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COVID Could Add 20K+ Americans a Day to ‘Preexisting Conditions’

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Every day, another 20,000 Americans between 20 and 60 years of age could be classified as living with a “preexisting condition” because of COVID-19, researchers from the Commonwealth Fund report.

Overall, the pandemic could cause almost 3.5 million Americans to be added to this category, a fact that has important implications approximately 1 month before the US Supreme Court is expected to weigh in on the constitutionality of the Affordable Care Act (ACA), the investigators note.



Dr Eric Schneider

“Polls show that most Americans are worried that preexisting conditions could lead to loss of insurance coverage. People are surprised and even more worried when they realize that the pandemic is adding to this problem,” lead author Eric Schneider, MD, PhD, told Medscape Medical News.

The study was posted online in a blog post on October 8 by the Commonwealth Fund.

Schneider, senior vice president for policy and research at the Commonwealth Fund, and research associate Arnav Shah based their calculations on approximately 7.5 million cases of COVID-19 reported in the United States as of October 7, 2020. The figures include an estimated 45,000 new cases reported daily.

Using data from the Centers for Disease Control and Prevention and Johns Hopkins University, they found that 32% of 1,502,309 people with laboratory-confirmed or probable COVID-19 already had an underlying condition. This proportion varied by age.

Table. COVID-19 and Underlying Conditions

Age in years Proportion of confirmed or probable COVID-19 cases
20 – 29 23%
30 – 39 28%
40 – 49 36%
50 – 59 44%
Source: CDC Case Surveillance Task Force data.

 

If almost one third already have an underlying condition, this means that for the remaining 68%, insurers might consider COVID-19 their first preexisting condition.

More Than 3 Million Could Be Affected

“We estimated that just over 3.4 million nonelderly adults had COVID-19 as a new pre-existing condition,” the authors write.

“If the Supreme Court overturns the preexisting condition provision of the ACA, private insurers will be able to deny insurance coverage to adults under age 65 who are unable to get insurance through an employer or large group,” Schneider said. “Testing positive for COVID-19 could be treated as a preexisting condition.”

Furthermore, he added, “Because the long-term health effects of COVID-19 are unknown, these adults could be uninsurable until they reach age 65 and qualify for Medicare.”

There could also be economic consequences, Schneider said. “If COVID-19 causes long-term health problems the way hepatitis C or HIV do, these costs could be high for patients, providers, and government programs.”

Removing preexisting condition protections could also act as a disincentive. “Healthy people might avoid COVID-19 testing altogether. And that is exactly the opposite of what must happen if we are ever to get this pandemic under control,” the researchers note.

“A Frightening Picture”

“These findings highlight the importance of preexisting protection,” Nathalie Huguet, PhD, who was not affiliated with the study, told Medscape Medical News.



Dr

Trump Age And Weight Add To Covid Risks: Experts

As a 74-year-old obese man, Donald Trump has several known risk factors after contracting Covid-19, but experts say it is difficult to predict how the American president will be affected by a disease that leaves some without symptoms but is deadly to others.

Trump has become the highest profile patient of the new coronavirus, which has scorched across the planet killing more than a million people, including 200,000 Americans.

The US president is currently “well” according to his official doctor and able to continue performing his duties from quarantine.

Experts said that while he does have several of the risk factors associated with severe forms of Covid-19 — being male, older and overweight — it is hard to say how the disease will affect him.

“The risk of serious disease and death depends on many factors — some unmeasurable, so there is always uncertainty — and it is not so simple as to make inferences from one or two alone,” said Naveed Sattar, professor of metabolic medicine at the University of Glasgow.

Trump has seldom appeared in public wearing a face mask Trump has seldom appeared in public wearing a face mask Photo: AFP / Brendan Smialowski

He said that the risks may be “offset” by other factors, including if Trump has no chronic conditions and is reasonably active, noting the US leader’s love of golf.

At his most recent medical check-up, published in June, Trump weighed-in at 244 pounds (110.67 kg). For his height of six feet and three inches (1.91 meters), this means he exceeded the official threshold of obesity for a second year in a row.

