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High Risk and COVID-19 Identifying and Protecting Patients at Elevated Risk

Things have changed dramatically since the pandemic erupted two and a half years ago, throwing the country into lockdown. Now, thanks to vaccines and milder Omicron variants of the virus, many Canadians are learning to live with COVID-19, forgoing masks and returning to regular life and indoor gatherings. But for a more vulnerable group of people, getting even a mild infection could lead to serious illness resulting in hospitalization, mechanical ventilation or death.

Who is at elevated risk? 

Age has always been a big risk factor in getting seriously ill from COVID-19. More than 81 percent of COVID-19 deaths occur in people over 65. While we tend to think of COVID-19 primarily as a respiratory condition, data accumulated over the past few years shows that it is a multi-system disorder, which can affect the heart, liver, and kidneys. This can make contracting the virus especially risky for people who are immunocompromised, or those who have a weakened immune system due to a medical condition and treatment for the condition. This includes individuals living with the following:

Diabetes: COVID-19 triggers an inflammatory cytokine storm in the body, potentially elevating blood glucose levels. Adults with diabetes (type 1 and 2) who contract the virus are at greater risk of serious complications like pneumonia, and they are almost three times as likely to die in hospital.

Obesity: People living with obesity often have elevated inflammatory markers, making them more vulnerable to the cytokine storm. Having obesity may triple the risk of hospitalization, and increase the risk of death.

Cardiovascular disease: COVID-19 can damage the heart in multiple ways, even putting those with mild heart disease at risk for cardiovascular problems for up to a year. A recent study showed that people who had COVID-19 had 72 percent increased risk of heart failure, 63 percent increased risk of heart attack, and 52 percent increased risk of stroke.

Kidney Disease: People with kidney failure, either on dialysis or with a transplant, have had a disproportionately high rate of hospitalization for COVID-19. In addition, transplant patients may not respond well to the vaccines.

Cancer: Cancer and its treatments, such as those for blood leukemia, can weaken the immune system, making these individuals more vulnerable to complications.

Does this mean that immunocompromised people always need to isolate themselves? 

Not necessarily.

A lot depends on a person’s age, general health and control of their condition. The more comorbidities a person has—for example, diabetes with obesity and cardiovascular disease—the more likely they will experience poor outcomes with COVID-19. However, some factors such as losing weight or achieving better blood glucose control are within an individual’s control and should be discussed with a healthcare professional.

Strategies to reduce your patient’s risk of getting seriously ill

Staying up to date with vaccine doses is critically important for these vulnerable groups. The new bivalent booster is an essential tool for warding off the virus. Many experts now recommend getting the booster at the same time as the flu shot.

If an individual’s body can’t mount a strong enough immune response to a COVID-19 vaccine, a monoclonal antibody drug such as Evusheld may be an option. It is authorized as pre-exposure prophylaxis (PrEP) to prevent COVID-19 who have not a known recent exposure to an individual infected with SARS-CoV-2:

  • Who are immunocompromised and unlikely to mount an adequate immune response to COVID-19 vaccination or
  • For whom COVID-19 vaccination is not recommended.


Good candidates for this medication include people who had solid organ transplants such as heart or kidney, stem cell transplants, and those who are taking treatments for blood cancers. However, it is not used to treat COVID-19 symptoms, nor is it a replacement for vaccinations. It is also important to note that it may not be effective against certain SARS-CoV-2 Omicron subvariants.

Even with vaccines and prophylaxis drugs, vulnerable individuals still need to take additional precautions such as wearing well-fitting surgical masks, washing hands often and steering clear of crowded places, especially during local surges. Home-testing kits should be readily on hand should worrisome sniffles or coughs crop up.

When your patient tests positive for COVID-19

Oral antiviral and monoclonal antibody treatments are available for people who are more likely to experience severe outcomes, but the treatments must be started right away to be effective. Recognizing emergency warning signs such as fever or chills, shortness of breath or difficulty breathing is critical for immunocompromised people.

As the weather gets colder, and people move inside, experts are predicting another wave of infections for fall and winter. Learn more about how healthcare professionals can help protect those who need it most in our webinar on demand.

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