If I Got Over Bronchitis and Sick Again Whay Dos That Mean

How to reduce risk of infection and what to do if you get sick

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Who is at highest risk for getting very sick from COVID-19?

Age is the strongest risk factor for severe COVID-19 illness. The risk of serious illness increases steadily with age, especially for those with underlying medical problems. In addition, a person's risk of severe illness from COVID-19 increases as the number of underlying medical conditions they have increases.

According to the CDC, adults of any age with the following conditions can be more likely to get severely ill from COVID-19:

Visit our Coronavirus Resource Center for more information on coronavirus and COVID-19.

Cancer, cancer treatment, and history of cancer
Chronic kidney disease
Chronic liver disease, including alcohol-related liver disease, nonalcoholic fatty liver disease, autoimmune hepatitis, and cirrhosis (scarring of the liver)
Chronic lung diseases, including asthma (moderate to severe), bronchiectasis (thickening of the lungs' airways), bronchopulmonary dysplasia (chronic lung disease affecting newborns), COPD (including chronic bronchitis or emphysema), interstitial lung disease (damaged or scarred lung tissue), pulmonary embolism (blood clot in the lungs), and pulmonary hypertension (high blood pressure in the lungs)
Cystic fibrosis
Dementia or other neurological conditions
Diabetes (type 1 or type 2)
Disabilities, including attention-deficit/hyperactivity disorder (ADHD), cerebral palsy, birth defects, intellectual and developmental disabilities, learning disabilities, spinal cord injuries, and Down syndrome. People with any type of disability that makes it more difficult to do certain activities or interact with the world around them, including people who need help with self-care or daily activities, may be at increased risk for getting very sick from COVID-19.
Heart conditions, such as heart failure, coronary artery diseases, or cardiomyopathies (diseases of the heart muscle that make it harder for the heart to pump blood to the rest of your body), and possibly high blood pressure (hypertension)
HIV (human immunodeficiency virus) infection
Immunocompromised state (weakened immune system), including from inherited conditions (including primary immunodeficiency) or prolonged used of corticosteroids or other immune-weakening medicines
Mental health conditions, including depression and schizophrenia spectrum disorders
Overweight and obesity (body mass index [BMI] of 25 or higher)
Physical inactivity
Pregnancy and recent pregnancy
Sickle cell disease, thalassemia, or other hemoglobin blood disorders
Smoking, current or former
Solid organ or blood stem cell transplant, including bone marrow transplant
Stroke or cerebrovascular disease, which affects blood flow to the brain
Substance use disorders such as alcohol, opioid, or cocaine use disorder
Tuberculosis

Everything we know underscores the importance of maintaining health-promoting behaviors, even as restrictions begin to ease, especially if you have one or more underlying medical conditions. To reduce your risk of getting sick, get vaccinated and boosted as soon as you are eligible, wear a mask indoors, especially when community levels of COVID are elevated, maintain a physical distance of at least six feet when you're around other people, and wash your hands often.

I have a weakened immune system. How many doses of the COVID-19 vaccine do I need?

The CDC recommends the following COVID-19 vaccination schedule for moderately to severely immunocompromised people:

a three-dose initial mRNA COVID-19 vaccine series for adults and children ages 12 years and older, followed by a first booster shot at least three months after the third shot, and a second booster at least four months after their first booster.
a three-dose initial mRNA COVID-19 vaccine series for children ages 5 to 11 years, followed by a booster dose.
one dose of an mRNA vaccine at least 28 days after an initial Johnson & Johnson vaccine, followed by a booster dose at least two months after the second shot.

The COVID-19 vaccines, like other vaccines, work by stimulating a person's immune system to produce antibodies against the virus. If the antibodies later encounter the actual virus, they are ready to recognize and destroy it.

A person with a weakened immune system may not be able to produce a strong enough immune response to even a three-dose COVID mRNA vaccine regimen. This leaves them more likely to have a breakthrough infection, and increases the risk of more severe disease if they do become infected.

