The Centers for Disease Control and Prevention on Thursday broadened its warning about who is at risk of developing severe disease from Covid-19 infection, suggesting even younger people who are obese or have other health conditions can become seriously ill if they contract the virus.

The new advice, timed to influence behavior going into the July 4 weekend, came as CDC Director Robert Redfield acknowledged serology testing the agency has conducted suggests about 20 million Americans, or roughly 6% of the population, has contracted Covid-19. Redfield said for every person who tests positive, another 10 cases have likely gone undiagnosed.

While the 20 million estimate is far higher than the figure on the CDC’s Covid-19 website, it still represents a fraction of the country’s population, Redfield said.

advertisement

Support STAT: If you value our coronavirus coverage, please consider making a one-time contribution to support our journalism.

“This pandemic is not over. The most powerful tool that we have, a powerful weapon, is social distancing,” he insisted during a press conference, only the second the CDC has been allowed to conduct since early March.

The new advice frames the risk as rising with age, jettisoning earlier warnings that mainly those 65 and older faced higher risk. It also puts greater emphasis on the risk presented by a number of health conditions, including having a body mass index of 30 or over. Previously the warning related to people who had a BMI of 40 or over.

advertisement

“Younger people are in no way completely immune to the effects of SARS-CoV-2 nor are they at zero risk of severe manifestations,” said the Jay Butler, incident manager for the CDC’s Covid-19 response. “And among young people, that risk is elevated in those with underlying illness or health conditions, including things like diabetes or obesity.”

The agency is also warning that being pregnant may increase a woman’s risk of being hospitalized and having a severe bout of the illness, based on a study of more than 8,000 pregnant women in the United States who were diagnosed with Covid-19.

The study, published in the CDC’s Morbidity and Mortality Weekly Report, an online journal, found that pregnant women were 50% more likely to be hospitalized with Covid-19 than infected women who weren’t pregnant and had a 70% greater chance of needing mechanical ventilation than non-pregnant women with the infection.

But the study did not find an increased risk of death among the pregnant women.

The new guidance reflects what has been apparent for months now, with countless new severe cases among young people and those with underlying conditions. But warnings of those cases have largely gone unheeded as states have begun to reopen.

The country is seeing a fresh surge of cases, particularly in the West and South, where hospitals are swelling with new cases and state governments are struggling to respond. On Thursday, Texas Gov. Greg Abbott announced the state would pause its reopening in the face of outbreaks across the state.

Despite the surge in cases, President Trump has continued to express the view that the virus is going away. When asked if Americans were getting mixed messages about whether they need to take precautions to prevent becoming infected, the CDC director appeared to seek a middle ground.

Redfield suggested many of the infections now being diagnosed would have been missed earlier in the pandemic, when testing was less common.

“I’m asking people to recognize that we’re in a different situation today than we were in March, in April, where the virus was being disproportionately recognized in older individuals with significant comorbidities and was causing significant hospitalizations and deaths,” he said.

“Today we’re seeing more virus. It’s in younger individuals. Fewer of those individuals are requiring the hospitalizations and having a fatal outcome. But that is not to minimize it.”

But Redfield went on to note that descriptions of the state of the pandemic in the country can be misleading, with maps that show where transmission is high suggesting much of the nation is experiencing high levels of spread. In reality, he said, about 110 or 120 counties in the country currently have significant transmission. There are more than 3,100 counties in the United States.

The new guidance breaks down medical conditions that can influence disease severity into those for which there is strong evidence, and those for which the evidence is not as strong, classifying the latter as conditions that might increase the risk of severe illness.

Cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease or COPD, obesity, any immuno-suppressing condition, sickle cell disease, a history of an organ transplant, and type 2 diabetes are classified as having strong evidence of increasing the risk of Covid-19 infection.

Conditions that are considered ones that might increase the risk of severe illness are chronic lung diseases, including moderate to severe asthma and cystic fibrosis, high blood pressure, a weakened immune system, neurologic conditions, such as dementia or history of stroke, liver disease, and pregnancy.

  • So what to do besides wearing a mask in public when contact with others is imminent, staying 6 or more feet away form other people, wash the hands continuously and just hoping you don’t contact Chronovirus.

