Covid-19 and co-morbidities: who are the most at risk?

Recalling the need to vaccinate the most vulnerable people against covid-19, the High Authority for Health (HAS) has updated its recommendations relating to the risk factors of developing a severe form of the disease.

With an average of more than 20,000 new cases of covid-19 contamination every day, the vaccination of the most vulnerable people is a central issue. Recalling the need to boost the vaccination campaign, the HAS is today updating its recommendations relating to the risk factors for developing a severe form of the disease, on the basis of an exhaustive review of the literature and a close analysis of 200 studies published since his first work. Among them, the EpiPhare study (see below) and the study of the Information Systems Medicalization Program (PMSI) carried out by the Bordeaux medical information department. “These studies confirm that age is the predominant factor in the occurrence of severe forms and death linked to Covid-19” says the High Authority for Health in a press release.

Age remains the main risk factor

According to the analysis of data from hospital stays in France, patients with Covid-19 present, compared to 18 to 49 years old, approximately:

  • 3 times more risk of dying from Covid-19 if they are between 50 and 64 years old,
  • 7 times more risk if they are 65 to 74 years old,
  • 10 times more risk if they are between 75 and 80 years old
  • 16 times more over the age of 80.

Co-morbidities, these other risk factors

The presence in patients of certain comorbidities is also a risk factor for serious forms and death, “even if their impact is less,” says the HAS. In an opinion dated November 30, the HAS had already determined co-morbidities with a high risk of death:

  • diabetes (type 1 and type 2)
  • obesity (BMI> 30 kg / m2)
  • cancers in particular if it is a recent cancer and / or in progression and / or under chemotherapy
  • COPD and respiratory failure
  • heart failure
  • complicated arterial hypertension.

She has just added the following four pathologies:

  • chronic liver disease and in particular cirrhosis
  • psychiatric disorders
  • Madness
  • people with a history of stroke.

In addition, the HAS has also identified three of the pathologies with “very high risk of death”, justifying a prioritization whatever the age:

  • people with Down’s syndrome
  • people who have received an organ transplant
  • renal insufficiency on dialysis.

In addition, the High Authority draws the attention of people known as “polypathological” because studies show that the accumulation of 3 comorbidities almost reaches the same level of risk of dying as in the upper age group without polypathologies. These people should therefore be vaccinated as a priority.

About the Epi-Phare study

During the first wave of the pandemic, a scientific interest group (called Epi-Phare), made up of the National Health Insurance Fund and the National Medicines Safety Agency (ANSM) carried out an almost exhaustive analysis of the data from the French population, i.e. more than 66 million people, in order to identify chronic diseases and factors such as age or gender likely to present an increased risk of hospitalization or death for Covid-19. Not surprisingly, this study cit was confirmed that the elderly are the most vulnerable to the virus with a risk of death multiplied by 12 in 60-64 year olds, by 30 in 70-74 year olds, by 100 in 80-84 year olds and by almost 300 in 90 year olds and more.

The study also confirmed that men are more at risk hospitalization and death for Covid-19 than women, multiplied by 1.4 and 2.1 respectively and determined that the most vulnerable people were those suffering from one of the following 7 pathologies:

  • Trisomy 21 : 7 times more risk of hospitalization and 23 times more risk of death
  • Retard mental : 4 times more risk of hospitalization and 7 times more risk of death
  • Cystic fibrosis : 4 times more risk of hospitalization and 6 times more risk of death
  • End-stage chronic kidney disease on dialysis : 4 times the risk of hospitalization and 5 times the risk of death
  • Active lung cancer : 3 times more risk of hospitalization and 4 times more risk of death
  • Kidney transplant : 5 times the risk of hospitalization and 7 times the risk of death
  • Lung transplant : 3 times the risk of hospitalization and 6 times the risk of death.

Who are the vulnerable people who can be kept in partial employment?

The decree of 5 May 2020 provided for an exceptional compensation scheme for vulnerable employees at risk of developing a serious form of Covid-19 infection. These precautions allow the most vulnerable not to take the risk of exposing themselves to the virus in the absence of treatment. But upon returning from the summer holidays, a new decree published in the Official Journal of Sunday August 30, modified the criteria for identifying vulnerable employees and reduced the list of people who can request to be placed in partial activity.

October 15, a prescription of the summary judge of the Council of State pronounced the suspension of these restrictions. The judge considering “that the choice of pathologies which were kept as eligible compared to the decree of last May is not coherent nor sufficiently justified by the Government”. Finally, the decree defining the list of vulnerable people was published on November 11, 2020.

According to this new decree, are considered vulnerable people who are in one of the following situations:

  • Be 65 years olds and more.
  • Have a history of cardiovascular disease : complicated arterial hypertension (with cardiac, renal and vascular complications), cerebrovascular accident or coronary artery disease, history of cardiac surgery, cardiac insufficiency.
  • Have unbalanced diabetes or having complications.
  • Have a chronic respiratory pathology likely to decompensate during a viral infection: obstructive pulmonary disease (the disease that killed the singer Christophe), severe asthma, pulmonary fibrosis, sleep apnea syndrome, cystic fibrosis in particular.
  • Have kidney failure chronic dialysis.
  • Suffer from progressive cancer under treatment (excluding hormone therapy).
  • Present with obesity (ie a body mass index (BMI)> 30 kgm2).
  • Suffer from immunosuppression congenital or acquired.
  • Have cirrhosis at least Child Pugh score stage B.
  • Have major sickle cell syndrome or have a history of splenectomy.
  • Be in the 3rd trimester of pregnancy.
  • Have motor neuron disease, myasthenia gravis, multiple sclerosis, Parkinson’s disease, cerebral palsy, quadriplegia or hemiplegia, primary brain malignancy, progressive cerebellar disease or a rare disease

A new criterion for benefiting from partial activity

But to be placed in partial activity, vulnerable people must meet a second cumulative criterion which is “not to be able to use telework completely, nor to benefit from reinforced protection measures”. These protective measures are as follows:

  • Isolation of the workstation, in particular by providing an individual office or, failing that, its layout, to minimize the risk of exposure.
  • Respect, in the workplace and in any place frequented by the person during their professional activity, of reinforced barrier gestures.
  • The absence or limitation of workstation sharing.
  • The cleaning and disinfection of the workstation and the surfaces touched by the person at least at the beginning and at the end of the shift.
  • Adaptation of arrival and departure times and any other business trips, in order to avoid rush hour.
  • The provision by the employer of surgical-type masks in sufficient number to cover journeys between home and the workplace when the person uses collective means of transport.

If these protective measures cannot be ensured, the employee may request to be placed in partial activity, upon presentation to the employer of a certificate drawn up by a doctor. In the event of disagreement with the employer, he refers the matter to the occupational physician, who decides by calling upon, if necessary, the multidisciplinary occupational health team.

If you live with someone who is considered vulnerable : teleworking should be encouraged as much as possible.

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