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Understand What Factors Can Make COVID-19 Worse

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The recent surge in cases of COVID-19, hospitalizations and deaths have been difficult for many communities in Oregon, including ours. While advanced age is the strongest risk factor for severe COVID-19 outcomes, having an underlying condition can affect how severe a COVID-19 infection can be.

“Having an underlying condition has been a risk factor for severe COVID-19 and death since the beginning of the pandemic,” said Adam Brady, MD, from Samaritan Infectious Disease who heads the Coronavirus Task Force at Samaritan. “If you have medical conditions that put you at high risk of severe infection you should get vaccinated and adhere to recommended precautions like masking in public and avoiding crowded places.”

Underlying Conditions Associated With Severe COVID-19 & Death

Nationwide, the Centers for Disease Control and Prevention reports the following conditions have a significant association with a risk of severe COVID-19 illness:

  • Cancer.
  • Cerebrovascular disease.
  • Chronic kidney disease.
  • Chronic obstructive pulmonary disease (COPD).
  • Diabetes, type 1 and type 2.
  • Heart conditions such as heart failure, coronary artery disease or cardiomyopathies.
  • Obesity (BMI of 30 or more).
  • Pregnancy and recent pregnancy.
  • Smoking, current and former.

Locally, the Oregon Health Authority (OHA) reported the most common underlying conditions for Oregon patients who have died from COVID-19 are cardiovascular, neurological, other chronic illness and diabetes. The group also reports that 92 percent of Oregonians who have died from COVID-19 had an underlying condition.

Obesity affects 29.8 percent of adults in Oregon according to the OHA, making it the most common underlying condition in the state that raises the risk for severe illness or death. However, having cardiovascular disease appears to be the most common underlying condition in deaths from COVID-19. While just 7.2 percent of Oregonians reported having cardiovascular disease, the condition is present in 47 percent of those who have died from COVID-19.

Underlying Conditions & Death From COVID-19 – Oregon

Graph showing underlying conditions and deaths in Oregon from COVID-19 in late 2021.

Why Do Some Conditions Affect COVID-19 Outcomes?

Having one or more of these underlying conditions makes it harder for your body to fight infection due to:

  • Chronic Inflammation

    An underlying condition often creates chronic inflammation, which makes it difficult for the body to repair and recover from damage due to infection.
  • Weakened Immunity

    The body’s immune system targets germs to fight infection. Some underlying conditions weaken the immune system, making it slower to respond to infection. This can give the virus that causes COVID-19 more time to replicate and overwhelm the body. Some conditions that weaken the immune system may make the vaccine less effective.
  • Cardiovascular & Pulmonary Effects

    COVID-19 primarily affects the lungs but it can also affect the heart. For people who have an underlying condition, their heart and lung function are often already compromised or damaged, and the body is not able to recover once it is infected with the coronavirus. 

How Does Vaccine Protection Measure Up?

The overwhelming majority of COVID-19 cases in hospitals at Samaritan Health Services and around the country are made up of unvaccinated patients.

“About 90 percent of our patients hospitalized with COVID-19 are not fully vaccinated,” said Dr. Brady. “The low proportion of breakthrough hospitalizations we see indicates the vaccine is doing a good job of keeping fully vaccinated people out of the hospital.”

Hospitalized COVID-19 Patients by Vaccine Status – Oregon

Graph showing vaccinated and unvaccinated hospitalized COVID-19 patients in Oregon hospitals from July to October 2021. Original Source: Oregon Health Authority

Breakthrough cases, where a fully vaccinated person develops COVID-19, are happening. However, a vaccinated person’s risk of developing severe disease or dying is much lower.

“A breakthrough case that leads to death is rare but generally occurs in people who have other health conditions or are immunocompromised,” said Dr. Brady. 

Data out of the United Kingdom found that in breakthrough deaths, 76 percent were considered extremely clinically vulnerable. The median age for breakthrough death was 84.

“It’s especially important for people who have underlying conditions and are at risk for severe illness to be vaccinated,” said Dr. Brady. “This includes third doses of mRNA vaccine for people 65 years or older who received the Pfizer vaccine, who are immunocompromised, have underlying medical conditions, or otherwise qualify for booster doses of vaccine. The COVID-19 vaccines authorized for use in the United States are safe and effective, and the number one preventative measure we have to combat the virus.”

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