You are not powerless in the face of Coronavirus
During this pandemic, it is easy to feel that you have no control over what could happen to you or your loved ones. Daily reports that the virus is spreading despite our best efforts is increasing anxiety and concern.
The current “flatten-the-curve” strategy is designed to slow, but not eliminate the spread of the Coronavirus. As a result, researchers like Harvard epidemiologist Marc Lipsitch projects that as much as 70% of the world’s population will be infected with COVID19.
Fortunately, while the virus is extremely contagious, in most cases, its impact is mild, with more serious cases involving patients with certain health issues such as hypertension and diabetes.
If, as predicted, 70% of the world contracts COVID-19, you need to know your risks. Are you more likely to recover without incident or advance to more serious progression of the virus? While there are some variables that you may not be able to control, there are many that are in your power to change.
Factors that Increase Risk of Severity
Although it will take some time to fully understand the mechanics of the coronavirus, information published by Chinese epidemiologists and physicians may provide early insight into who is most vulnerable to the virus. Note that these studies are being published so quickly that they cannot be peer reviewed, and are called “pre-print” studies, though they do supply valuable information about who is more likely to progress to severe and critical stages and to reveal therapies that have worked. There is no indication that the virus is mutating so we can learn from China what we may expect here in the US.
Almost all of the studies show that there are common comorbid factors that increase the likelihood that an infected patient will progress to serious and possibly critical. Here are some of these details.
Gender and Age
Although men and women contract the virus at about the same rate, men have a worse prognosis, as 63.8% of those who have died were men, and only 36.2% women. It’s possible that this statistic is based on the fact that in China more men smoke than women.
One important finding is that the young are not immune, despite misleading statements to the contrary. Rather, younger populations do get infected but are more likely to show mild symptoms (see Table below). Only a few, with comorbid conditions, are hospitalized and progress to pneumonia.
The latest data from Italy shows a similar pattern, as the median age for those infected is 63 while the median age for those who died is 80.5. The data out of France is early and needs to be further evaluated but reports are revealing that many of those who are currently in the ICU are under the age of 60. Comorbid conditions are not known.
Analysis of first 44, 672 cases of COVD-19 in China as of 2/11/20
While age may be seen as increasing the risk of dying from coronavirus, most of the published studies from China document one or two comorbid factors contributing to a worse outcome.
Underlying Health Issues
All reports from China and Italy confirm that those at greatest risk of dying from coronavirus suffered from chronic diseases before contracting the virus, with the top three factors contributing to a more serious outcome being hypertension, heart disease, and diabetes. Other risks include cancer, cerebral disease and COPD. Fatality rates were mostly associated with cardiovascular disease.
I’ve included some summary information from several studies at the end of this post.
All of the findings suggest that patients with comorbidities had a greater disease severity compared to those without.
You can improve your odds of beating COVID-19 should you become infected. First, you need to determine if you have any of these comorbid factors, such as diabetes, hypertension, cardiac disease, lung disease and generalized deconditioning. If you do, you need to be proactive and take steps now. This is not the time to wait. You need to start addressing your health with your fullest effort, starting now.
I will provide more information over the next several days concerning each of the specific comorbid factors and the steps you can take to diagnose and minimize your risks. Even if you feel healthy and have no diagnosed medical problems, you should eat healthily, get 8 hours of deep and restful sleep, exercise daily and spend time outdoors as much as possible. Continue to follow the recommendations of the CDC to avoid contracting the virus.
This is a challenging, scary time for all of us. But as I said at the start, you are not powerless in the face of the Coronavirus. You should do everything in your power to avoid catching the Coronavirus and to improve your odds of having a mild case.
Below are summaries from a few studies.
JAMA: March 2020. Small study looking at risk factors for those hospitalized with COVID-19 pneumonia. Medium age was 51. Of the 201 patients, 41% developed ARDS (Adult Respiratory Distress Syndrome) and of those who developed ARDS 52% died. Those who developed ARDS had comorbidities such as hypertension and diabetes. Other common factors included older age.
PrePrint Article. Reviewing 1590 cases in China. Mean age was 48.9 with 42.7% female. Severe cases were 16% of the study population with 8.2% dying. Of the 1590 cases, 25% had at least one comorbidity with the most common being hypertension , diabetes and CVD disease. COPD was identified in 24 cases. 130 patients had 2 or more comorbidities and were more likely to be older 66.2 vs 58.2.
Circulatory (HTN and CHD) and endocrine (diabetes) comorbidities were common among patients who were hospitalized and associated with poorer outcomes.
JAMA: Feb 24, 2020. Large Chinese epidemiological study looking at the characteristics of COVID-19. 87% were between the ages of 30-79; 8% between 20-29; 1% between 10-19 and 1% <10. Of all those who tested positive 81`% were mild, 14% severe and 5% critical. Fatality rate: 2.3% of all cases. For patients over the age of 80, the fatality rate was 14.8%; for those between 70-79 the fatality rate was 8%. All critical cases, 49% died.
There were no deaths in the mild and severe cases. The case fatality rate was elevated among those with pre-existing comorbid conditions. 10.5% for CVD; 7.3% for diabetes, 6.3% for respiratory diseases, 6% for HTN and 5.6% for cancer.
JAMA; February 7, 2020. Looking at hospitalized patients with pneumonia. Medium age was 56 with a range from 22-92 with 52% being male. Comorbidities for progression to critical were hypertension, cardiovascular disease, diabetes, Malignancy, and COPD.