COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations
Open accessAbstract
Background: A high burden of severe disease and death from the coronavirus disease 2019 (COVID-19) has been consistently observed in older patients, especially those with pre-existing medical co-morbidities. The global pandemic lockdown has isolated many patients with chronic illnesses from their routine medical care. This narrative review article analyses the multitude of issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. Methods: Sources for this publication were identified through searches of PubMed for articles published between 31st December 2019 and 4th June 2020, using combinations of search terms. Guidelines and updates from reputable agencies were also consulted. Only articles published in the English language were included. Results: The volume of literature on COVID-19 continues to expand, with 17,845 articles indexed on PubMed by 4th June 2020, 130 of which were deemed particularly relevant to the subject matter of this review. Older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with pre-existing cardiovascular disease, especially hypertension and coronary heart disease, are at greatly increased risk of developing severe and fatal COVID-19 disease. A controversial aspect of the management of COVID-19 disease has been the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Obese COVID-19 patients are more likely to require complex ICU management. Putative mechanisms of increased COVID-19 disease severity in diabetes include hyperglycaemia, altered immune function, sub-optimal glycaemic control during hospitalisation, a pro-thrombotic and pro-inflammatory state. Patients with mental health disorders are particularly vulnerable to social isolation, and this has been compounded by the suspension of non-emergency care in hospitals around the world, making it difficult for patients with chronic mental illness to attend outpatient appointments. Conclusions: The global pandemic of COVID-19 disease has had a disproportionately negative impact on patients living with chronic medical illness. Future research should be directed at efforts to protect vulnerable patients from possible further waves of COVID-19 and minimising the negative impact of pandemic mitigation strategies on these individuals.
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COVID-19 caused especially high morbidity and mortality among people with comorbidities such as obesity, diabetes, kidney disease, and heart disease.
“COVID-19 has imposed especially high morbidity and mortality burdens on people with comorbid conditions, such as obesity, diabetes, kidney disease, and heart disease.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [389]
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Schizophrenia and COVID-19 delirium
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Travel vaccination recommendations and infection risk in HIV-positive travellers
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Severe obesity as a barrier to international travel: a qualitative analysis
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Self-citationRetrospective analysis of older travellers attending a specialist travel health clinic
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Self-citationEnsuring care for clozapine-treated schizophrenia patients during the COVID-19 pandemic
Nichols, J. E., Gannon, J. M., Conlogue, J., Sarpal, D. K., Montgomery, J. L., Sherwood, R., Fabian, T. J., Ballough, J. R., Fredrick, N. M., & Chengappa, K. N. R. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.05.053 · Cited by 16 · see citing works
Health challenges of international travel for obese patients
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Self-citationOne size does not fit all: towards personalized risk assessment in travel medicine
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Self-citationThe significance of non-communicable threats to travellers: time for a sea-change?
Sanford, C. A., & Flaherty, G. T. (2018) · Journal of Travel Medicine · doi:10.1093/jtm/tay103 · Cited by 10 · see citing works
Self-citationPatel, T. K., Barvaliya, M. J., Kevadiya, B. D., Patel, P. B., & Bhalla, H. L. (2020) · Journal of Neuroimmune Pharmacology · doi:10.1007/s11481-020-09940-9 · Cited by 10 · see citing works
Caring for Patients with Advanced Stage Cancer at the Time of COVID-19
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Psoriasis, biologic therapy, and the pandemic of the 21st century
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Sleep apnoea: no obstruction to international travel
Walsh, S. M., & Flaherty, G. T. (2020) · Journal of Travel Medicine · doi:10.1093/jtm/taaa078 · Cited by 5 · see citing works
Self-citationPre-travel Health Advice for Patients With Cardiovascular Disease
Liew, C. H., & Flaherty, G. T. (2019) · International Journal of Travel Medicine and Global Health · doi:10.15171/ijtmgh.2019.18 · Cited by 3 · see citing works
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The Lancet Commission on lessons for the future from the COVID-19 pandemic
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Immunology of aging: the birth of inflammaging
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SARS-CoV-2, ACE2 expression, and systemic organ invasion
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Neuropsychiatric Complications of COVID-19
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Immune response in COVID-19: what is next?
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Covid-19 and non-communicable diseases: evidence from a systematic literature review
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Disturbed lipid and amino acid metabolisms in COVID-19 patients
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Gynecologic oncology care during the COVID-19 pandemic at three affiliated New York City hospitals
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Travel in the Time of COVID: A Review of International Travel Health in a Global Pandemic
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Self-citationIs post-COVID syndrome an autoimmune disease?
