COVID-19: Who's at higher risk of serious symptoms? (2024)

COVID-19: Who's at higher risk of serious symptoms?

Advanced age and some health conditions can raise the risk of serious COVID-19 (coronavirus disease 2019) illness.

By Mayo Clinic Staff

Many people with COVID-19, also called coronavirus disease 2019, recover at home. But for some, COVID-19 can be a serious illness. Some people may need care in the hospital, treatment in the intensive care unit and the need for breathing help. In some people, severe COVID-19 illness can lead to death.

Not every risk factor for serious COVID-19 illness is known. But some risks stand out thanks to research gathered since the start of the pandemic.

What raises the risk of severe or critical COVID-19 illness?

The risk for serious COVID-19 illness depends on your health status, age and activities. Your risk also depends on other factors. This includes where you live, work or learn, how easy it is for you to get medical care, and your economic stability.

If you have more than one risk factor, your risk goes up with each one.

Age raises the risk of serious COVID-19

People age 65 and older and babies younger than 6 months have a higher than average risk of serious COVID-19 illness. Those age groups have the highest risk of needing hospital care for COVID-19.

Babies younger than 6 months aren't eligible for the COVID-19 vaccine, which adds to their risk. For older people, the challenge is that the immune system is less able to clear out germs as people age. Also, as people age, medical conditions that raise the risk of severe COVID-19 are more likely. In the U.S. as of March 2024, about 76% of all deaths from COVID-19 have been among people age 65 and older.

Aging plus disease raises the risk of serious COVID-19

Severe COVID-19 disease is more likely for people who have other health issues.

Some common diseases linked to aging are:

  • Heart disease. Examples are heart failure or coronary artery disease.
  • Diabetes mellitus. The risk is higher for both type 1 and type 2.
  • Chronic lung diseases. This includes airway disease and conditions that damage lung tissue.
  • Obesity. The risk goes up as body mass index (BMI) increases, with the highest risk for a BMI of 40 or greater.
  • Chronic kidney disease. Especially if you are on dialysis.

These diseases become more common as people age. But they can affect people of any age. The risk of serious COVID-19 illness is linked to having one or more underlying medical condition.

Asthma, COPD, other lung diseases raise risk of severe COVID-19

Your risk of having more severe COVID-19 illness is higher if you have lung disease. Having moderate to severe asthma raises some risks of serious COVID-19 illness. It raises the risk of needing care in the hospital, including intensive care, and needing mechanical help breathing.

The risk of serious COVID-19 illness also is higher for people who have conditions that damage lung tissue over time. Examples are tuberculosis, cystic fibrosis, interstitial lung disease, bronchiectasis or COPD, which stands for chronic obstructive pulmonary disease. These diseases raise the risk of needing care in the hospital for COVID-19. Depending on the condition, the risk of needing intensive care and the risk of death from COVID-19 also may go up.

Other lung conditions, such as a history of pulmonary hypertension or pulmonary embolism affect a person's risk of serious illness after COVID-19. The risk of death may be higher after these conditions.

Cancer raises the risk of severe COVID-19

In general, people with cancer have a greater risk of getting serious COVID-19. People who have or had blood cancer may have a higher risk of being sick for longer, or getting sicker, with COVID-19 than people with solid tumors.

Having cancer raises the risk of needing care in the hospital, intensive care and the use of breathing support. Having blood cancer and getting COVID-19 raises the risk of death from the illness.

Treatment for blood cancer may raise the risk of severe COVID-19 but the research is still unclear. Cancer treatment may also affect your COVID-19 vaccine. Talk to your healthcare professional about additional shots and getting vaccinated after treatments that affect some immune cells.

Other conditions that raise the risk of severe COVID-19

If an organ or body system is already weakened by disease, infection with the COVID-19 virus can cause further damage. In other cases, medicine for the original condition can lower the immune system's response to the virus that causes COVID-19.

Many different diseases can raise the risk of severe COVID-19 illness.

  • Brain and nervous system diseases, such as strokes.
  • Chronic liver disease, specifically cirrhosis, nonalcoholic fatty liver disease, alcoholic liver disease and autoimmune hepatitis.
  • HIV not well managed with medicine.
  • Heart disease, including congenital heart disease and cardiomyopathies.
  • Mood disorders or schizophrenia.
  • Dementia.
  • Having received an organ or stem cell transplant.
  • Sickle cell anemia and thalassemia blood disorders.

Other risk factors for severe COVID-19 are:

  • Not getting enough physical activity.
  • Smoking.
  • Pregnancy or having recently given birth.
  • Use of medicines that lower the immune system's ability to respond to germs.

Also, as a general group, disability is linked to an increased risk of severe COVID-19. The risks are different depending on the disability.