A person may have a weakened immune system for a variety of reasons. These include being born with an immunodeficiency, having advanced or untreated HIV, and having a chronic medical condition such as chronic kidney disease or lack of a spleen. Many types of medication also suppress the immune response, including some cancer treatments, TNF blockers, some biologic agents, and high-dose corticosteroids. Talk to your doctor if you think you may qualify for an additional COVID vaccine dose.

In addition to getting vaccinated and boosted, people with a weakened immune system should continue to wear a mask and try to stay six feet apart from others in indoor public places. They should still avoid crowds and poorly ventilated indoor spaces.

Who could benefit from monoclonal antibody therapy to prevent COVID-19?

Vaccines are the best way to protect against COVID-19. But some people with weakened immune systems do not produce enough antibodies after vaccination, and others are severely allergic to the vaccine. The FDA has authorized Evusheld, a pre-exposure prophylaxis (PrEP) monoclonal antibody therapy developed by AstraZeneca, which should help prevent COVID-19 in these populations.

To be eligible for Evusheld, individuals must be 12 years or older and have a moderately to severely weakened immune system, or have a history of severe adverse reactions to the COVID-19 vaccine or its components. In addition, the therapy cannot be given to someone with a current SARS-CoV-2 infection, or who has been recently exposed to someone who is infected. Evusheld is given as two consecutive shots, and evidence suggests it can help prevent symptomatic infection for at least six months.

Monoclonal antibodies are manmade versions of the antibodies that our bodies naturally make to fight invaders, such as the SARS-CoV-2 virus. The monoclonal antibodies in Evusheld, tixagevimab and cilgavimab, are directed against the virus's spike protein and are designed to block the virus from attaching to, and entering, human cells.

When considering authorization, the FDA looked at results from the PROVENT trial. This was a randomized, double-blind, placebo-controlled clinical trial that enrolled adults ages 59 years and older, people with certain chronic medical conditions, and those who were at increased risk of infection for other reasons and had not gotten a COVID-19 vaccine. None of the participants had a current or previous case of SARS-CoV-2 infection. 3,441 study participants received Evusheld and 1,731 received a placebo.

Study participants who'd received Evusheld were 83% less likely to have had symptomatic COVID-19 during the six-month study period than those who had a received a placebo. This was a statistically significant difference. An animal study, not yet published or peer-reviewed, found that Evushiled effectively protects against infection in the lungs caused by three Omicron variants (BA1, BA1.1, and BA.2).

Possible side effects of this therapy including allergic reactions, bleeding at the injection site, headache, fatigue, and cough. In addition, although serious heart-related events such as heart attack and heart failure were infrequent during the trial, they were more common in participants who received Evusheld than in those who received a placebo.

Unlike other monoclonal antibody treatments that have been authorized by the FDA, Evusheld is not authorized to treat an active COVID-19 infection or to prevent infection after exposure to the virus.

Which COVID-19 vaccines are available for children?

The CDC recommends that children ages 5 to 17 years receive the two-dose Pfizer/BioNTech COVID-19 vaccine. Children 12 to 17 years may be vaccinated with the standard Pfizer/BioNTech vaccine, while children ages 5 to 11 years should receive Pfizer/BioNTech's pediatric vaccine, which is a lower dose (10 micrograms, compared to 30 micrograms for people 12 year and older). For now, only the Pfizer/BioNTech vaccine is authorized in the US for anyone under age 18.

The CDC also recommends a single-dose Pfizer/BioNTech COVID-19 booster shot for children ages 5 years and older, at least five months after getting their second dose of that vaccine.

In addition, the CDC advises that children ages 5 years and older who are moderately to severely immunocompromised should get an additional primary dose of the vaccine 28 days after their second shot. Children who fall into this category and are 5 to 11 years old are eligible for a single booster shot, while those 12 years and older are eligible for a second booster shot.

Who can get a COVID-19 vaccine booster shot?