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Na+/K+-ATPase as a Target of Cardiac Glycosides for the Treatment of SARS-CoV-2 Infection
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Clinical characteristics and symptom duration among outpatients with COVID-19
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Rehabilitation of Post-COVID-19 Musculoskeletal Sequelae in Geriatric Patients: A Case Series Study
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PANDEMIC EPIDEMIOLOGY: A COMPREHENSIVE REVIEW OF COVID-19 LESSONS AND FUTURE HEALTHCARE PREPAREDNESS
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Implications of Low-grade Inflammation in SARS-CoV-2 Immunopathology
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Lifestyle Medicine: Overcoming Systemic and Cultural Barriers to Better, More Affordable Care
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Self-care Behaviors and Technology Used During COVID-19: Systematic Review
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Wybrane aspekty medyczne i społeczne pandemii Covid-19
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Aging, Care, and Isolation in the Time of COVID-19.
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SARS-CoV-2 Infection and Alpha-Synucleinopathies: Potential Links and Underlying Mechanisms
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Exploring the Metabolic Syndrome Trend in Young Adults in COVID-19 ERA
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Anazonwu, N. P., Igboeli, E. E., Ajaero, C. K., Okafor, N. I., Ezeibe, E. N., Mbaegbu, C. C., & Ogu, I. (2025) · Discover Public Health · doi:10.1186/s12982-025-00454-4 · Cited by 1 · see citing works
Fredj, M. B., Gara, A., Kacem, M., Dhouib, W., Hassine, D. B., Bennasrallah, C., Zemni, I., Alaya, N. B. B., Derouiche, S., Maatouk, A., et al. (2025) · Archives of Public Health · doi:10.1186/s13690-024-01485-0 · Cited by 1 · see citing works
Laddha, U. D., Kshirsagar, K., Kotwal, G., Jadhav, A., Patil, D., & Magar, G. B. (2025) · Biomedical & Pharmacology Journal · doi:10.13005/bpj/3232 · Cited by 1 · see citing works
Dires, E. D., Negash, A. A., Yohannes, G. W., Mohammed, F. A., Redi, M. A., Tsega, B. F., Mihiretie, A. M., Demshasha, S. D., Bedore, T. M., & Mohammed, Y. E. (2026) · PLOS Global Public Health · doi:10.1371/journal.pgph.0005838 · Cited by 1 · see citing works
Predisposing Factors Promoting COVID-19 Infection and Mortality
Azike, C. A., Ngowari, J. O., & Orudukobipi, T.-O. (2021) · International Journal of Pathogen Research · doi:10.9734/ijpr/2021/v6i430170 · Cited by 1 · see citing works
Shamseldin, Y. F., Hussein, A. K., Sadek, E. M., Shalaby, H., & Mowafi, H. (2022) · The Egyptian Journal of Hospital Medicine · doi:10.21608/ejhm.2022.242999 · Cited by 1 · see citing works
Patient-reported distress at a cancer center during the COVID-19 pandemic
Shah, M. P., Rosenthal, S. W., Roy, M., Khaki, A. R., Hernandez‐Boussard, T., & Ramchandran, K. J. (2023) · Scientific Reports · doi:10.1038/s41598-023-36025-3 · Cited by 1 · see citing works
COVID-19: Its Impact on Delayed Management of Pre-established Chronic Conditions
Villacreses, C. A., Herson, A. B., Phrathep, D. D., Igbonagwam, C. B., Briceno, S. A., Khan, H., & Barnouti, Z. (2023) · Cureus · doi:10.7759/cureus.44667 · Cited by 1 · see citing works
Mahmood, M. Y., Ashiru, A., Shettima, F. B., Abdullahi, A. A., Ngulde, A. M., Abbas, Z. U., Jibrin, I. M., Musami, U. B., & Wakawa, I. A. (2023) · Nigerian Journal of Medicine · doi:10.4103/njm.njm_40_23 · Cited by 1 · see citing works
Aghdam, M. M., & Crowley, Q. (2023) · Medicina de Familia SEMERGEN · doi:10.1016/j.semerg.2023.102159 · Cited by 1 · see citing works
Suciu, M., Vlaia, L. L., Boujneh, E., Suciu, L., Buda, V. O., Jianu, N., Vlaia, V., & Cristescu, C. (2024) · Pharmacy · doi:10.3390/pharmacy12020068 · Cited by 1 · see citing works
