Older age as a risk factor
The largest risk group for severe cases is older people. From the age of 40, the risk initially increases very slowly and then rises ever faster – from 0.2 percent in those under 40 to up to 14.5 percent in those over 80.
The explanation: in old age, the immune system is no longer as powerful as in younger years – and it becomes weaker and weaker (immune senescence). As there are still no specific drugs to combat the virus, the body’s own defenses have to deal with it on their own. Many older people also lack the reserves of strength to cope with the strain of a severe course of the disease.
How should I behave? Older people should take special precautions against infection – even if they still feel fit. The best protection is a vaccination against Sars-CoV-2. It becomes particularly critical if a pre-existing condition is added to old age – and this is the case for most senior citizens.
People with pre-existing conditions
What is observed with other infectious diseases also applies to Covid-19: people who are already weakened cannot easily cope with an infection with the novel coronavirus. Pre-existing conditions – for example heart disease, chronic respiratory diseases and metabolic disorders such as diabetes – can therefore have a significant impact on the course of the disease.
It is also important that other people who live in a household with at-risk patients take special care to ensure that they do not introduce Sars-CoV-2. The most important protective measures include
- Vaccination against Sars-CoV-2
- As little social contact as possible with people outside your household
- Strict adherence to social distancing rules (at least 1.5, preferably 2 meters)
Read more about the protective measures in the article “Covid-19: How can I protect myself?”
Cardiovascular diseases
People with cardiovascular diseases such as heart failure or coronary heart disease (CHD) are more likely to suffer from a coronavirus infection. According to Chinese data, a good one in ten people who also suffer from heart disease die from Covid-19. The German Heart Foundation advises: “Increased caution yes, but please don’t be overly afraid.”
The explanation: every infection puts additional strain on the heart. In severe cases, patients develop pneumonia with shortness of breath. As a result, the blood is no longer enriched with as much oxygen as usual. The heart tries to compensate for this and pumps harder than usual. Damaged hearts are more quickly overwhelmed than healthy ones.
In addition, an infection with the novel coronavirus can also affect the heart directly.
High blood pressure
People who only suffer from high blood pressure are also at risk of Sars-CoV-2 infection.
The explanation: It is not yet known for certain why elevated blood pressure levels could have an unfavorable effect on the course of Covid-19. As a rule, the blood vessels in hypertensive patients are damaged and can only adapt poorly to a circulatory system that has been altered by the infection. In addition, hypertension is one of the most common causes of heart failure. And this in turn favors severe courses of Covid-19.
What should I do? High blood pressure patients should make sure that their blood pressure is well controlled in times of coronavirus. It is therefore important to take your high blood pressure medication reliably.
Diabetes
According to the German Diabetes Association (DDG), well-adjusted diabetics do not currently have a higher risk of severe courses of Sars-CoV-2 infection.
However, during the major outbreak in China, the number of deaths among diabetes patients was higher than among other infected persons.
What should I do? Less well-controlled diabetes patients should try to optimize their blood glucose control in consultation with their doctor. They will benefit from this not only in the current infection situation, but also later on.
Chronic respiratory diseases (asthma, COPD)
People with chronic respiratory diseases also have a higher risk of severe courses. These include, for example, patients with COPD, asthma, pulmonary fibrosis or sarcoidosis.
Explanation: In chronic lung diseases, the barrier function of the airways is weakened. Pathogens such as the coronavirus can therefore penetrate more easily and cause severe pneumonia. In fact, the risk of acute lung failure is also higher in people with previously damaged lungs.
What should I do? Like all other risk groups, people with lung disease should take particularly strict protective measures and get vaccinated.
Some people with lung disease are also unsettled because they fear that their cortisone-containing medication could further weaken the immune protection of their lungs. However, the German Respiratory League writes that well-adjusted patients should not change or even stop their medication, even in times of corona.
There is also a real risk that reducing or stopping the medication could cause the asthma to worsen in a dangerous way.
Smokers
Smoking damages the airways and lungs both in the short and long term. In fact, smokers are more at risk of suffering severe pneumonia as a result of a Covid-19 infection. How high the risk is depends primarily on how much the person concerned smokes and how long they have been a smoker.
Experts therefore advise people to give up cigarettes and the like right now. Even if someone has been smoking for a long time, quitting smoking immediately can still have a positive effect on the course of an infection with Sars-CoV-2.
You can find out more about this in our article “Coronavirus: smokers fall more seriously ill”
Cancer diseases
According to the Robert Koch Institute, cancer patients also have a higher risk of severe courses of COVID-19 disease. However, a higher risk of death does not apply to all cancer patients, especially not to those who have been ill for a long time.
According to the German Cancer Information Service, there is currently little knowledge about how cancer patients react to the coronavirus. In fact, their immune system may be weakened by various factors and thus favor the penetration and spread of the viruses.
- However, a severely weakened immune system can also be the result of cancer therapies (e.g. chemotherapy, radiotherapy, targeted therapy, antibody therapy, blood stem cell transplantation or CAR-T cell therapy). The decisive factor is how severely the immune system has actually been stressed.
Nevertheless, the German Society for Hematology and Medical Oncology (DGHO) recommends not postponing or suspending a planned cancer therapy. Prompt treatment of the cancer is usually crucial for the patient’s chances of survival. Only after careful medical consideration can it currently make sense to postpone treatment in individual cases of well-controllable cancer.
Cancer patients are also prioritized for vaccination. However, cancer therapy can weaken the development of immune protection. The optimum interval is three, preferably six months after the last treatment.
Immunodeficiency
A weakened immune system always poses an increased risk of infections and subsequent serious illnesses – including Covid-19. A distinction is made between the following patient groups:
- People with a congenital immunodeficiency
- People with an acquired immunodeficiency, e.g. people infected with HIV who are not receiving therapy
Taking immunosuppressive medication
Consequently, patients who have to take long-term medication that suppresses the immune system (immunosuppressants such as cortisone) are also at greater risk. These include in particular
- Patients with an autoimmune disease, e.g. inflammatory rheumatic diseases in which the immune system attacks the body’s own tissue
- Patients after an organ transplant, where medication must prevent the immune system from rejecting the transplanted organs
The extent to which the medication downregulates the immune system depends on the active ingredient and the respective dose. It is important not to stop or reduce the medication without consulting your doctor. The negative health consequences can be serious.
Liver and kidney diseases
The Robert Koch Institute considers people with liver disease, such as cirrhosis or hepatitis, to be at risk of a severe course of Covid-19. In fact, some infected people have increased liver values, even if they did not previously have liver disease. This is not unusual in infectious diseases.
The situation is similar for patients with kidney damage. The Robert Koch Institute also considers them to be at risk. However, it has not yet been proven that they are more likely to become seriously ill or even die from Covid-19. Current studies show that patients who have contracted Covid-19 are more likely to develop kidney dysfunction and kidney function impairment. There does not yet appear to be any data on how this affects existing kidney disease.
Men
Men and women contract Covid-19 at roughly the same rate, but the risk of death is 31 to 47 percent higher for men. In Germany, 3.1 percent of known infected men died, but only 2.7 percent of women. There are various possible reasons for this. For example, men’s cells are equipped with more ACE2 receptors, through which the virus penetrates the cells. In addition, women’s immune systems are generally more active and therefore better equipped to fight infections.
Pregnant women
Severe cases are also observed more frequently in pregnant women. Possibly because the immune system shuts down during pregnancy in order to tolerate the fetus. Vaccination is therefore recommended for pregnant women with pre-existing conditions such as diabetes or obesity.