  • Down syndrome is linked to a higher risk of needing care in the hospital. The risk of death from severe COVID-19 also is higher than typical for people with Down syndrome.
  • Attention deficit/hyperactivity disorder is linked to an increased risk of needing care in the hospital from severe COVID-19.
  • Cerebral palsy is linked to an increased risk of needing care in the hospital from severe COVID-19.

These are not the only conditions that increase the risk of severe COVID-19. Talk to your healthcare professional if you have questions about your health and risk for getting a serious COVID-19 illness.

A COVID-19 vaccine can lower your risk of serious illness

The COVID-19 vaccine can lower the risk of death or serious illness caused by COVID-19. Your healthcare team may suggest added doses of COVID-19 vaccine if you have a moderately or seriously weakened immune system.

How else can you lower the risk of severe COVID-19?

Everyone can lower the risk of serious COVID-19 illness by working to prevent infection with the virus that causes COVID-19.

  • Avoid close contact with anyone who is sick or has symptoms, if possible.
  • Use fans, open windows or doors, and use filters to move the air and keep any germs from lingering.
  • Wash your hands well and often with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer with at least 60% alcohol.
  • Cough or sneeze into a tissue or your elbow. Then wash your hands.
  • Clean and disinfect high-touch surfaces. For example, clean doorknobs, light switches, electronics and counters regularly.
  • Spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.
  • The U.S. Centers for Disease Control and Prevention recommends that people wear a mask in indoor public spaces if COVID-19 is spreading. This means if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.

These basic actions are even more important for people who have weakened immune systems, and their caregivers.

The FDA also has authorized the monoclonal antibody pemivibart (Pemgarda) to prevent COVID-19 in some people with weakened immune systems.

People can take other actions based on their risk factors.

  • If you're at a higher risk of serious illness, talk to your healthcare professional about how best to protect yourself. Know what to do if you get sick so you can quickly start treatment.
  • Lower your risk of COVID-19 complications by making sure that any health issues are well managed. This includes staying on track with managing medical conditions, going to all healthcare appointments and planning ahead to avoid running out of medicine. Keep taking medicines as suggested by your healthcare professional.
  • Stay up to date on vaccines. This includes vaccines for flu, pneumonia and RSV. These vaccines won't prevent COVID-19. But becoming ill with a respiratory illness may worsen your outcome if you also catch COVID-19.

You may consider making a care plan. In the care plan, write your medical conditions, the medicine you take, and any special food or diet needs you have. The care plan also includes who you see for care and your emergency contacts.

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April 30, 2024

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  2. Regan JJ, et al. Use of Updated COVID-19 Vaccines 2023-2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices—United States, September 2023. MMWR. Morbidity and Mortality Weekly Report 2023; doi:10.15585/mmwr.mm7242e1.
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  11. COVID-19: What people with cancer should know. National Cancer Institute. Accessed April 2, 2024.
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  13. Preventing respiratory viruses. Centers for Disease Control and Prevention. Accessed April 2, 2024.
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  15. COVID-19: What People with Cancer Should Know. National Cancer Institute. Accessed April 11, 2024.

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  7. Herd immunity and respiratory illness
  8. COVID-19 and pets
  9. COVID-19 and your mental health
  10. COVID-19 antibody testing
  11. COVID-19, cold, allergies and the flu
  12. Long-term effects of COVID-19
  13. COVID-19 tests
  14. COVID-19 drugs: Are there any that work?
  15. COVID-19 in babies and children
  16. Coronavirus infection by race
  17. COVID-19 travel advice
  18. COVID-19 vaccine: Should I reschedule my mammogram?
  19. COVID-19 vaccines for kids: What you need to know
  20. COVID-19 vaccines
  21. COVID-19 variant
  22. COVID-19 vs. flu: Similarities and differences
  23. Debunking coronavirus myths
  24. Diarrhea
  25. Different COVID-19 vaccines
  26. Extracorporeal membrane oxygenation (ECMO)
  27. Fever
  28. Fever: First aid
  29. Fever treatment: Quick guide to treating a fever
  30. Fight coronavirus (COVID-19) transmission at home
  31. Honey: An effective cough remedy?
  32. How do COVID-19 antibody tests differ from diagnostic tests?
  33. How to measure your respiratory rate
  34. How to take your pulse
  35. How to take your temperature
  36. How well do face masks protect against COVID-19?
  37. Is hydroxychloroquine a treatment for COVID-19?
  38. Loss of smell
  39. Mayo Clinic Minute: You're washing your hands all wrong
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  41. Multisystem inflammatory syndrome in children (MIS-C)
  42. Nausea and vomiting
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  44. Red eye
  45. Safe outdoor activities during the COVID-19 pandemic
  46. Safety tips for attending school during COVID-19
  47. Sex and COVID-19
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COVID-19: Who's at higher risk of serious symptoms? (2024)


COVID-19: Who's at higher risk of serious symptoms? ›

Like adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or who are immunocompromised can also be at increased risk for getting very sick from COVID-19. Check out COVID-19 Vaccines for Children and Teens for more information on vaccination information for children.

