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Covid-19 and Chronic Health Conditions

AMBULATORY CARE:

What you need to know about coronavirus disease 2019 (COVID-19) and chronic health conditions:

Your chronic condition may increase your risk for COVID-19 or serious problems it can cause. Healthcare providers might need to make changes that affect how you usually manage your chronic health condition. Providers may change hours of operation or not have patients come in to be seen. You may not be able to make appointments to get blood drawn or to have tests or procedures. This may continue until the virus that causes COVID-19 is controlled. Until then, you can take steps to manage your condition. The steps will also lower your risk for COVID-19 or the serious problems it causes. If you do develop COVID-19, healthcare providers will tell you when it is okay to be around others after you recover. This depends on your chronic condition, any symptoms of COVID-19 that developed, and how severe the symptoms were.

What you need to know about serious problems from the virus:

  • The virus can affect many parts of the body. The virus can cause serious lower respiratory conditions, such as pneumonia or acute respiratory distress syndrome (ARDS). It can also affect many other organs, including the brain and heart. Blood vessels can also be affected, leading to blood clots. Serious effects can continue for weeks or months, and possibly years.
  • Anyone can develop serious problems from the virus, but some health conditions increase the risk. Healthcare professionals are still learning how the virus affects a person who has a chronic health condition. Protect yourself from infection, even if your chronic condition is not listed below. More is being learned about the virus every day. Health conditions known to increase the risk for COVID-19 or its serious complications include the following:
    • Obesity, diabetes, cancer, Down syndrome, or a liver disease
    • Kidney failure, chronic kidney disease, or sickle cell disease
    • Lung disease, COPD, moderate-to-severe asthma, cystic fibrosis, or pulmonary fibrosis (scarring in your lungs)
    • A severe heart disease, such as coronary artery disease or heart failure
    • A brain blood vessel disorder or disease, or a condition such as dementia
    • Hypertension (or high blood pressure), or thalassemia
    • An immune system problem, HIV or AIDS, or a blood, bone marrow, or organ transplant
  • Other factors that increase your risk are age 65 or older or living in a long-term care facility. Pregnancy, cigarette smoking, or long-term corticosteroid use can also increase your risk.

If you think you may be infected with the coronavirus,

do the following to protect others:

  • If emergency care is needed, tell the operator about the possible infection, or call ahead and tell the emergency department.
  • Call a healthcare provider for instructions if symptoms are mild. Do not arrive without calling first. Your provider will need to protect staff members and other patients.
  • Cover your mouth and nose while you are getting medical care. This will help lower the risk of infecting others.

Call your local emergency number (911 in the US) or an emergency department if:

  • You have trouble breathing or shortness of breath.
  • You have chest pain or pressure that lasts longer than 5 minutes.
  • You become confused or hard to wake.
  • Your lips or face are blue.
  • You have a fever of 104°F (40°C) or higher.

Call your doctor or healthcare provider if:

  • You do not have symptoms of COVID-19 but had close physical contact within 14 days with someone who tested positive.
  • You have questions or concerns about your COVID-19 or your chronic condition.

How the 2019 coronavirus spreads:

The virus spreads quickly and easily. The virus can be passed starting 2 days before symptoms begin or before a positive test if symptoms never begin. The following are ways the virus is thought to spread, but more information may be coming:

  • Droplets are the main way all coronaviruses spread. The virus travels in droplets that form when a person talks, coughs, or sneezes. The droplets can also float in the air for minutes or hours. Infection happens when you breathe in the droplets or get them in your eyes or nose. Close personal contact with an infected person increases your risk for infection. This means being within 6 feet (2 meters) of the person for at least 15 minutes over 24 hours.
  • Person-to-person contact can spread the virus. For example, a person with the virus on his or her hands can spread it by shaking hands with someone.
  • The virus can stay on objects and surfaces for a short time. You may become infected by touching the object or surface and then touching your eyes or mouth.
  • An infected animal may be able to infect a person who touches it. This may happen at live markets or on a farm.

Manage your chronic health condition during this time:

If you do not have a regular healthcare provider, experts recommend you contact a local community health center or health department. The following can help you manage your condition and prevent COVID-19:

