People with underlying medical conditions like asthma and diabetes are more likely to develop deadly complications from the novel coronavirus if they are infected.

The risk also increases with age, especially for those older than 65, said University of Washington’s director of Neighborhood Clinics Peter McGough. And the advice to those feeling sick is now call before you go to a doctor.

Health care providers are recommending people with symptoms, including fever and coughing, should call their primary care doctors. A hotline set up by the state Department of Health appeared to be down on the morning of March 4. This reporter called numerous times, but the hotline disconnected within seconds.

This keeps people from visiting health care centers and emergency rooms unnecessarily, where they could be exposed to the virus.

“For people at high risk, if they get a fever, a productive cough, shortness of breath, contacting one of the nurse lines or contacting your provider initially is a good thing,” McGough said.

Symptoms generally appear mild at first, but for people with underlying health problems, like asthma, other respiratory diseases like COPD, diabetes or HIV infections, COVID-19 can develop into pneumonia or respiratory failure.

There are many reasons for this, but older patients are more prone to damaging inflammation from the virus. For those with diabetes, the immune system isn’t as prepared to fight off COVID-19. People are more likely to get secondary infections, like pneumonia.

“Those can be tough for the body to fight off, and need more medical support,” McGough said.

The same holds true for those with other diseases that reduce the body’s ability to fight off infections. People who have had transplants are also more at risk.

For asthmatics, respiratory illness can trigger bronchial spasms, even relatively minor ones like colds. It triggers the body’s inflammatory response and makes it difficult to breath. Infections further leave them at risk for secondary infections.

Since COVID-19 emerged in Washington state, it appears to be hitting older people hardest. Of the nine dead and dozens sickened by the virus, nearly all of them were older than 40, with the exception of two men in their 20s hospitalized in Issaquah. Ages of those who died range from from their 40s to 80s.

The Life Care Center in Kirkland has been ground zero for the current outbreak locally, but the virus may have been spreading through Western Washington for as long as six weeks.

McGough said it’s especially important for people more susceptible to the diesease to follow public health guidelines. These include frequent hand washing for at least 20 seconds with soap and warm water, staying away from people who are ill and being careful about personal contact. People may have to give up on hugging and kissing for a bit, he said.

As of March 4, the Centers for Disease Control expanded the criteria for who can be tested. It now lets clinicians decide whether someone should receive a COVID-19 test. Previously, only those who had traveled to a country with a known outbreak, or who had come into contact with a known source of transmission, were being tested.

At the same time, the state is working with the University of Washington and other testing facilities to increase the number of tests which can be performed. Until now, the state’s Public Health Lab in Shoreline – with the capacity to fully test around 100 people a day – was the only lab performing tests.

McGough said UW is also looking at setting up one or two “drive-thru” testing facilities, and more details should be available early next week. These could be similar to ones used in South Korea.