According to the US Centers for Disease Control and Prevention, a person in this category is three times as likely to need hospital care than someone with a lower weight.

Another high risk factor is age.

The CDC reports that eight of 10 Covid-19 related deaths in the US are of people over 65.

“In general, your risk of getting severely ill from COVID-19 increases as you get older,” it says on its website.

There are concerns about others Trump came into contact with in recent days -- including his 77-year-old electoral challenger Joe Biden.  There are concerns about others Trump came into contact with in recent days — including his 77-year-old electoral challenger Joe Biden.  Photo: AFP / Jim WATSON

Michael Head, senior research fellow in global health at the University of Southampton, said Trump would be classified as “vulnerable”.

“Many people in their 70s will also have further co-morbidities that increase the risks of a more severe illness,” he added.

Currently, however, the US leader appears to have few if any symptoms.

Britain's Prime Minister Boris Johnson was hospitalised after contracting coronavirus in April Britain’s Prime Minister Boris Johnson was hospitalised after contracting coronavirus in April Photo: POOL / Matthew Horwood

His official physician, Sean Conley, also described the presidential couple as “both well at this time”.

“We are feeling good & I have postponed all upcoming engagements,” said First Lady Melania Trump in a tweet.

Coronavirus infection can begin on a slow burn, often taking several days before symptoms appear.

“Most studies suggest that those with symptomatic COVID-19 infections could remain outside hospital during the first 5-7 days of the illness

Atlas, health officials feuds add to Trump coronavirus turmoil

The feuds between White House coronavirus adviser Scott Atlas and top public health officials are raising more questions about President TrumpDonald John TrumpFive takeaways from Trump-Biden debate clash The Memo: Debate or debacle? Democrats rip Trump for not condemning white supremacists, Proud Boys at debate MORE’s response to the COVID-19 pandemic. 

Atlas, a Stanford University neuroradiologist without experience in public health, first joined the White House coronavirus task force this summer after appearing frequently on Fox News.

He has come under fire from public health experts inside and outside the administration who accuse him of feeding Trump misinformation. 

They argue public health agencies are already facing a public confidence crisis and that Atlas’s influence is undermining those agencies even further.

“The only qualification he has is that he parrots what President Trump wants to hear. To me, that makes him doubly dangerous,” said Mark Rosenberg, who ran the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control from 1994 to 1999.

“Scott Atlas is pushing away the good advice of people like Tony Fauci and replacing it with absolutely baseless and misguided bad advice that will result in more people dying,” added Rosenberg, referring to the director of the National Institute of Allergy and Infectious Diseases, Anthony FauciAnthony FauciThe Hill’s Morning Report – Sponsored by JobsOhio – Showdown: Trump-Biden debate likely to be nasty Tillis appears to reinforce question about COVID-19 death toll Overnight Health Care: Trump signs largely symbolic pre-existing conditions order amid lawsuit | White House puts off action on surprise medical bills | Rising coronavirus cases spark fears of harsh winter MORE.

Like Trump, Atlas has publicly questioned the value of doing more testing and has said pandemic restrictions amount to “panic.” 

Atlas has argued that even if low-risk people get infected with COVID-19, it won’t lead to more deaths. He has also pushed to minimize the impact of the coronavirus on children as a way to reopen schools, a key goal for the Trump administration. 

Atlas has seen his role in the administration grow. 

Trump has invited Atlas to speak to the public and answer questions from reporters at recent White House news conferences about schools reopening, COVID-19 testing and other events. 

Noticeably absent have been Fauci, task force coordinator Deborah BirxDeborah BirxAtlas contradicts Redfield on population susceptibility to coronavirus Controversial CDC guidelines were written by HHS officials, not scientists: report Trump coronavirus adviser threatens to sue Stanford researchers MORE and CDC Director Robert Redfield.

White House deputy press secretary Sarah Matthews said Trump is not playing favorites.

“The President consults with many experts both inside and outside of the federal government, who sometimes disagree with one another,” Matthews said in a statement to The Hill. 

“President Trump relies on the advice and counsel of all of his top health officials every day and then makes policy decisions based on all of the information. Any suggestion that their role is being diminished is just false,” Matthews