    • If you really want more protection, stay more than 6 feet away and maybe use a hood. Not just a face shield, a hood. Apparently, just letting the contagious particles fall out of the air is a big help. Having a hood on, and slowing the intake of air into the hood, gives them a lot better chance to fall, instead of being inhaled.

  • I am highly skeptical. What evidence shows that BMI alone is a risk factor? Remember, correlation is not causation.

    • Hi Lisa,

      I am not burying my head in the sand. I am asking for the evidence. That is the opposite.

      Your comment about Ruffles is shaming and fatphobic. I am in a thin body, but I can imagine the harm that would do to my friends in larger bodies. I hope you feel called in to interact with people with more compassion and kindness.

      Thanks

    • JB – The evidence for BMI being a risk factor is that people with high BMI get more sick, and die more.
      Now, suppose it was not a risk factor – but instead, the risk was something causing the high BMI, not the BMI itself but some other cause.
      So, that means, SOME of the high BMI people are at risk, from this unknown factor, and some, who have high BMI for other reasons, are not.
      So, researchers can look at obese people who got Wuhan but had a very mild case, and try to figure out why, but overall, this mysterious unknown thing which makes people obese, and makes them vulnerable to severe Wuhan, DOUBLES THE RISK YOU WILL DIE – this is not some small scale effect, it is huge – and, if you look at obesity, really a lot of it seems to be lifestyle.
      Considering all that, it seems very likely it is the obesity, rather than something else, which makes you vulnerable – which is really good news, potentially, because we can get less obese and less diabetic.

  • The way the comments quickly turn political is why a lot of people continue to hold the Democrat state administrations suspect and blame them for the economic ruin of local communities.

  • More nonsense from the CDC and echoed by STAT. The virus is contagious and it is in the general population. As testing becomes more widespread two things become evident: the virus is virulent but not nearly as virulent as first thought. It is more akin to the H3/N2 pandemic.
    First and foremost: infection is extremely common; mild disease (with viral or flu like symptoms) is common but no worse than exposure to the innumerable pathogens that our immune systems deal with on a daily basis.

    Second: the disease progresses from a asymptomatic or mildly symptomatic population in a small minority of patients. This is true of COVID-19. This is true of many other pathogens.

    Third: the populations at risk and why they are at risk is well known and well understood: Diabetes type 2, hyperglycemia, hypertension, obesity and low vitamin D levels are the major risk factors. It is likely these are not completely independent variables. Healthcare workers are at risk as obesity is fairly common, they are working under stressful situations, have a tendency to eat highly sugared diets, and have exposure to a larger viral inoculate. A small population of genetic susceptible individuals are present in the population.

    Why are the obese at risk? Many, but not all, are “fat on the inside and fat on the outside”. Those who fit this latter category, and this is the vast majority, are in a state of chronic inflammation with high interferon 1 levels and are predisposed to diseases of chronic inflammation.

    They usually have hyperglycemia with a diagnosis of either pre-diabetes or diabetes type 2.

    Patients with diabetes type 2 (DMT2) are in a state of chronic inflammation with an altered immune response. The acute phase is blunted. The chronic response is exaggerated with an elevation of TH17/TH1. TH17/TH1 elevation is the hallmark of autoimmune disease. They are insulin resistant. Insulin is protective. Although they have high levels of insulin, it does not work. This results in inefficient utilization of glucose. Not only does this interfere with the acute/neutrophilic response, it also interferes with the T-helper cell response. This results in T cell exhaustion; the hallmark of those who succumb to the virus. Fortunately it only happens in the minority.

    They have hyperglycemia. Hyperglycemia causes inactivation of IRF5. IRF5 is necessary to keep the immune system under control. Deficiency in IRF5 results in increased autoimmune disease. Hyperglycemia by itself, either transiently in “normal” people or chronically elevated as in diabetics type 2, has the same effect. Oral hypoglycemic agents, such as metformin, futher interfere with energy generation and may increase susceptibility (due to the above).