As of March 2022, the following groups are eligible for a second booster shot:

everyone ages 50 years and older who received their first booster (Pfizer/BioNTech, Moderna, or Johnson & Johnson) at least four months ago
certain immunocompromised individuals ages 12 years and older who received their first booster at least four months ago.

The CDC is only recommending mRNA vaccines for second boosters, and has stated that a second booster is "…especially important for those 65 and older and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19…"

The CDC recommends a single-dose COVID-19 vaccine booster for all adults ages 18 years and older. Those who initially received the Pfizer/BioNTech or Moderna mRNA vaccine can get their booster five months after their second shot, and those who received an initial dose of the Johnson & Johnson vaccine can get a booster dose two months after their initial vaccine. Adults may select any vaccine for their booster, either the same (homologous) or different (heterologous) than their initial vaccine(s). However, the FDA has limited use of the Johnson & Johnson vaccine to adults who cannot get, or refuse to get, one of the mRNA vaccines.

The CDC also recommends a single-dose Pfizer/BioNTech COVID-19 booster shot for children ages 5 years and older, at least five months after getting their second dose of that vaccine. As of now, individuals in this age group are only authorized to receive the Pfizer/BioNTech vaccine.

Which COVID-19 vaccine booster should I get?

Adults ages 18 years and older may select a COVID-19 vaccine booster that is the same as (homologous) or different than (heterologous) their initial vaccine(s). Only mRNA vaccines (Pfizer/BioNTech and Moderna) have been authorized for second boosters.

The FDA's mix-and-match authorization makes booster shots less dependent on which vaccines are available and gives people more choices. For example, if you had an unpleasant reaction to your initial vaccine, you could choose a different one for your booster. Or, if you don't remember which vaccine you started with, you can still get a booster.

Although Johnson & Johnson's vaccine is still available as an option for the first booster, in May 2022 the FDA limited use of the Johnson & Johnson vaccine to adults who cannot get, or refuse to get, one of the mRNA vaccines, due to concerns about a rare but potentially fatal blood clotting disorder.

The CDC also recommends boosters for children ages 5 to 17 years. Right now, only the Pfizer/BioNTech vaccine is authorized for this age group.

What should I consider before getting a second COVID-19 vaccine booster?

In March 2022, the CDC recommended a second booster shot for anyone ages 50 years and older, as well as certain immunocompromised individuals ages 12 years and older, at least four months after their first booster. The CDC noted: "This is especially important for those 65 and older, and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19, as they are the most likely to benefit from receiving an additional booster dose at this time."

Data from the CDC has shown that the effectiveness of booster shots decreases over time. A study published in MMWR reported that vaccine effectiveness against COVID-related hospitalizations dropped from 91% within two months after a booster dose to 78% four months after a booster dose. Data for this study were collected during the Omicron surge.

A second booster shot may help protect against COVID-related death in older adults, according to a small preprint study from Israel. Of the study participants, all of whom were ages 60 years and older, 232 of the 234,868 people who received one booster shot had a COVID-related death, compared to 92 of the 328,597 people who received two booster shots. That means people who got a second booster were 78% less likely to die than those who got a single booster. This was a significant difference.

The benefits of a second booster for younger, healthier populations are less certain. In a small report published in NEJM, researchers reported only "marginal benefits" of a second booster for middle-aged healthcare workers compared with a single booster. Although the second booster was safe and resulted in a large bump in neutralizing antibodies, vaccine efficacy was low against COVID infections.

Although vaccine effectiveness decreases over time, especially against infection and symptomatic infection, vaccines are still the best way to protect against severe illness. Consider the following factors when thinking about a second booster shot for yourself or a loved one.

