Am I at High Risk for Severe Illness from Covid-19?

The Covid-19 pandemic is over, but the virus hasn’t gone away. Not as many people are getting sick now that vaccines are available, but the infection can still cause serious illness — and even death — especially if you’re at high risk of severe Covid-19.

What is severe Covid-19?

According to Vidya Sundareshan, M.D., an infectious disease specialist at Southern Illinois University Medicine, the difference between mild, moderate and severe Covid-19 depends on whether you’re admitted to the hospital. Those with mild or moderate illness can be treated on an outpatient basis at home. People with severe Covid-19 must be treated in a hospital. They are too sick to go home. “These are the patients who likely will need oxygen and they may even be sick enough to be intubated,” she said. “They may need to be admitted to the ICU.”

Anyone can develop severe disease from Covid-19, but some people are at higher risk than others. This group includes older people as well as pregnant women.

High-risk groups include people with:

  • Weakened immune systems due to conditions and treatments like:
    • Organ transplants
    • Cancer
    • HIV
    • Long-term use of drugs that affect your immune system, like prednisone
  • Lung diseases like:
    • Asthma
    • Chronic obstructive lung disease (COPD)
    • Lung cancer
  • Heart disease
  • Stroke
  • Dementia
  • Diabetes
  • Obesity
  • Blood disorders like sickle cell anemia
  • Chronic liver or kidney disease
  • Down syndrome
  • Some mental health conditions, such as schizophrenia spectrum disorders or depression

Preventing severe Covid-19

When the pandemic began, we only had the usual infection prevention strategies to protect ourselves. These included regular and thorough handwashing, wearing a mask in crowded places, and avoiding people who are sick. But when Covid-19 vaccines became available, infection rates dropped. The vaccines reduced how many people got the disease, and if a vaccinated person did get infected, their illness and symptoms were usually less severe.

Covid-19 is constantly mutating or changing though, which means vaccines must be updated. This is why you’ve seen multiple updated vaccines over the past few years. These are not booster shots.Those are designed to help boost the immunity you already have. Updated vaccines contain updated formulas.

The best way to protect yourself from severe Covid-19 is by ensuring you are up-to-date with your vaccines. Speak with your healthcare provider if you recently had the virus though, because the timing for the vaccine changes.

Treating Covid-19

Not long after the vaccines were approved, the U.S. Food and Drug Administration (FDA) authorized two oral antiviral medications to treat Covid-19: Paxlovid (nirmatrelvir with ritonavir) and Lagevrio (molnupiravir). These are for people who are at high risk for severe Covid-19.

Both antivirals must be taken within five days after your symptoms start. Not everyone can take Paxlovid, but Lagevrio can often be used if you can’t take Paxlovid. Your healthcare provider can help you figure out which medicine is best for you to take.

How do antivirals work against Covid-19?

Paxlovid is made of two drugs. They work together to manage the Covid-19 virus. Nirmatrelvir prevents the Covid-19 virus from entering uninfected cells. This way, the virus can’t spread. The second part, ritonavir, slows down how quickly the nirmatrelvir leaves your body. This gives the drug more time to do its work.

Lagevrio works differently from Paxlovid. It stops the virus from reproducing. When the virus can’t reproduce, it can’t spread throughout your body.

Planning for severe Covid-19

The best-laid plans can go awry. Even if you’re vaccinated and take all the precautions you can, there’s still a chance you will get Covid-19. If you’re at risk for severe illness from Covid-19, speak with your healthcare provider about your concerns before anything happens.

You or your caregiver can take some steps to be ready ahead of time if something does happen, said Yadira Montoya, MPH, programs director at the National Alliance for Caregiving. They include having a plan for if you test positive, having an up-to-date list of your medications, and ensuring you have your healthcare provider and insurance contact information easily accessible.

Your plan depends on your unique situation.

  • If you live alone and are struggling to manage, who will you call if you need to go to a doctor? The antiviral medications must be taken within five days of the symptoms appearing. Who can bring groceries and medication, cook for you, take your dog for a walk, or take care of other immediate needs?
  • If you live with someone else, how will that person keep from getting infected?
  • Having an up-to-date list of medications is always a good idea. Be sure to include any over-the-counter (OTC) drugs and supplements, even if they are sold as natural. Some, like St. John’s Wort, don’t combine well with the antiviral medications.
  • Ensure your healthcare provider’s contact information is easily accessible and, if possible, register a family member or close family friend as your patient advocate so they can speak on your behalf. Because of privacy regulations, healthcare professionals are not supposed to speak to anyone without your authorization unless they are the next of kin.

The National Alliance for Caregiving has a document you can print out with a checklist and a place to write down important information, including your provider information, emergency contacts, and more.

Covid-19 is not spreading as quickly as during the pandemic, but you must still be careful. Keep protecting yourself and have a plan in place, just in case.

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