COVID-19 & Chronic Conditions: Why Vaccination Should Be Routine Care

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As clinicians, we see every day how respiratory infections- whether influenza or COVID-19 – can destabilize or precipitate exacerbations of chronic conditions in our patients. What may begin as “just another viral infection” can cascade into complications that worsen underlying disease, drive hospitalizations, and accelerate long-term decline.1-7

The data are clear – vaccination is not simply a preventive measure against infection;7,8 it has the potential to serve as an essential tool in routine care of chronic disease.

The Bidirectional Threat

COVID-19 and chronic disease can create a reinforcing cycle:

  • Chronic conditions can worsen COVID-19 outcomes.  Diabetes, heart disease, kidney disease, and Chronic Obstructive Pulmonary Disease (COPD) all increase the risk of intensive care unit (ICU) admission, mechanical ventilation, and death.8
  • COVID-19 can worsen chronic disease.
    • Diabetes: A 2022 meta-analysis found a 64% greater risk of new-onset diabetes (Type 1 and Type 2) in patients following COVID-19 infection compared to non-COVID-19 controls;1 A separate study noted that, compared to uninfected diabetes patients, the risk of end stage renal disease was doubled in diabetes patients who had been infected with COVID-19.2
    • Cardiovascular disease (CVD): Compared to non-COVID controls, patients who had COVID-19 had 55% higher risk of major adverse cardiac events following infection—even in patients without prior CVD.3
    • Kidney disease: Compared to influenza patients, COVID-19 patients had a 3x higher incidence of acute kidney injury, more than 2x greater incidence of chronic kidney disease, and were more frequently assessed as having reduced estimated glomerular filtration rate (eGFR).4
    • COPD & asthma: COVID-19 increases risk of acute exacerbations in COPD patients and severe exacerbations in asthma patients.5,6

This loop can drive both acute and chronic burden. Integrating vaccination into routine disease management could help decrease severe COVID-19 outcomes that can exacerbate existing chronic disease burden.1-6,9

Vaccination as a Preventive Intervention in Chronic Disease Care

Much like statins for cardiovascular risk or angiotensin-converting enzyme (ACE) inhibitors for chronic kidney disease (CKD) progression,10,11 vaccines can offer a risk-reducing intervention.9 According to the evidence:

  • Vaccination lowers the risk of COVID-19 and influenza-related hospitalization and death, including in patients with heart disease, diabetes, and kidney disorders.7,9,12
  • By reducing the risk of severe COVID-19 outcomes, COVID-19 vaccination can reduce the risk of long-term complications – such as new dependence on dialysis – following infection in patients with chronic conditions.8,13
  • Even in patients with well controlled conditions, vaccines can offer critical protection against severe outcomes when underlying risk may not be obvious.8,14

Practical Strategies for Providers

How can we support vaccination becoming part of routine care for patients with chronic conditions?

  1. Normalize vaccination as “standard of care” for high-risk patients
  • Frame COVID-19 vaccines as part of the same preventive package as flu, pneumococcal, and shingles vaccines.
  • Use language patients already understand: “This can help protect you from severe outcomes,9 not just against infection.”
  1. Bundle preventive care
  • Incorporate recommended COVID-19 vaccination(s) into chronic disease follow-ups, medication reviews, or lab appointments.
  1. Address risk misperception
  • Patients with well-controlled or early-stage conditions may not view themselves as being ‘high risk’ for severe outcomes of COVID-19.
  • Reinforce that risk can be condition-driven, not just symptom-driven.8,15 
  1. Leverage teachable moments
  • Hospital discharges, post-exacerbation visits, and new-diagnosis conversations are key opportunities to recommend indicated vaccines.
  1. Engage the whole care team
  • Medical assistants and nurses can screen vaccine status.
  • Social workers and pharmacists can help address barriers like transportation, access, or vaccine hesitancy.

Equity Considerations

Black and Hispanic patients bear disproportionate burdens of both chronic disease and severe COVID-19 outcomes.12,16 As trusted providers, we can:

  • Offer culturally tailored vaccine education that acknowledges historical mistrust.17
  • Partner with community organizations, churches, and pharmacies to expand access points.
  • Use empathetic language that frames vaccination as a form of empowerment, not obligation.

Clinical Takeaway

COVID-19 is not “just another infection” for patients with chronic illness—it can be an accelerator of disease progression.1-6 By reducing the risk of severe illness, vaccination can help reduce the risk of hospitalization and disease exacerbations and help protect against long-term complications in patients with chronic conditions.2,7-9,12,18,19

Action for Providers:

  • Review vaccine status at every chronic disease encounter.
  • For patients with chronic conditions, reframe vaccination as part of routine care – not just infection prevention.
  • Advocate for bundled, equitable vaccine delivery models that make protection the default.

