On June 25, 2020, the Centers for Disease Control and Prevention (CDC) updated and expanded the list of people considered at high risk of severe illness from the COVID-19 virus. The CDC enumerated seven underlying medical conditions for people who are at an increased risk to develop severe illness from COVID-19, in addition to 12 underlying conditions or behaviors that might increase the risk of severe complications from the virus.
According to the CDC, people of any age with the following conditions are at increased risk of severe illness from COVID-19:
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Immunocompromised state (weakened immune system) from solid organ transplant
- Obesity (body mass index of 30 or higher)
- Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Sickle cell disease
- Type 2 diabetes mellitus
The CDC warns that people with more than one underlying medical condition are at an even higher risk for developing severe illness from the COVID-19 virus.
The CDC states that studies have shown that these specific underlying conditions increase a person’s risk of severe illness regardless of age. Notably, the CDC removed the specific language of “those over the age of 65” from the older adult classification and now warns that risk increases steadily with age. CDC states that while age is an independent risk factor for severe illness (noting that eight out of 10 COVID-19 related deaths in the U.S. have been among adults aged 65 or older), risk in older adults often is linked to the increased likelihood that older adults also have underlying medical diagnoses.
This expanded list significantly increases the number of people who fall in the CDC “higher risk” category. For example, more than 40 percent of U.S. adults are considered obese, one of the most common underlying conditions that increases risk for severe illness for COVID-19. The CDC reports an estimated 60 percent of American adults have at least one chronic medical condition and warns that one or more comorbidities heightens the risk.
The CDC also notes that there are other underlying medical conditions that “might” increase a person’s risk of severe complications from coronavirus. These include:
- Asthma (moderate to severe)
- Cerebrovascular disease (affects blood vessels and blood supply to the brain)
- Cystic fibrosis
- Hypertension or high blood pressure
- Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
- Neurologic conditions, such as dementia
- Liver disease
- Pulmonary fibrosis (having damaged or scarred lung tissues)
- Thalassemia (a type of blood disorder)
- Type 1 diabetes mellitus
“Understanding who is most at risk for severe illness helps people make the best decisions for themselves, their families, and their communities,” said CDC Director Robert Redfield MD. “While we are all at risk for COVID-19, we need to be aware of who is susceptible to severe complications so that we take appropriate measures to protect their health and well-being.”
The CDC advises higher risk individuals to limit their interactions with other people as much as possible, focus on activities where social distancing can be maintained, and if engaging in public activities to practice preventative measures such washing hands frequently, limiting contact with and disinfecting commonly touched surfaces or shared items, and wearing a face covering when around others.
Employers should be aware that employees in high risk categories due to a disability may request reasonable accommodation to reduce or eliminate potential exposure to the virus. Such requests trigger the interactive process to explore potential reasonable accommodations. According to the EEOC’s pandemic guidance, jobs requiring presence at the worksite may involve accommodations designed to reduce contact between an individual and others at the worksite, such as one-way aisles, shielding or barriers, enhanced PPE, restricting marginal job functions, or modifying work schedules or shift assignments.
There are some situations where an accommodation is not required. The ADA, however, does not mandate accommodating an employee who has a high-risk family or household member. Also, age alone does not entitle the employee to an accommodation. Pregnancy may require accommodation considerations if there is an underlying pregnancy-related medical condition, or if the employer has provided accommodations to non-pregnancy employees who are similar in their ability or inability to work.
Under the EEOC’s pandemic guidance, employers are reminded not to exclude from the workplace an employee solely because the employee has an underlying condition that the CDC identifies as placing them at higher risk, unless the employee’s medical condition poses a “direct threat” that cannot be eliminated or reduced by reasonable accommodation. This requires the employer to show a “significant risk of substantial harm” through an individualized assessment based on reasonable medical judgment about the employee’s underlying medical condition.