Age. The risk of severe COVID-related illness increases with age. A second booster increases neutralizing antibody levels, and there is evidence that a second booster protects older people from COVID-related death. The CDC has noted that a second booster is especially important for those 65 years and older.
Underlying medical conditions. Immunocompromised individuals and those with certain underlying medical conditions are at increased risk for severe illness, hospitalization, and death due to COVID. The CDC has said that these groups are among those most likely to benefit from a second booster.
Timing. There is some evidence that longer intervals between booster doses result in a stronger and longer-lasting immune response. However, that can leave you more vulnerable between booster doses.
Goals. Are you trying to reduce your risk of any infection, symptomatic infection, or severe illness and hospitalization? The answer may depend on your age, medical history, and other factors, and could influence how you think about a second booster.
What's next? Omicron-specific mRNA vaccines are in development and may be available later this year.

You can take a variety of precautions against infection in addition to vaccination. These include masking indoors, not eating in indoor restaurants, and avoiding crowded spaces. You can adopt or discard layers of protection depending on COVID risk levels in your community.

I'm older and have a chronic medical condition, which puts me at higher risk for getting seriously ill, or even dying from COVID-19. What can I do to reduce my risk of exposure to the virus?

The risk of serious illness or death from COVID-19 increases steadily with age. This is true whether or not you also have an underlying medical condition, although the sickest individuals and most of the deaths have been among people who were both older and had chronic medical conditions, such as heart disease or diabetes.

The CDC suggests the following measures for those who are at higher risk:

Get vaccinated and boosted.
Keep at least six feet of space between yourself and others outside of your household.
When you go out, wear a mask, keep away from others who are sick, limit close contact, and wash your hands often.
Avoid crowds.
Avoid nonessential travel.
During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.
Obtain several weeks of medications and supplies in case you need to stay home for prolonged periods of time.

For certain people with a weakened immune response, the CDC recommends a three-dose initial mRNA COVID-19 vaccine series, followed by a booster shot at least three months after the third shot. If your medical condition or treatment for that medical condition impacts your immune response, ask your doctor if you qualify for an additional COVID vaccine dose.

Have the COVID vaccines effectively protected older adults in the real world?

Two reports published in MMWR in September 2021 found that vaccine protection has declined in older adults. However, vaccinated older adults still enjoy significant protection compared to older adults who are unvaccinated.

One report describes the results of a study looking at the effectiveness of the COVID vaccines (Pfizer/BioNTech, Moderna, and Johnson & Johnson) in preventing COVID-related hospitalization at five Veterans Affairs Medical Centers in the US. It found that vaccines were 80% effective in preventing COVID-related hospitalization in people aged 66 years and older compared to 95% in people aged 18 to 65 years.

The second report is an interim analysis of ongoing data collection from medical sites in nine different states. The vaccines were found to be 89% effective at preventing COVID-related hospitalization in people ages 18 to 74 and 76% in people aged 75 or older. The researchers based their findings on an analysis of 32,867 medical encounters, including visits to hospitals, emergency departments, and urgent care sites. The data collection occurred during a time when Delta was responsible for more than half of infections.

I have a chronic medical condition that puts me at increased risk for severe illness from COVID-19, even though I'm only in my 30s. What can I do to reduce my risk?

You can take steps to lower your risk of getting infected in the first place:

Get vaccinated and boosted.
Wear a mask indoors when you are with friends and family from outside of your household.
Limit contact with people outside your family.
Maintain enough distance (six feet or more) between yourself and anyone outside your family.
Wash your hands often with soap and warm water for 20 to 30 seconds.
Stay away from people who are sick.
During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.
Avoid nonessential travel.

In addition, do your best to keep your condition well-controlled. That means following your doctor's recommendations including taking medications as directed. If possible, get a 90-day supply of your prescription medications.

How does obesity increase risk of COVID-19?

According to a review and meta-analysis that looked at 75 international studies on the subject, obesity is a significant risk factor for illness and death due to COVID-19.

When looking at people with COVID-19, the analysis found that, compared with people who were normal weight or overweight, people who were obese were

more than twice as likely to be hospitalized
if hospitalized, nearly 75% more likely to be admitted to the intensive care unit (ICU)
almost 50% more likely to die of COVID-19.