Bottom Line

COVID-19 and influenza vaccination should be viewed in the same way we view prescribing medications to reduce heart failure risk10 or slow CKD progression11 – as core components of routine chronic disease care.

By embedding vaccination into routine practice, we can not only reduce the risk of negative outcomes – we can help protect our patients’ long-term health.9

References

  1. Lai H, Yang M, Sun M, et al. Risk of incident diabetes after COVID-19 infection: A systematic review and meta-analysis. Metabolism. 2022;137:155330. doi:10.1016/j.metabol.2022.155330
  2. Huang TS, Chao JY, Chang HH, Lin WR, Lin WH. COVID-19 and Diabetes: Persistent Cardiovascular and Renal Risks in the Post-Pandemic Landscape. Life (Basel). 2025;15(5):726. doi:10.3390/life15050726
  3. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590. doi:10.1038/s41591-022-01689-3
  4. Chen IW, Chang LC, Ho CN, et al. Association between COVID-19 and the development of chronic kidney disease in patients without initial acute kidney injury. Sci Rep. 2025;15(1):10924. Published 2025 Mar 29. doi:10.1038/s41598-025-96032-4
  5. Kim SH, Lee H, Kim MJ, et al. Risk of acute exacerbation of chronic obstructive pulmonary disease after COVID-19 recovery: a nationwide population-based cohort study. Respir Res. 2025;26(1):116. Published 2025 Mar 27. doi:10.1186/s12931-025-03123-x
  6. Lee H, Kim BG, Jeong CY, et al. Long-Term Impacts of COVID-19 on Severe Exacerbation and Mortality in Adult Asthma: A Nationwide Population-Based Cohort Study. J Allergy Clin Immunol Pract. 2024;12(7):1783-1793.e4. doi:10.1016/j.jaip.2024.03.035
  7. Centers for Disease Control and Prevention. People at Increased Risk for Flu Complications. Accessed October 10, 2025. https://www.cdc.gov/flu/highrisk/index.htm
  8. Centers for Disease Control and Prevention. People with Certain Medical Conditions and COVID-19 Risk Factors. Accessed October 10, 2025. https://www.cdc.gov/covid/risk-factors/index.html
  9. Centers for Disease Control and Prevention. Benefits of Getting Vaccinated. https://www.cdc.gov/covid/vaccines/benefits.html. Accessed November 3, 2025.
  10. Medications for Acute Coronary Syndromes. In: Merck Manual Professional Version. Merck Publishing. Updated April 2025. Accessed October 10, 2025. https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/medications-for-acute-coronary-syndromes
  11. Medications for Diabetes Mellitus Treatment. In: Merck Manual Professional Version. Merck Publishing. Updated October 2023. Accessed October 10, 2025. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/medications-for-diabetes-mellitus-treatment
  12. Centers for Disease Control and Prevention. Underlying Conditions and the Higher Risk for Severe COVID-19. Accessed October 10, 2025. https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html
  13. Huang CY, Wu JY, Lin GY, et al. Impact of prior COVID-19 vaccination on major adverse kidney events in patients with non-dialysis dependent chronic kidney disease: a global retrospective study. Expert Rev Vaccines. 2025;24(1):657-666.
  14. American College of Cardiology. American College of Cardiology Issues Vaccine Guidance for Adults with Heart Disease. Published August 26, 2025. https://www.acc.org/About-ACC/Press-Releases/2025/08/26/13/46/American-College-of-Cardiology-Issues-Vaccine-Guidance-for-Adults-with-Heart-Disease
  15. Singh D, Mathioudakis AG, Higham A. Chronic obstructive pulmonary disease and COVID-19: interrelationships. Curr Opin Pulm Med. 2022;28(2):76-83.
  16. Martsolf G, Kim DK, Fair L, et al. Racial Disparities in Chronic Conditions Outcomes in Primary Care Settings: Between- Versus Within-Practice Differences. Inquiry. 2024;61:00469580241282227. Published 2024 Oct 5. doi:10.1177/00469580241282227 
  17. Bajaj SS, Stanford FC. Beyond Tuskegee – Vaccine Distrust and Everyday Racism. N Engl J Med. 2021;384(5):e12
  18. Taylor CA, Whitaker M, Patton ME, et al. Trends in COVID-19-Attributable Hospitalizations Among Adults With Laboratory-Confirmed SARS-CoV-2-COVID-NET, June 2020 to September 2023. Influenza Other Respir Viruses. 2024;18(11):e70021. doi:10.1111/irv.70021 

Kim SH, Lee H, Kim MJ, et al. Effects of Vaccination on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Cohort Study. Tuberc Respir Dis (Seoul). 2025;88(3):526-534. doi:10.4046/trd.2024.0182

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