  • Get emergency care for your condition if needed. Talk to your healthcare providers about symptoms of your chronic condition that need immediate care. Your providers can help you create a plan or add exacerbation management to your plan. The plan will include when to go to an emergency department and when to call your local emergency number. This will depend on where you live and the services that are available during this time.
  • Go to dialysis appointments as scheduled. It is important to stay on schedule. You will need to have enough food to be able to follow the emergency diet plan if you must miss a session. The emergency diet needs to be part of the management plan for your condition.
  • Reschedule any upcoming appointments as needed. Medical facilities may be closed until the coronavirus is better controlled. This means you may need to reschedule a surgery, procedure, or check-up appointment. If you cannot have a phone or video appointment, you will need to make a new appointment. Some providers may be scheduling appointments several months in advance. Some surgeries and procedures will happen as scheduled. This depends on the medical condition and the reason for the surgery or procedure. You may need to have extra testing for COVID-19 several days before.
  • Follow any regular management plan you use. Your healthcare provider will tell you if you need to make any changes to your regular management plan. For example, if you have asthma, continue to follow your asthma action plan. If you have diabetes, you may need to check your blood sugar level more often. Stress and illness can make blood sugar levels go up. You may need to adjust medicine such as insulin. If you have a heart condition or high blood pressure, you may need to check your blood pressure more often. Stress and illness can also raise your blood pressure.
  • Talk to your healthcare providers about your medicines. You may be able to get more than 1 month of medicine at a time. This will lower the number of times you need to go to a pharmacy to get your medicines. Make sure you have enough medicine if you have a condition that can lead to an emergency. Examples include asthma medicines, insulin, or an epinephrine pen. Check the expiration dates on the medicines you currently have. Ask for refills as soon as possible, if needed. If it is not time to refill prescriptions, you may be able to get an emergency supply of some medicines. Medicine plans vary, so ask your healthcare provider or pharmacist for options.
  • Have supplies available in your home. If possible, get extra supplies you use regularly. Examples include absorbent pads, syringes, and wound cleaning solutions. This will limit the number of trips out of your home to get supplies.
  • Know the signs and symptoms of COVID-19. Signs and symptoms usually start about 5 days after infection but can take 2 to 14 days. Signs and symptoms range from mild to severe. You may feel like you have the flu or a bad cold. Your chronic health condition may cause some of the same symptoms COVID-19 causes. This can make it hard to know if a symptom is from COVID-19 or your chronic condition. Keep a record of any new or worsening symptom you have. This is especially important if you have a condition that often causes shortness of breath. Your provider can tell you if you should be tested for COVID-19. Information is still being learned. Tell your healthcare provider if you think you were infected but develop signs or symptoms not listed below:
    • A cough
    • Shortness of breath or trouble breathing that may become severe
    • A fever of at least 100.4°F, or 38°C (may be lower in adults 65 or older)
    • Chills that might include shaking
    • Muscle pain, body aches, or a headache
    • A sore throat
    • Suddenly not being able to taste or smell anything
    • Feeling very tired (fatigue)
    • Congestion (stuffy head and nose), or a runny nose
    • Diarrhea, nausea, or vomiting

What you can do to prevent having to go out of your home during this time:

  • Ask your healthcare provider for other ways to have appointments. Some providers offer phone, video, or other types of appointments.
  • Have food, medicines, and other supplies delivered. Some pharmacies can send certain medicines to you through the mail. Grocery stores and restaurants may be able to deliver food and other items. If possible, have delivered items placed somewhere. Try not to have someone hand you an item. You will be so close to the person that the virus can spread between you.
  • Ask someone to get items you need. The person can get groceries, medicines, or other needed items for you. Choose a person who does not have signs or symptoms of COVID-19 or has tested negative for it. The person should not be waiting for test results. He or she should not have a condition that increases the risk for COVID-19 or serious problems it causes.

Lower your risk for COVID-19:

The best way to prevent infection is to avoid anyone who is infected, but this can be hard to do. An infected person can spread the virus before signs or symptoms begin, or even if signs or symptoms never develop. The following are ways to prevent the spread of the virus and lower your risk for COVID-19:

Prevent COVID-19 Infection
  • Wash your hands often throughout the day. Use soap and water. Rub your soapy hands together, lacing your fingers. Wash the front and back of each hand, and in between your fingers. Use the fingers of one hand to scrub under the fingernails of the other hand. Wash for at least 20 seconds. Rinse with warm, running water for several seconds. Then dry your hands with a clean towel or paper towel. Use hand sanitizer that contains alcohol if soap and water are not available. Do not touch your eyes, nose, or mouth without washing your hands first. Teach children how to wash their hands.
    Handwashing
  • Cover sneezes and coughs. Turn your face away and cover your mouth and nose with a tissue. Throw the tissue away. Use the bend of your arm if a tissue is not available. Then wash your hands well with soap and water or use hand sanitizer. Turn your head and cover your face if someone near you is coughing or sneezing. Teach children how to cover a cough or sneeze. Remind them to wash their hands.
  • Make a habit of not touching your face. If you get the virus on your hands, you can transfer it to your eyes, nose, or mouth and become infected.
  • Wear a face covering (mask) around anyone who does not live in your home. A covering helps protect the person wearing it from being infected or passing the virus to others. Use a disposable non-medical mask, or make a cloth covering with at least 2 layers. Cover your mouth and your nose. Securely fasten it under your chin and on the sides of your face. Do not use coverings on children younger than 2 years or on anyone who has breathing problems or cannot remove it. Your healthcare provider can tell you what to do if you cannot wear a face covering.
    How to Wear a Face Covering (Mask)
  • Clean and disinfect high-touch surfaces and objects in your home often. Some surfaces and objects may need to be cleaned several times each day, depending on how often they are used. Use disinfecting wipes, or make a solution by mixing 4 teaspoons of bleach with 1 quart (4 cups) of water. Do not use any cleaning or disinfecting products that can trigger an asthma attack or other breathing problems. Open windows or have circulating air as you clean. Do not mix ammonia with bleach. This will create toxic fumes.

