COVID-19 and Chronic Disease: The Impact Now and in the Future

Karen A. Hacker, MD, MPH; Peter A. Briss, MD, MPH; Lisa Richardson, MD, MPH; Janet Wright, MD1; Ruth Petersen, MD, MPH


Prev Chronic Dis. 2021;18(6):e62 

In This Article

The Problem of COVID-19 and Chronic Disease

Chronic diseases represent 7 of the top 10 causes of death in the United States.[1] Six in 10 Americans live with at least 1 chronic condition, such as heart disease, stroke, cancer, or diabetes.[2] Chronic diseases are also the leading causes of disability in the US and the leading drivers of the nation's $3.8 trillion annual health care costs.[2,3]

The COVID-19 pandemic has resulted in enormous personal and societal losses, with more than half a million lives lost.[4] COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can result in respiratory distress. In addition to the physical toll, the emotional impact has yet to be fully understood. For those with chronic disease, the impact has been particularly profound.[5,6] Heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk for severe illness from COVID-19.[7] Other factors, including smoking and pregnancy, also increase the risk.[7] Finally, in addition to COVID-19–related deaths since February 1, 2020, an increase in deaths has been observed among people with dementia, circulatory diseases, and diabetes among other causes.[8] This increase could reflect undercounting COVID-19 deaths or indirect effects of the virus, such as underutilization of, or stresses on, the health care system.[8]

Some populations, including those with low socioeconomic status and those of certain racial and ethnic groups, including African American, Hispanic, and Native American, have a disproportionate burden of chronic disease, SARS-CoV-2 infection, and COVID-19 diagnosis, hospitalization, and mortality.[9] These populations are at higher risk because of exposure to suboptimal social determinants of health (SDoH). SDoH are factors that influence health where people live, work, and play, and can create obstacles that contribute to inequities. Education, type of employment, poor or no access to health care, lack of safe and affordable housing, lack of access to healthy food, structural racism, and other conditions all affect a wide range of health outcomes.[10–12] The COVID-19 pandemic has exacerbated existing health inequities and laid bare underlying root causes.

The COVID-19 pandemic has had direct and indirect effects on people with chronic disease. In addition to morbidity and mortality, high rates of community spread and various mitigation efforts, including stay-at-home recommendations, have disrupted lives and created social and economic hardships.[13] This pandemic has also raised concerns about safely accessing health care[14] and has reduced the ability to prevent or control chronic disease. This essay discusses the impact that these challenges have or could have on people with chronic disease now and in the future. Exploring the impact of COVID-19 should help the public health and health care communities effectively improve health outcomes.