma to be at higher risk for a severe case although there isn’t data on asthma and COVID-19. Respiratory illnesses are more likely to induce asthma attacks, which is why individuals with asthma have to be more careful during flu season, he said.

CDC listed asthma as a condition for increased risk of serious illness, a move he described as “going out a bit of a limb” but that emerged from an abundance of caution and concern.

Almost 8% of U.S. adults aged 18 years and older have asthma, according to the CDC.

Dr. Schaffner said smoking predisposes a person to bacterial pneumonia, which is a marker of more severe COVID-19. Although there is great interest in looking at smoking and coronavirus risk, he said he has not seen the issue addressed in studies. While smoking hasn’t been validated as a risk factor for serious coronavirus disease, Dr. Schaffner said it likely is.

The CDC estimates about 14% of U.S. adults smoked cigarettes in 2018.

What about obesity?

General trends show people who are morbidly obese are more likely to develop pneumonia when they catch the flu. So, there is concern that they could develop pneumonia from COVID-19 as well, Dr. Schaffner said.

People who are obese aren’t able to expand their lungs. Dr. Schaffner noted the lower parts of their lungs are compressed because of abdominal fat, making them more susceptible to complications.

A recent CDC report revealed that more than 40% of U.S. adults are obese and nearly 10% are severely so.

How about those who are older than 60 years but are healthy?

While this subset of the population might not have the “double dose” of age and health problems, Dr. Schaffner said there is an increased risk on the basis of age alone.

Although the health of people 60 years and older varies, he said all individuals in this age bracket should exercise more caution.

What are the symptoms?

The coronavirus can cause mild, flu-like symptoms and more severe disease. According to the WHO, about 83% to 98% of patients develop a fever, 68% of them report coughing, and 19% to 35% experience shortness of breath.

Based on the latest data, 81% of people infected have had only a mild disease, about 14% have progressed to severe disease and about 5% have become critically ill.

In more severe cases, COVID-19 can cause respiratory distress such as pneumonia and organ failure.

What is the fatality rate?

Chinese authorities are reporting a mortality rate between 2% and 4%, but WHO says calculating fatality is difficult since the total number of coronavirus cases is unknown.

“Fatal cases seem so far to be strongly associated with age. We are still lacking epidemiological data to assess the fatality rate outside China, and a higher [coronavirus fatality rate] cannot be excluded for countries with weaker health systems,” said WHO spokesman Tarik Jaarevi. “This is a new disease and our understanding is changing rapidly.”

Who can get tested? Are costs covered?

Health officials will decide if a patient meets the criteria to get tested. Clinicians will determine if a patient has the signs and symptoms of the coronavirus. The CDC strongly recommends physicians to test for other causes of respiratory illness such as influenza. A patient who has had close contact with a person diagnosed with COVID-19 or traveled to an affected area such as China, Italy or Iran could qualify for testing.

State labs do not charge for testing. Major insurers including United Health and Cigna have pledged to cover coronavirus test and to waive copayments for beneficiaries.

What can people do to protect themselves?

A vaccine to prevent COVID-19 is at least a year away. The best way to prevent illness until then is to avoid being exposed to the virus, which spreads through close contact and coughing and sneezing, the CDC says.

Health experts have a number of recommendations to stay safe and prepared.

Keep up-to-date on coronavirus trends and information.

Know the signs and symptoms of the coronavirus.

Stay home when sick.

Limit movement in the community.

Practice social distancing.

Wash hands frequently with soap and water for at least 20 seconds.

Disinfect frequently touched surfaces daily.

Practice proper coughing and sneezing etiquette.

Call health care providers ahead of a visit.

Create a household plan of action in case daily activities are disrupted.

Establish plans for remote work and child care.

Consider stocking a two-week supply of prescription and over-the-counter medications, food and other necessities.

Be aware of emergency plans for schools and workplaces of household members.

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