How to follow social distancing guidelines:

Social distancing means people avoid close personal contact so the virus cannot spread from one person to another. Close personal contact means being within 6 feet (2 meters) of someone for at least 15 minutes over 24 hours. National and local social distancing rules vary. Rules may change over time as restrictions are lifted, but they may return if an outbreak happens where you live. It is important to know and follow all current social distancing rules in your area. The following are general guidelines:

  • Stay home if you are sick or think you may have COVID-19. It is important to stay home if you are waiting for a testing appointment or for test results. Even if you do not have symptoms, you can pass the virus to others.
  • Limit trips out of your home. Plan your route so you make the fewest stops possible to limit contact. Keep track of places you go. This will help contact tracers notify others if you become infected.
  • Stay at least 6 feet (2 meters) away from anyone who does not live in your home. Do not shake hands with, hug, or kiss a person as a greeting. Stand or walk as far from others as possible, especially around anyone who is sneezing or coughing. If you must use public transportation (such as a bus or subway), try to sit or stand away from others. Check in on anyone who lives alone.
  • Do not have anyone over to your home unless it is necessary. It is okay to have medical workers or other helpers in to provide care. Wear a face covering, and remind others to wear a mask or face covering. Remind them to wash their hands when they arrive and before they leave. Do not have anyone over just to visit, even if you both do not feel sick. The virus can pass from one of you to the other before symptoms of COVID-19 begin. Some people never even develop symptoms. It is important that you continue social distancing with everyone, including children. It may be hard to tell a child not to hug or kiss you. Explain that this is how he or she can help you stay healthy.
  • Do not go to someone else's home unless it is necessary. Do not go over to visit, even if the person is lonely. Only go if you need to help him or her.
  • Avoid in-person gatherings and crowds. Gatherings or crowds of 10 or more individuals can cause the virus to spread. Avoid places such as parks, beaches, sporting events, and tourist attractions. For events such as parties, holiday meals, religious services, and conferences, attend virtually (on a computer), if possible.
  • Stay safe if you must go out to work. Keep physical distance between you and other workers as much as possible. Follow your employer's rules so everyone stays safe.

Help strengthen your immune system:

  • Ask about vaccines you may need. A COVID-19 vaccine is a shot given to help prevent infection caused by the novel coronavirus. Your healthcare provider can give you more information about when a vaccine may be available to you. He or she can also help you know what to expect after the vaccine, depending on your chronic condition. Get the influenza (flu) vaccine as soon as recommended each year, usually starting in September or October. Get the pneumonia vaccine, if recommended.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can increase your risk for infection and for serious COVID-19 effects. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Eat a variety of healthy foods. Examples include vegetables, fruits, whole-grain breads and cereals, lean meats and poultry, fish, low-fat dairy products, and cooked beans. Healthy foods contain nutrients that help keep your immune system strong.
    Healthy Foods
  • Find ways to manage stress. You may be feeling more stressed than usual because of the COVID-19 outbreak. The situation is very stressful to many people. Talk to your healthcare providers about ways to manage stress during this time. Stress can lead to breathing problems or make the problems worse. Stress can trigger an attack or exacerbation of many health conditions. It is important to do things that help you feel more relaxed, such as the following:
    • Pick 1 or 2 times a day to watch the news. Constant news watching can increase your stress levels.
    • Talk to a friend on the phone or through a video chat.
    • Take a warm, soothing bath.
    • Listen to music.
    • Exercise can also help relieve stress. This may be hard if your regular gym or outdoor exercise area is closed. If you do not have exercise equipment at home, try walking inside your home. You can walk quickly or turn on music and dance.

Follow up with your doctor or healthcare provider as directed:

Your providers will tell you when you can come in for tests, procedures, or check-ups. Bring your symptom record with you to all appointments. Write down your questions so you remember to ask them during your visits.

For more information:

  • Centers for Disease Control and Prevention
    1600 Clifton Road
    Atlanta , GA 30333
    Phone: 1- 404 - 6393311
    Phone: 1- 800 - 3113435
    Web Address: http://www.cdc.gov

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

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