The COVID-19 pandemic has been a shock for most people, but for Clay Drake, much of it was familiar: the need to stay in, the stocking up on hand sanitizer, the concern that a simple trip to church could turn deadly.

Drake, of Windsor, has multiple myeloma, a blood cell cancer, and underwent two stem cell transplants that knocked out his immune system for months. A bout with the seasonal flu lasted more than a month, and for a while he was getting colds that took him weeks to shake, he said.

That was my COVID, he said. I spent probably about a year doing what everybody started doing in March.

While many though not all healthy people who get COVID-19 can recover at home, those who have chronic conditions are six times as likely to be hospitalized and 12 times as likely to die, according to a report from the Centers for Disease Control and Prevention.

Drake still gets chemotherapy and immunotherapy treatments to keep the cancer in remission. Because of the heightened risk from infections, he tries to minimize trips to crowded places but has started seeing small groups of friends again and occasionally eating out. Most people around Windsor seem to be wearing masks and following other recommendations, which makes it safer, he said.

For the most part, I feel comfortable going out in public, he said.

People who have chronic conditions need to be vigilant about social distancing, wearing a mask and washing their hands, according to the CDC, and should talk to their doctors about additional precautions.

While those who know they face a higher risk of dying can take some steps to protect themselves, the rest of the community also needs to help keep the virus from breaking out, said Dr. Peter Buttrick, a cardiologist and member of the board for the Denver branch of the American Heart Association. Most people who get the virus can spread it before developing symptoms, meaning they could inadvertently give it to someone whos at a higher risk especially if they arent wearing masks, he said.

The likelihood youll be in contact with someone who is infected and asymptomatic is higher when theres ongoing community spread, he said.

Colorados new cases are down from a peak in April, but theyve started to tick back up and Gov. Jared Polis has urged the public to continue avoiding large events and wearing masks.

The Centers for Disease Control and Prevention released an updated list Thursday of the clearest risk factors for getting severely sick or dying from COVID-19:

The CDC also listed other conditions as possible risk factors, though the evidence is mixed or from small studies:

A large study in the United Kingdom found that the risk of dying increased sharply with age, but younger people were also at a higher risk if they had certain conditions, said Dr. Jonathan Samet, dean of the Colorado School of Public Health. Diabetes and chronic lung conditions such as emphysema roughly doubled the risk of dying compared to a healthy person of the same age, and heart disease increased the risk by about 25%. Obesity also raised a persons risk of complications, he said.

About 7% of adults in Colorado have diabetes and 23% have obesity, which are some of the lowest rates in the country, according to Americas Health Rankings. Still, that means thousands of people are at an elevated risk, and not all of them may have the ability to stay at home. Ideally, those who are at a high risk would continue social distancing at a high level, Samet said.

Its certainly a time for caution, if peoples jobs and lives allow it, he said.

Not everyone with diabetes is at an equal risk, said Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association. People who have poorly controlled blood sugar and have other chronic conditions generally are at a higher risk from infections, including COVID-19. That makes it important to keep in touch with your doctor and to manage your diabetes well, he said.

If you have diabetes, you have high blood sugars, youre obese and you have maybe cardiovascular disease, youre at high risk and you need to be really careful, he said, adding that age also is a factor to consider.

Its not entirely clear why certain conditions are linked to a higher risk of complications. One possibility is that when hearts are stressed by high blood pressure or coronary artery disease, their cells produce more of certain receptors that the virus binds to though more research is needed to understand if thats the issue, Buttrick said. He urged people not to put off seeking medical advice if they have symptoms that could suggest heart trouble, such as chest pain, shortness of breath, heart palpitations or fainting not only because of the virus risk, but also because the problem itself may need immediate treatment.

Heart disease doesnt go on vacation during the pandemic, he said.

Buttrick and Samet dont advise people with chronic illnesses to stay at home at all times, but say they should consider ways to avoid crowds, like visiting the grocery store during hours set aside for high-risk customers. Ultimately, each patient and doctor need to discuss individual risks, though.

Im telling all of my patients, and I think everybody is, that if youre of a certain age, you need to be really careful, Buttrick said.

People with diabetes and other conditions have to consider their individual level of risk, as well as how risky any particular activity is, Gabbay said. If you have well-controlled blood sugar and no other chronic conditions, you might feel more comfortable going to a lower-risk social event, while someone whose health is more precarious might avoid any exposure that isnt absolutely necessary.

Thats whats made this so difficult there are no hard and fast rules, he said.

Hyoung Chang, The Denver Post

Drake, who volunteers with the American Cancer Society, said he sometimes gets calls from people trying to figure out what they should do, and he steers them toward the ACS guidelines. Some of them are particularly worried about how to move forward with cancer treatment during a pandemic, he said.

I feel like theres a lot of people, particularly the more susceptible and elderly, who are scared, he said.

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COVID threat isnt over, especially for Coloradans with chronic conditions - The Denver Post