Obesity may impact COVID risk in several ways. For example, obesity increases the risk of impaired immune function and chronic inflammation, both of which could make it harder for the body to fight the COVID-19 infection. Excess fat can also make it harder for a person to take a deep breath, an important consideration for an illness that can impair lung function.

People who are obese are also more likely to have diabetes and high blood pressure, which are themselves risk factors for severe COVID-19. And obesity is more common in Black, Latinx, and Native Americas, who are more likely to get infected and die from COVID-19 than whites for a variety of reasons.

If you have obesity (defined as a body mass index, or BMI, of 30 or higher), stay vigilant about protecting yourself from infection. That means getting vaccinated and boosted, wearing a mask indoors if you live in or visit an area of the country with widespread transmission, and washing your hands often.

I have asthma. If I get COVID-19, am I more likely to become seriously ill?

The coronavirus that causes COVID-19 infection primarily attacks the upper airways and can also attack the lungs. So, similar to any other respiratory infection, such as the flu or viral bronchitis, your asthma symptoms could get much worse if you get COVID-19.

However, you can take steps to lower your risk of getting infected in the first place. These include

getting vaccinated and boosted
physical distancing
wearing masks in indoor public places
washing your hands often with soap and warm water for 20 to 30 seconds
staying away from people who are sick.

In addition, you should continue to take your asthma medicines as prescribed to keep your asthma under control. If you do get sick, follow your asthma action plan and call your doctor.

Do pregnant women face increased risks from COVID-19?

According to the CDC, pregnant and postpartum women are at increased risk of severe COVID-19 illness, death, and pregnancy complications compared to women who are not pregnant. In addition, COVID-19 increases risk for premature birth, stillbirth, and possibly also for other undesirable pregnancy outcomes. It's important to note that the overall risk of these complications is low. But the risk is higher than in people who are not pregnant.

Results from a large, observational study from Scotland conducted between December 2020 and October 2021 showed that risks to both mother and baby are substantially higher in pregnant women who are unvaccinated, compared to those who are vaccinated.

The CDC recommends that women who are pregnant, thinking about becoming pregnant, or who are breastfeeding should get vaccinated against COVID-19. The American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal-Fetal Medicine also agree that all pregnant and breastfeeding individuals should be vaccinated.

If you are pregnant, talk to your doctor about the COVID-19 vaccine. And be vigilant about taking additional precautions as well. For example, wear a high-quality, well-fitted mask, physically distance from others, and do your best to follow the CDC's recommendations to protect yourself if someone in your household becomes infected.

Continue to see your doctor for prenatal visits and get any other recommended vaccines. Call your doctor's office to discuss safety precautions if you have concerns.

I am pregnant and plan to eventually breastfeed my baby. Is it safe for me to get a COVID-19 vaccine?

The CDC recommends that women who are pregnant, thinking about becoming pregnant, or were recently pregnant — including those who are breastfeeding — should get vaccinated against COVID-19. The American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal-Fetal Medicine also agree that all pregnant and breastfeeding individuals should be vaccinated.

Here are some factors to consider. First, although the actual risk of severe COVID-19 illness and death among pregnant individuals is very low, it is higher when compared to nonpregnant individuals from the same age group. In addition, COVID-19 increases risk for premature birth, stillbirth, and possibly also for other undesirable pregnancy outcomes. Results from a large, observational study from Scotland conducted between December 2020 and October 2021 showed that risks to both mother and baby are substantially higher in pregnant women who are unvaccinated, compared to those who are vaccinated.

Evidence supporting the safety of COVID vaccines for pregnant women and their babies continues to grow. One study published in MMWR looked at data from more than 40,000 pregnant women between December 2020 and July 2021. About 10,000 of these women received a COVID-19 vaccine (typically an mRNA vaccine, either Pfizer/BioNTech or Moderna) during their pregnancy, most during their second or third trimester. Women who were vaccinated against COVID-19 while pregnant were no more likely than unvaccinated women to give birth prematurely or have a baby that was small for its gestational age.

