NEW YORK – The nation's top public health agency on Thursday revamped its list of which Americans are at higher risk for severe COVID-19 illness, adding pregnant women and removing age alone as a factor.
The Centers for Disease Control and Prevention also changed the list of underlying conditions that make someone more susceptible to suffering and death. Sickle cell disease joined the list, for example. And the threshold for risky levels of obesity was lowered.
The changes didn't include adding race as a risk factor for serious illness, despite accumulating evidence that Black people, Hispanics and Native Americans have higher rates of infection, hospitalization and death.
Agency officials said the update was prompted by medical studies published since CDC first started listing high-risk groups. They sought to publicize the information before Independence Day weekend, when many people may be tempted to go out and socialize.
“For those at higher risk, we recommend limiting contact with others as much as possible, or restricting contacts to a small number of people who are willing to take measures to reduce the risk of (you) becoming infected,” said CDC Director Dr. Robert Redfield.
The same advice holds for people who live with or care for people at higher risk, Redfield added.
Previously, the CDC said those at high risk of serious illness included people aged 65 years and older; those who live in a nursing home or long-term care facility; and people with serious heart conditions, obesity, diabetes, liver disease, chronic kidney disease, chronic lung disease, and conditions that leave them with weakened immune systems.
In the changes, CDC created categories of people who are at high risk and people who might be at high risk.
Those who are at high risk include people with chronic kidney disease, chronic inflammatory lung disease, obesity, serious heart conditions, sickle cell disease, Type 2 diabetes, and weakened immune systems because of organ transplants. The threshold for obesity concern was lowered from a body mass index of 40 down to 30.
The CDC said people are at increasing risk as they get older, but it removed people 65 and older as a high risk group.
The list of people who might be at high risk includes pregnant women, smokers and those with asthma, diseases that affect blood flow to the brain, cystic fibrosis, high blood pressure, dementia, liver disease, scarred or damaged lungs, Type 1 diabetes, a rare blood disorder called thalassemia, and people who have weakened immune systems due to HIV or other reasons.
Pregnant women joined the list on the same day a CDC report found they accounted for about 9% of lab-confirmed COVID-19 cases in women of childbearing age. About 5% of women of childbearing age are pregnant at any given time.
The report showed that pregnant women had higher rates of hospitalization, of admission to a hospital intensive care unit and of winding up on a breathing machine vs. young women who weren’t pregnant. There was no clear evidence of a higher death rate among pregnant women, however.
It's not completely surprising, said Dr. Denise Jamieson, chair of obstetrics and gynecology at the Emory University School of Medicine. Pregnant women have been found to be at higher risk from other infectious respiratory diseases, likely because the lungs decrease in the volume as the uterus grows, Jamieson said.
What is surprising, she said, is that CDC didn't place pregnant women in the highest risk category.
“To me this is the most compelling evidence to date that pregnant women are at increased risk,” said Jamieson, who spent 20 years at CDC as a reproductive health expert.
Earlier this week, CDC officials called on a panel of experts to help them identify groups that should be prioritized for coronavirus vaccinations if one becomes available and supplies are limited.
Pregnant women could be among that group. So could certain racial and ethnic groups.
CDC officials shared data with the Advisory Committee on Immunization Practices that showed, compared with white Americans, coronavirus hospitalization rates were 4 times higher for Hispanics, 4.5 times higher for Black people, and 5.5 higher for American Indians and Alaska Natives. A recent study in the Atlanta area suggested that being Black was as large a risk for hospitalization as having diabetes, being a smoker or being obese.
“If we fail to address racial and ethnic groups as at high risk for prioritization, whatever comes out of our group will be looked at very suspiciously and with a lot of reservation,” said Dr. Jose Romero, chair of the expert panel.
“They are groups that need to be moved to the forefront,” he said.
CDC officials say they expect to come out with recommendations for racial and ethnic minority groups soon.
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