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Updated: August 20, 2020

Does being immunocompromised present particular risks once infected with COVID-19?

Summary

The following is a summary of evidence sources that provide high quality information in reference to the risk of COVID-19 infection risks for immunocompromised individuals.   For additional information about each of the sources, see the Table below.

The Government of Canada states in its Vulnerable populations and COVID-19 guidance that vulnerable populations—groups at greater risk of getting an infection and developing severe complications due to their health, social, and economic circumstances—include individuals who have underlying medical conditions or who have comprised immune systems from a medical condition or treatment [11]. A review and meta-analysis found that immunosuppression and immunodeficiency were associated with increased risk of severe COVID-19 disease [3]. However, another review on How immunosuppressive status is affecting children and adults in SARS-CoV-2 infection, found that, among both adults and children, immunosuppressed patients without other comorbidities had overall better outcomes compared to patients with other comorbidities and that these immunosuppressed patients appeared to have no increased risk for severe disease than the general population. [4]
 
Other potential risk factors for more severe disease outcomes include elderly age, male sex, and smoking, as well as having hypertension, diabetes, obesity, respiratory disease, cardiovascular disease, cerebrovascular disease or a malignancy [1,2,4,5,7]. The authors of a review of COVID-19 in 7,780 pediatric patients noted that 65% of children in intensive care unit (ICU) observation reported an underlying medical condition, either immunosuppression or a history of respiratory or cardiac conditions [6]. Another systematic review, Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China, including both pediatric and adult patients, found incidence of  hypertension and diabetes were twice as high as those not in the ICU, while there were three times the number of patients with cardia-cerebrovascular diseases in ICUs compared to not in the ICUs [7].  
 
The World Health Organization (WHO) and the Government of Canada recommend high risk individuals minimize trips outside their homes unless medically necessary [8,9]. In its If you are at higher risk of severe COVID-19, prepare now guidance, the WHO recommends these individuals have sufficient quantities of regular medications to reduce outdoor trips, as well as recommends scheduling appointments during off-peak hours [8]. The Centers for Disease Control and Prevention (CDC) recommends in its If You Are Immunocompromised, Protect Yourself From COVID-19 guidance that individuals on immunosuppressants or other medications should not change or stop taking their medicines without talking to their doctor as this may cause serious health problems [10]. The CDC also explains that immunosuppressed individuals are at an increased risk of severe infection due to their decreased ability to fight infections [10]

Evidence

What‘s Trending on Social Media and Media

Millions of tweets have been published explaining different methods to prevent the spread of COVID-19. Many of the tweets focus on the workplace and preventative measures that can be put in place to protect immunocompromised employees.  
 
YouTube videos from @VICENews @CTVnews surface averaging millions of views and instructing individuals on how to best prevent spreading COVID19 in hopes of containing the virus and ensuring those who are immunocompromised remain healthy, well and not at risk. The most suggested method is mask to mask interaction and keeping six feet apart in all public areas.  

Organizational Scan

The Government of Ontario states that at-risk groups have a higher risk of getting COVID-19. Their  list for at-risk groups includes (but is not limited to) the following those who: 1) are 70 years old or older; 2) are getting treatment that compromises their immune system; 3) have a condition that compromises their immune system; 4) have a chronic health condition; and/or 5) regularly go to a hospital or health care setting for a treatment.[12] 

The Canadian Medical Association states that people with underlying conditions are not necessarily more susceptible to COVID-19. However, if an immunocompromised individual is infected with the virus, their symptoms may be more severe.[13] 

Review of Evidence

Resource Type/Source of Evidence Last Updated
Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis
— Yang et al.
Meta-Analysis

This review states that risk factors such as hypertension, respiratory system disease and cardiovascular disease may be associated with more severe disease outcomes compared to non-severe disease outcomes. Patients with cardiovascular diseases were more likely to have a severe outcome compared to those with hypertension and respiratory system disease.  

Last Updated: April 30, 2020
Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis
— Wang et al.
Meta-Analysis

This meta-analysis found that there was no increased risk of adverse outcomes related to COVID-19 with those with liver disease or renal disease. However, hypertension, diabetes, COPD, cardiovascular disease and cerebrovascular disease are major risk factors for patients with COVID-19.  

