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 did not include adding race as a risk factor for serious illness, despite accumulating evidence that black, Hispanic, and Native American people have higher rates of infection, hospitalization, and death.
Agency officials said the update was prompted by published medical studies since the CDC began to include high-risk groups. They tried to publicize the information before the 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 steps to reduce the risk of (you) becoming infected,” said the Dr. Director of the CDC. Robert Redfield.
The same advice is valid for people living with or caring for people at higher risk, Redfield added.
Previously, the CDC said that those at high risk for serious illness included people age 65 and older; those who live in a nursing home or long-term care facility; and people with severe heart conditions, obesity, diabetes, liver disease, chronic kidney disease, chronic lung disease, and conditions that leave them with a weakened immune system.
In the changes, CDC created categories of high-risk people and high-risk people.
People at high risk include people with chronic kidney disease, chronic inflammatory lung disease, obesity, severe heart conditions, sickle cell disease, type 2 diabetes, and weakened immune systems due to organ transplants. The threshold for concern about obesity was lowered from a body mass index of 40 to 30.
The CDC said people are at higher risk as they age, but it removed people 65 and older as a high-risk group.
The list of people who could be at high risk includes pregnant women, smokers, and people 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 the same day a CDC report found that they accounted for about 9% of laboratory-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, admission to a hospital intensive care unit, and ending up on a breathing machine compared to young women who were not pregnant. However, there was no clear evidence of a higher mortality rate among pregnant women.
Not entirely surprising, said Dr. Denise Jamieson, president of obstetrics and gynecology at Emory University School of Medicine. Pregnant women have been found to be at a higher risk of contracting other infectious respiratory diseases, likely because the lungs decrease in volume as the uterus grows, Jamieson said.
The surprising thing, he said, is that the CDC did not put pregnant women in the highest risk category.
“For 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 asked an expert panel to help them identify groups that should have priority for coronavirus vaccines if one is available and supplies are limited.
Pregnant women could be in that group. They could also certain racial and ethnic groups.
CDC officials shared data with the Advisory Committee on Immunization Practices that showed that, compared to white Americans, rates of hospitalization for coronavirus 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 great a risk of hospitalization as having diabetes, smoking, or being obese.
“If we do not address racial and ethnic groups as high-risk for prioritization, what comes out of our group will be analyzed in a very suspicious manner and with great reserve,” said Dr. José Romero, chairman of the panel of experts.
“They are groups that need to be moved to the forefront,” he said.
CDC officials say they hope to make recommendations for racial and ethnic minority groups soon.
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