Who is most at risk for severe COVID? ›

COVID-19 is often more severe in people 60+yrs or with health conditions like lung or heart disease, diabetes or conditions that affect their immune system. ​ Do your part to protect those who are at most risk.

What are considered serious COVID symptoms? ›

When to Seek Emergency Medical Attention
  • Trouble breathing.
  • Persistent pain or pressure in the chest.
  • New confusion.
  • Inability to wake or stay awake.
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone.
Mar 15, 2024

When to worry about COVID? ›

If you are having a hard time breathing, that is a sign that you or a family member should contact a medical provider right away,” Kline said. Other emergency warning signs can include persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and bluish lips or face.

Who is most at risk of infection? ›

Groups at higher risk from infection

People who are immunosuppressed may have a reduced ability to fight infections and other diseases. Most people in this group will be under the care of a hospital specialist and will have received advice on the risks to them and when to seek medical advice.

When is COVID life threatening? ›

Severe COVID-19 symptoms can lead to serious outcomes from COVID-19, defined as hospitalization, admission to the intensive care unit (ICU), intubation or mechanical ventilation, or death. Anyone having trouble breathing should seek medical attention immediately.

What is the biggest risk factor for COVID mortality? ›

Age is the strongest risk factor for severe COVID-19 outcomes. Patients with one or multiple of certain underlying medical conditions are also at higher risk. Additionally, being unvaccinated or not being up to date on COVID-19 vaccinations also increases the risk of severe COVID-19 outcomes.

Who gets worse COVID symptoms? ›

Some people may have symptoms that get worse about 7 to 14 days after symptoms start. Most people with COVID-19 have mild to moderate symptoms. But COVID-19 can cause serious medical complications and lead to death. Older adults or people who already have medical conditions are at greater risk of serious illness.

What helps COVID go away? ›

Many people with COVID-19 get better with rest, fluids and treatment for their symptoms. Medicine you can get without a prescription can help. Some examples are: Fever reducers.

When should you go to the hospital with COVID? ›

Symptoms that may indicate a life-threatening emergency include: Shortness of breath or difficulty breathing. Chest or upper abdominal pain or pressure. Sudden dizziness, weakness or fainting.

When should I be concerned when having COVID? ›

Call a GP or out-of-hours GP immediately if. your symptoms of COVID-19 get worse and you: start feeling very unwell, particularly if your breathing changes, becomes difficult, or your cough gets worse. feel that you are getting increasingly short of breath.

Does COVID weaken your immune system? ›

What you need to know. In a small study supported by the National Institute of Allergy and Infectious Diseases (NIAID), severe cases of COVID-19 were shown to cause long-lasting changes to the immune system.

What to eat if you have COVID? ›

If you're wondering what to eat with COVID, many whole foods—like fruits and whole grains—and dairy products can contain nutrients beneficial to immune system functioning while you're sick. Other foods and drinks, such as sweets and sodas, can be less helpful.

Who is at high risk for severe COVID? ›

Older adults are at highest risk of getting very sick from COVID-19. More than 81% of COVID-19 deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than the number of deaths among people ages 18-29 years.

What is considered a severe case of COVID? ›

Patients with COVID-19 are considered to have severe illness if they have an SpO2 <94% on room air at sea level, PaO2/FiO2 <300 mm Hg, a respiratory rate >30 breaths/min, or lung infiltrates >50%. These patients may experience rapid clinical deterioration and should be given oxygen therapy and hospitalized.

Why do some people not get COVID? ›

Researchers suggest high levels of activity of a gene called HLA-DQA2 before exposure also helped people prevent a sustained infection from taking hold.

Who is at risk for progressing to severe COVID? ›

Like adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or who are immunocompromised can also be at increased risk for getting very sick from COVID-19. Check out COVID-19 Vaccines for Children and Teens for more information on vaccination information for children.

What are the factors affecting the severity of COVID-19? ›

These nine studies were assessed for quality, data extraction and synthesis. Risk factors that contribute to the severity of COVID-19 are age, gender, chronic comorbidities, cardiovascular disease, diabetes, hypertension, kidney failure, cancer and a history of smoking.

What population is most affected by COVID? ›

Adjustments to the population distributions: In April and May 2020, the majority of COVID-19 deaths in the U.S. occurred in urban areas that have a larger percentage of their populations that are non-Hispanic black, non-Hispanic Asian, or Hispanic, and a smaller percentage that are non-Hispanic white.

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