Last Updated: April 7, 2020
Impacts of immunosuppression and immunodeficiency on COVID-19: A systematic review and meta-analysis
— Gao et al.
Meta-Analysis

This meta-analysis showed that immunosuppression and immunodeficiency were associated with an increased risk of severe COVID-19 clinical presentation. Special preventative and protective measures should be provided to patients who are immunosuppressed. More high-quality studies are needed to provide robust evidence of the association.  

Last Updated: July 31, 2020
How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review
— Minotti et al.
Systematic Review

This review noted that immunosuppressed patients showed an overall better outcome as compared to other comorbidities, and these results were consistent among adults and children. Immunosuppressed patients without other comorbidities appear to have no increased risk or a more severe disease than the general population. The major risk factors for a worse outcome appear to be elderly age, obesity, diabetes, cardiovascular problems and the male sex.  

Last Updated: June 30, 2020
Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence
— Moujaess et al.
Systematic Review

This review notes that patients with severe COVID-19 were more likely to have a malignancy compared to non-severe cases. Cancer status did not appear to be as great of a risk factor compared to smoking status and age.  

Last Updated: May 31, 2020
COVID-19 in 7780 pediatric patients: A systematic review
— Hoang et al.
Systematic Review

This review notes that among children who were in need of intensive care unit observation, the  majority (65%) of the children reported an underlying medical condition. These children were either immunosuppressed or had a history of respiratory or cardiac conditions. 

Last Updated: June 30, 2020
Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China
— Li et al.
Systematic Review

This review describes that patients with previous cardiovascular metabolic diseases face a greater risk of developing a severe condition of COVID-19. Among patients found admitted to ICUs, incidence for hypertension and diabetes were twice as high as those not in the ICU, while there were three times the number of patients with cardia-cerebrovascular diseases in ICUs compared to not in the ICUs.   

Last Updated: April 30, 2020
If you are at higher risk of severe COVID-19, prepare now
— WHO: World Health Organization
International Guidance

The WHO recommends to those who are at a higher risk to: 1) talk to a doctor about seeking routine care during off-peak hours and what to do if someone is sick; 2) make sure they are up to date on vaccinations; 3) have sufficient quantities of their regular medication and other supplies to minimize the number of trips outside the  home; and 4) limit in-home services and visitors to what is essential.  

Last Updated: March 24, 2020
People who are at high risk for severe illness from COVID-19
— Government of Canada
National Guidance

The Government of Canada recommends that those who are immunocompromised or older should do the following things to reduce their risk of COVID-19: 1) if possible, don’t leave  the house too often but attend all medically necessary appointments; 2) stay away from people who are sick; 3) practice physical distancing and wash hands frequently; and 4) avoid touching their face or food with their hands.  

Last Updated: June 24, 2020
If You Are Immunocompromised, Protect Yourself From COVID-19
— CDC: Centers for Disease Control and Prevention
National Guidance

The CDC recommends that individuals who are on immunosuppressants or other medications for their specific conditions, they should not change or stop taking their medicines without talking to their doctor as this may cause serious health problems. The CDC also explains that immunosuppressed individuals are at an increased risk of severe infection due to their decreased ability to fight infections. 

Last Updated: May 13, 2020
Vulnerable populations and COVID-19
— Government of Canada
National Guidance

The Government of Canada states that those who have underlying medical conditions or who have compromised immune systems from a medical condition or treatment are more at risk for severe outcomes and are classified as Canada’s “vulnerable population.” Vulnerable populations are described as a group more at risk of getting an infection and developing severe complications due to their health, social and economic circumstances. 

Last Updated: May 27, 2020
Re-opening your practice during COVID-19
— Canadian Medical Association
Organizational Scan

The Canadian Medical Association states that people with underlying conditions are not necessarily more susceptible to COVID-19. However, if an immunocompromised individual is infected with the virus, their symptoms may be more severe. 

Last Updated: June 24, 2020
COVID-19: Stop the spread
— Government of Ontario
Organizational Scan

At-risk groups have a higher risk of getting COVID-19. Their non-exhaustive list for at-risk groups includes the following: are 70 years old or older, are getting treatment that compromises your immune system, have a condition that compromises your immune system, have a chronic health condition, and/or regularly go to a hospital or health care setting for a treatment. 

Last Updated: July 12, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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