A study published in NEJM in October 2021 analyzed safety data collected by the CDC. The researchers looked at data from nearly 2,500 women who received a COVID-19 vaccine, either before becoming pregnant or during their first 20 weeks of pregnancy, and found that they did not have an increased risk of miscarriage. A previous study, conducted by the CDC and published inNEJM, found the COVID-19 vaccines to be safe when given during the second or third trimester.

Increasing evidence shows that vaccine-generated antibodies pass from mother to baby and protect newborns for several months after birth. A small study published in theAmerican Journal of Obstetrics and Gynecology found that mRNA vaccines effectively produce antibodies that protect against SARS-CoV-2 in women who are pregnant or breastfeeding, and that this immunity is passed from mother to newborn through the placenta and breast milk. A study published in JAMA found that 98% of babies born to mothers who received an mRNA COVID-19 vaccine during pregnancy had detectable levels of antibodies two months after birth, and 57% of babies had detectable antibody levels six months after birth. And a report published in MMWR found that babies born to mothers who received two doses of an mRNA COVID-19 vaccine during pregnancy were 61% less likely to be hospitalized with COVID in their first six months of life than babies born to mothers who were not vaccinated while pregnant. Protective antibodies are particularly important for infants because COVID vaccines are not authorized for babies younger than 6 months.

mRNA vaccines do not contain any virus, so they cannot cause COVID-19 in a woman or her baby. And our bodies quickly break down and eliminate mRNA particles used in the vaccine, so they cannot reach or cross the placenta.

Similar to any decision regarding over-the-counter medications and supplements during pregnancy, your own doctor is in the best position to advise you based on your personal health risks and preferences.

I'm taking a medication that suppresses my immune system. Should I stop taking it so I have less chance of getting sick from the coronavirus?

If you contract the virus, your response to it will depend on many factors, only one of which is taking medication that suppresses your immune system. In addition, stopping the medication on your own could cause your underlying condition to get worse.

Most importantly, don't make this decision on your own. It's always best not to adjust the dose or stop taking a prescription medication without first talking to the doctor who prescribed the medication.

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Podcasts

COVID-19 and underlying conditions: Why symptoms may be more severe for people with chronic disease(recorded 5/6/20)

People who have diabetes, a heart condition, cancer, kidney disease or other underlying condition are impacted more severely if they contract the coronavirus. Harvard Medical School endocrinologist Dr. Enrique Caballero explains why. Dr. Caballero is on the staff of Brigham and Women's Hospital in Boston, Massachusetts, and is the director of diabetes education in the post-graduate medical education department at Harvard Medical School.

Entendiendo como afecta la infección por COVID-19 a personas con enfermedades crónicas subyacentes (recorded 5/6/20)

Las personas que tienen diabetes, una afección del corazón o de los riñones u otra enfermedad crónica subyacente se ven afectadas más severamente si contraen el coronavirus. El Dr. Enrique Caballero, endocrinólogo de la Escuela de Medicina de Harvard explica la forma en que estas enfermedades favorecen infecciones severas por COVID-19 y como el coronavirus puede empeorar estas condiciones crónicas. El Dr. Caballero forma parte del personal del Hospital Brigham and Women's y es el director de educación en diabetes en el departamento de educación médica de posgrado de la Facultad de Medicina de Harvard en Boston, Massachusetts.

COVID-19 and the vulnerable: How we can help the sick and the elderly? (recorded 3/17/20)

There's a lot we don't know about the novel coronavirus that's shutting down the world. But we do know this: The sick, the elderly, the immune-compromised are particularly at risk. If you or a loved one fall into this category, there are some things you can do to help keep COVID-19 at bay. As Harvard's Dr. Rob Shmerling points out, it starts with situational awareness.

Visit our Coronavirus Resource Center for more information on coronavirus and COVID-19.

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Source: https://www.health.harvard.edu/diseases-and-conditions/if-you-are-at-higher-risk