Nurturing mental health in the postpandemic era
Prakash, J., Ghosh, P., Chaudhury, S., & Srivastava, K. (2024) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_139_24 · Cited by 1 · see citing works
Bala, S. Z., Livinus, M. U., Hassan, M., & Bitrus, S. (2021) · International Journal of Infectious Diseases and Therapy · doi:10.11648/j.ijidt.20210602.12 · Cited by 1 · see citing works
Aedh, A. I., Al-Swedan, A. D., Alshahrani, A., Ghazwani, E. Y., Sultan, S., Mahnashi, N. A., Alyami, A. H. M., Mahjari, A., Babker, A. M. A., & Mohamed, H. (2021) · Journal of Pharmaceutical Research International · doi:10.9734/jpri/2021/v33i46b32914 · Cited by 1 · see citing works
COVID-19, Co-Morbidities and Its Impact on Prognosis in a Tertiary Care Hospital of Bangladesh
Mamun, A. A., Maqbool, A., Islam, S. M. S., Chowdhury, I. B., Rahman, M., Sohael, F., Rahman, A., Islam, M., Shima, T., Shimojo, N., et al. (2022) · Journal of Medical - Clinical Research & Reviews · doi:10.33425/2639-944x.1270 · Cited by 1 · see citing works
Fatty liver disease in obese patients with COVID-19: a tale of two pandemics?
Yeoh, S. L., & Flaherty, G. T. (2020) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaa059
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Predicting severe COVID-19 outcomes for triage and resource allocationPreprint
Morada, A. O., Scheidel, C., Brown, J., Albright, J., Kolade, V. O., & Cagir, B. (2021) · medRxiv · doi:10.1101/2021.04.12.21255201
COVID-19 Incidence in a Large Cohort of Hemodialysis Libyan PatientsPreprint
Elgriw, N., Gusbi, E., Elshwekh, H., Shiboub, A., Elcosbi, J., Abdusalam, M., Alhudiri, I. M., Belhaj, E. M., Alamin, A. M., Elzagheid, A. I., et al. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3910353
Importance of patients’ care after COVID-19 positive test
Yadang, S. A. F., & Agbor, G. A. (2021) · Journal of the Cameroon academy of sciences · doi:10.4314/jcas.v17i1.5
Recomendaciones para el calculo de la rectificacion de cauces en los rios de cuba
Projorenko, S. I., Monteagudo, O. P., & Canolo, J. V. (1986) · Voluntad hidráulica
Locked in: The Elderly and Vulnerable
Briggs, D., Telford, L., Lloyd, A., Ellis, A., & Kotzé, J. (2021) · Springer eBooks · doi:10.1007/978-3-030-88825-1_7
OBESITY IN SARS-COV-2 INFECTION: LITERATURE REVIEW
da Silva, D. T., Lima, P. D. S. B., Neto, R. S. M., Valente, G. M., Cabral, D. D., Marques, N. D. D. S., Runo, C. E. V., Sousa, T. S. Q. D., Miranda, W. R. D. H., & Silva, A. G. D. (2021) · GLOBAL JOURNAL FOR RESEARCH ANALYSIS · doi:10.36106/2709661
- Authors
- Flaherty, G. T., Hession, P., Liew, C. H., Lim, B. C. W., Leong, T. K., Lim, V., & Sulaiman, L. H.
- Affiliations
- Ollscoil na Gaillimhe – University of Galway (IE)
- IMU University (MY)
- Corresponding author
- Flaherty, Gerard Thomas
- ORCID
- Venue
- Tropical Diseases, Travel Medicine and Vaccines
- Published
- 2020-08-28
- Volume
- 6
- Issue
- 1
- Pages
- 16-16
- ISSN
- 2055-0936 (ISSN-L)
- PMC
- PMC7453673
- OpenAlex
- W3082633457
- Cited by
- 127
- References
- 103
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 11 · 2023: 28 · 2022: 29 · 2021: 32 · 2020: 7
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Tropical Diseases Travel Medicine and Vaccines (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Greater South Information System
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, comorbid chronic disease, cardiovascular disease, respiratory diseases, metabolic disorders, diabetes mellitus, obesity, hypertension, coronary artery disease, ACE inhibitors, angiotensin receptor blockers, intensive care unit admission, hyperglycemia, social isolation, mental illness, pandemic lockdown, access to outpatient care, vulnerable populations
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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