COVID-19 and chronic conditions: A look at population health

The extent and impact of the COVID-19 pandemic is still emerging. Lack of experience with a novel virus is challenging governments, public health systems, and individuals worldwide.  We have a unique opportunity not just as a nation, but globally, to improve our understanding of infectious disease and population health while confronting this new virus.

During an infectious disease outbreak, we should still remember that non-communicable disease (NCD), including heart disease, cancer, chronic obstructive pulmonary disease and diabetes, is the leading cause of death and disability in the United States, not infectious disease.  However, while the proportion of deaths caused by infectious disease compared to NCDs is low in the United States, lower respiratory infections, such as pneumonia, account for nearly 8 of 10 infectious disease deaths. The new coronavirus, known as SARS-CoV-2, can contribute to lower respiratory infection morbidity and mortality by infecting the epithelial cells within the lung.

Population health interventions in the United States have typically focused on persons with chronic conditions. While recommendations to thoroughly wash hands and avoid exposure to infected individuals should be followed by everyone, the 60 percent of Americans with at least one chronic health condition represent a distinct risk group. A study of 1,590 coronavirus patients in China found that those with one chronic condition were 1.8 times more likely to have a poor outcome and those with two chronic conditions had a 2.6 times greater risk compared to those with none. While the risk of serious disease caused by coronavirus is well-publicized for older adults, it is important not to overlook the risks to those with chronic conditions, and particularly those who are in both risk groups.

It is advisable for all of us to take the necessary precautions of handwashing and exposure avoidance; however, those with chronic conditions have additional steps they can take to reduce their risk. Quitting smoking is advised for the 34 million American adults that smoke, particularly since COVID-19 is a respiratory disease. Controlling blood sugar levels among the 34 million Americans with diabetes can boost immunity. The 16 million Americans with chronic obstructive pulmonary disease (COPD) are at particular risk, since COVID-19 can exacerbate breathing difficulties.

While the healthcare system is encouraging everyone to practice the basic precautions for avoiding infectious disease transmission, a continued focus on those with complex chronic conditions should remain a priority. Interventions that address health behaviors among those with single and multiple chronic conditions, as well as older adults, will offer the best opportunity to reduce morbidity and mortality related to COVID-19.

Steve Delaronde is director of consulting for Payer and Population Health Services at 3M Health Information Systems.

During a pandemic, information is gathered, studied, and published rapidly without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. We share our thoughts and expertise based on currently available information.