The novel coronavirus pandemic is keeping Americans away from the doctors office. For most people, that means little more than postponing a dental checkup or enduring a minor illness at home.

But those with chronic medical conditions especially ailments that make them more susceptible to infections like COVID-19 face a nerve-wracking choice between staying home and letting their health deteriorate or taking their chances with the virus to get their regular care.

An estimated 45% of Americans, or about 133 million people, have some kind of chronic medical condition, like diabetes, high blood pressure, heart disease and arthritis, according to an analysis published in 2018.

These ailments require ongoing care in the form of frequent doctor visits, lab tests, scans, and medications administered in medical facilities. But these facilities are also places where people can contract the coronavirus, making life-or-death decisions about other health care more complicated.

The stakes are much higher for you if you have certain chronic diseases like kidney failure, said Joseph Vassalotti, a medical doctor and the chief medical officer of the National Kidney Foundation in New York. Youre going to be at increased risk for severe COVID-19.

Since the coronavirus reached the United States in January, physicians and other medical providers have seen significant reductions in the number of patients theyve treated. Those numbers began to rebound in May and June, but with COVID-19 infections soaring again around the country, they likely are declining again .

Fear is a major driver of this phenomenon. Last month, 52% of those surveyed said they or a family member had skipped needed medical care because they worried about contracting COVID-19, according to a poll conducted by the Henry J. Kaiser Family Foundation. Research also shows a sharp decline in emergency department visits for chest pain and heart attacks and a significant decrease in colorectal cancer screenings, for instance.

David Oberembt, a 39-year-old who had a kidney transplant in 2017, avoided going to the doctor for weeks, even though he needs to be regularly monitored because of his condition. He takes immunosuppressive drugs to prevent his body from rejecting the donated kidney, and would be more likely to catch COVID-19 if exposed to the virus.

Oberembt, who lives in Little Rock, Arkansas, must take great care under normal circumstances not to get sick. He also needs regular blood tests to make sure his body is tolerating the kidney, sees a kidney specialist four times a year and meets with his transplant team once or twice annually.

So far, Oberembt has put off all those things. Its a calculated risk, he said. This situation wont be tenable over a long period of time, though. I know I cant put this off forever.

While he hasnt taken care of all of those regular appointments, Oberembt experienced symptoms of a skin condition that might have indicated a new kidney problem and felt compelled to see a dermatologist and get some lab work done last month.

Overall, I was very anxious about the experience, Oberembt said. There were no screenings or anything to get into the building and that made me uncomfortable. I felt comfortable in the actual doctors offices. All indications were they were taking the proper precautions. My biggest fear was actually the elevator. What do you do if the doors shut in a crowded elevator and the person next to you starts coughing?

Many chronic diseases themselves dont present any increased risk for COVID-19 infection, but people often have other health issues that do, said Kathleen Costello, a nurse practitioner and the associate vice president for health care access at the National Multiple Sclerosis Society in Waltham, Massachusetts. MS patients, for example, may be obese because of limited mobility due to the autoimmune disease, which causes physical and cognitive disabilities.