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Table 3b. The Panel’s Framework for Assessing the Risk of Progression to Severe COVID-19 Based on Patient Conditions and COVID-19 Vaccination Status

Last Updated: February 29, 2024

Table 3b. The Panel’s Framework for Assessing the Risk of Progression to Severe COVID-19 Based on Patient Conditions and COVID-19 Vaccination Status
ConditionsRisk Level by Vaccination Status
Not Up to Datea,bUp to Datea
Strong or Consistent Association With Progression to Severe COVID-19
High
  • Obesity (BMI ≥95th percentile for age), especially severe obesity (BMI ≥120% of 95th percentile for age)c
  • Medical complexity with dependence on respiratory technologyd
  • Severe neurologic, genetic, metabolic, or other disability that results in impaired airway clearance or limitations in self-care or activities of daily living
  • Severe asthma or other severe chronic lung disease requiring ≥2 inhaled or ≥1 systemic medications daily
  • Severe congenital or acquired cardiac disease
  • Multiple moderate to severe chronic diseases
  • Pregnancy
HighIntermediate
Moderate or Inconsistent Association With Progression to Severe COVID-19
  • Aged <1 year
  • Prematurity in children aged ≤2 years
  • Sickle cell disease
  • Diabetes mellitus (poorly controlled)
  • Chronic kidney disease
  • Nonsevere cardiac, neurologic, or metabolic diseasee
Intermediate
Weak or Unknown Association With Progression to Severe COVID-19
  • Mild asthma
  • Overweight
  • Diabetes mellitus (well controlled)
Low
a See the current COVID-19 vaccination schedule from the CDC.
b Recent SARS-CoV-2 infection (i.e., within 3–6 months) may confer substantial immunity against closely related variants. A patient’s recent infection history should be factored into the risk assessment.
c The degree of risk conferred by obesity in younger children is less clear than it is in older adolescents.
d This includes patients with a tracheostomy and those who require NIV. 
e The data for this group are particularly limited. 
 
Key: BMI = body mass index; CDC = Centers for Disease Control and Prevention; NIV = noninvasive ventilation; the Panel = the COVID-19 Treatment Guidelines Panel