our understanding of severe covid risk has changed, top doctor says

as the height of the covid-19 pandemic becomes a memory and vaccination rates in ontario continue to rise, the threat of the disease might not seem as serious as it once did. some estimates suggest that 86 per cent of canada’s population has been infected with covid-19 at least once. while deaths attributed to the disease are still, tragically, a daily occurrence, their number is far lower than the previous highs since march 2020.   

yet cases of covid-19 can become severe — which can lead to hospitalization and admission to an intensive care unit — continue to occur. severe symptoms can include:  

• trouble breathing or severe shortness of breath 
• persistent pressure or pain in the chest 
• new onset of confusion 
• difficulty waking up or staying awake
• pale, grey or blue-coloured skin, lips or nail beds   

and as our understanding of the disease has evolved, so has our understanding of the people who may be at higher risk of developing more severe disease, as well as the recommendations for them.  

perhaps the most widely understood risk factor is age. the risk for severe covid-19 is higher in older adults and increases with each decade – especially over 60. but the list of other risk factors is significant. perhaps because the risks to older canadians have been highlighted in many of the conversations around covid-19, others at increased risk of covid may not be aware of their own risk factors. or they may underestimate their significance.    

age and compromised immune function, either through disease or medications, were risk factors identified by physicians in the early stages of the pandemic. dysfunction of the organs, such as lungs, liver, and kidneys were others. you can find out more about who is at risk of more severe disease or outcomes from covid-19, from the government of canada’s resource site.

dr. zain chagla is an infectious disease physician and medical director of infection control at st. joseph’s healthcare hamilton. he’s a sought-after voice in discussions around treating covid-19, and has seen first-hand how our understanding of the disease has evolved.   

“we identified several risk factors early on, and they weren’t very surprising,” dr. chagla says. “however, i think we were surprised to see that cognitive issues were a risk factor for severe covid and hospitalization. the same with obesity — especially in under-vaccinated people.”   

socio-economic factors also have an established connection to severe covid-19. prevalence of severe covid-19 in the shelter system was seen in 2020 and was well-publicized in the media. however, we also came to understand that indigenous and racialized populations also tended to have worse outcomes.  

“even as we have gained a deeper understanding of risk factors for severe covid and hospitalization, it hasn’t always meant the wider public is aware of them,” dr. chagla says. “people with risk factors have gotten fully vaccinated — which of course they should — and many believe that will be enough to protect them from severe covid. but especially with multiple risk factors, you can get severe illness.”   

dr. chagla elaborates. “for example, age with mild dementia and obesity might together contribute to a fully vaccinated individual getting a severe case of covid-19 and requiring hospitalization. or age and high blood pressure. smoking, of course, is another risk factor that cuts across age groups.”  

“establishing a plan in advance with your health-care provider can help make you aware of your options, including treatment.”

–dr. zain chagla

the way the medical community has approached covid-19 has evolved. dr. chagla observes, “covid, vaccinations and risk factors have been in the news and conversations so much over lately that it’s understandable if people have begun to tune it out.  

“however, things have changed. we better understand risk factors.”  

what’s changed, according to dr. chagla, is that now, people are encouraged to have a step-by-step action plan. “if you are a person at high risk of developing severe covid-19, establishing a plan in advance with your health-care provider can help give you peace of mind and make you aware of your options, including treatment.” having a plan is important because, in order to be effective, available treatments must be taken as soon as symptoms first appear and are confirmed by a diagnosis of covid-19.     

dr. chagla says discussions with your health-care provider should also include their suggestions on masking, limiting social interactions, vaccines and more. the ontario.ca page about covid19 is an excellent, reliable resource for planning ahead.   

“people should use the information available to determine if they’re at high risk for severe covid,” dr. chagla advises. “if you’re part of a high-risk population, you should know where to get tested, and do so at the first sign of symptoms. you can also check to see if there are treatments you’re eligible for. much of this can be done in advance with a health-care practitioner. so as soon as you think you’re symptomatic, you can pick up the phone and set your plan in motion.”  

 dr. chagla also has advice for physicians: “make sure you engage with your patients who are at higher risk. make them aware of their options and help make sure they have a plan in place, too. we’re in a position now where we can have more optimism than ever before — so let’s make sure our patients are aware of the options available to them.”  

this story was created by content works , postmedia’s commercial content division, on behalf of a canadian healthcare company.  

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our understanding of severe covid risk has changed, top doctor says

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