Contributing Factors That May Lead to Severe COVID-19 Infection


Experts discuss comorbidities as risk factors for patients developing severe COVID-19 symptoms.

Mitchel Rothholz, RPh, MBA: Are there particular patients who need to be more cognizant of the importance of being up to date on their vaccinations? As pharmacists who are working with patients with chronic diseases, which ones should they pay particular attention to in delivering the messages about the importance of being up to date on the recommended vaccines?

Jeff Goad, PharmD, MPH: Absolutely. We’ve learned throughout the pandemic. This is where you start to look at the data for people who were hospitalized or who died to be able to put together a pattern of which patients might be more likely to be at risk. For example, people who are immunocompromised certainly are at greater risk, along with those who are overweight or have chronic kidney disease, heart conditions, or diabetes. Some of these unfortunately common chronic diseases within our population also put you at risk for severe influenza or overwhelming pneumococcal disease. They’re the same ones that stress your immune system and perhaps don’t allow you to mount an immune response that would keep you out of the hospital or keep you from dying. We know the populations.

Age is a condition that none of us can do anything about. We’re all going to get older. The alternative isn’t good. All we can do is plan for those who are over 50 or over 65 years old in skilled nursing facilities, and be able to focus immunization efforts. Those carry the greatest weight. We’re going to get the most bang for our buck in keeping people out of the hospital and keeping them from dying if we can get our patients who are older, are obese, or have chronic kidney disease, heart disease, diabetes—all these diseases. We need to convince those patients that they’re at increased risk. Unvaccinated people are 8 times more likely to die. They’re 4½ times more likely to be hospitalized. It used to be 20 times. During the initial surge in COVID-19 in December 2021 with Omicron, it was 20 times. The risk of death is coming down—that’s an epidemiological finding—but the disease itself is worse for people with these diseases and older age.

Mitchel Rothholz, RPh, MBA: One statistic that I thought was interesting is that about 60% of American adults have 1 chronic disease. Those individuals should look at protection, because you never know when your system may be vulnerable to a virus like COVID-19. Pregnant patients are another population about whom there has been a lot of questions and concerns in terms of the importance of getting vaccinated and staying up to date on their vaccination against COVID-19. Give a little more insight in terms of the benefit of getting vaccinated vs getting the disease.

Jeff Goad, PharmD, MPH: Pregnancy is a very delicate time, if you look at the risk to the mother and to the fetus. With COVID-19, natural disease can be devastating during pregnancy. You can have early termination of pregnancy. The mom can get very ill and have a high-risk pregnancy. The influenza vaccine dramatically reduces the chances of adverse outcomes with pregnancy. [The COVID-19 vaccine] does that well. [It’s important to] make sure pregnant women are vaccinated, that they get their booster or start their primary series. It’s been a limited amount of time, but we have robust surveillance systems, and we haven’t detected any teratogenicity or fetal abnormalities that would give us pause for recommending this vaccine, so it’s definitely recommended.

Transcript edited for clarity.

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