    They often have hypertension. Hypertension has several affects that are likely synergistic with the virus. They have increased AEC2 receptors. AEC2 receptors are the portal of entry of the virus. Their renin-angiotensin axis is dysfunctional and the virus further accentuates this. Their blood vessels are stiff due to the chronically inflamed state. The virus directly attacks blood vessesl and exacerbates the problem.

    Middle aged males are sightly at increased risk. The reason is clearly understood: testosterone increases TMPRSS2. TMPRSS2 is a fusion protein necessary for activation of the virus and viral entry into the cell. Biological males have more testosterone than females. Testosterone supplementation among middle aged males is now common and may be a contributing factors.

    Young females have increased ER and PR. Both are protective. Both wane with age. ER shifts the M1 pro inflammatory macrophage to the M2 anti-inflammatory macrophage. Progesterone is protective.

    Vitamin D deficiency: Vitamin D is necessary for an optimal immune response and in particular suppresses autoimmune reactions by keeping the dendritic cell in an immature and immuno-tolerant state. It shifts the M1 to the M2 macrophage. It shifts the TH17/TH1 phenotype to TH2. Those who are low in vitamin D and low in sunshine. Sunshine has direct effects that are independent of vitamin D, including effect on cytotoxic T cells and adipose tissue. It is necessary to set the circadian rhythm for optima immune response.

    Diet is also important. Glucose causes inactivation of IRF5. Fructose is even more efficient at this. Those who consume heavily sugared snacks, especially those who sweetened by high fructose corn syrup, are altering their immune response. Among health care workers, consumption of high sugared snacks in place of nutritious foods is common. They are under stress. They are at increased inoculate exposure.

    So, if the CDC is serious here are the recommendations:
    Use a mask. It interferes with respiratory droplet contamination and impair viral transmission.
    Go outside. Get plenty of sunshine (20 minutes midday if fair skinned; up to 1 1/2 if heavily pigmented); avoid heavily sugared snacks (especially those sweetend with high fructose corn syrup); get 30 minutes of exercise and this helps restore insulin sensitivity and lose some weight.

    The general population is not at risk. If one of the above, do something. But stop the generalized hysteria.

  • When more concerns are raised for imminent future times, broad measures such as the usefulness of intake of substances like Vitamin C, Vitamin E, Vitamin D3, Vitamin B12, micronutrients such as Zinc and Chromium, natural substances such as turmeric powder and pepper along with the daily intake quantities could also be prescribed. These substances would not only make up for the deficiencies but would also improve innate immunity.

  • I sincerely hope that the “younger” US crowds finally pay attention – before the sand on the beaches, the grass in the parks, and the lights in the disco need to be disinfected ……

  • Photo of CDC Director Robert Redfield wearing a mask, but touching his face. Unconscious habits are hard to break. Shows how social distancing, wearing masks, hand washing, can be hard to implement on a public level. Stay cognizant!

  • At least one number that seems believable from the CDC. An estimation of 6% of population infected is in line with what Spain has reported (5%). That means that by the time the whole population will have been infected, between 2-2.5M citizens will have died. Being generous and halving it 1-1.5M. Still a big, beautiful number, the best the world has ever seen paraphrasing the leader with a gut feeling for science.

    • corrigendum:
      That means that by the time the whole population will have been infected, as both may local and the federal governments have done almost nothing to prevent that from happening, between 2-2.5M citizens will have died.

    • The whole population isn’t going to get infected. The elderly are staying holed up in their basements while the younger crowd are participating in business reopening. So they young will eventually get herd immunity, and then the old can come out again in a year or two.

  • “press conference, only the second the CDC has been allowed to conduct since early March.”

    That right there sums up why we are in this mess. A COMPETENT government response from appointed officials who actually listened to experts instead of denying/covering up/lying/witholding aid/dismantling task forces designed to deal with pandemics- to score political points would have us in a much better situation. Think about that when voting.

    • Monyka, I couldn’t agree more. What an effing disaster. We here in Minnesota are blessed with an extremely competent, intelligent governor with an EQ to match. Our health dept. is world class. They are filling the huge gaps in public health left by an utterly incompetent response from the administration of President Douchebag. I’m so glad I live in a place like this-not perfect, but pretty good.

Comments are closed.

Sign up to receive a free weekly opinions recap from our community of experts.
Privacy Policy