Factors Which Exacerbate COVID-19

COVID-19, like all viruses, seems to hit people differently. Most people are mildly impacted, some moderately and a few are hit very hard. The extremity in severity of symptoms between people is part of what makes this virus so unusual, hard to stop, and scary.

Majority are mild.GIF 

The graph above shows just the confirmed cases in China. The severe and critical numbers are likely pretty accurate, but the mild cases are definitely understated. It is very likely the mild percentage of cases is much higher than even this graph would imply.

There are some factors that appear to make patients more at risk for COVID-19. This does not mean any group below is more likely to become infected with the virus. Every age group will experience its share of cases. However, some age groups will be more severely impacted by it as defined by outcomes that include death, ICU or simply hospitalization. These groups need to take precautions.

Age: The average age of those that have died in the studies I have seen so far have ranged from 72-81 years old. The elderly are very much at increased risk, especially those in failing health or in assisted living homes.

Oldest Most At Risk.GIF 

I do expect the average age of COVID-19 victims to drop a few years over time. Italy and Spain basically stopped treating the elderly when their hospital systems became overwhelmed. In the data above, Italy has a lower death rate than China until the 70-year-old mark and then it switches dramatically. Had these people been treated, some percentage would logically have survived. Still, it is very clear in the data, the older and more frail someone is, the more at risk they are. This age group is also likely to have more of the other risk factors.

New York is showing a similar pattern in age disparity.

NY Deaths by Age April120202.GIF

Please note, I have seen recent news reports saying that young people are getting the disease now,  implying they weren’t before. No study I have ever seen has implied young people will not get the disease. The difference is that the severity and death rate is much lower for younger people than older people. As of March 31, the CDC listed no deaths of those under 19 years of age attributed to COVID-19  I have seen news reports implying there have been young or infant deaths in the title, but, when I read the details, I see items like the below:

First Infant Dies of COVID.GIF

In the article, there is this quote: “A full investigation is underway to determine the cause of death,” Dr. Ezike said in a news release. It seems like inappropriate journalism to list COVID-19 as the cause of death when cause of death has not yet been determined, especially when health officials said the infant had a bowel blockage and organ failure, and died four weeks after being hospitalized. Dying while having COVID-19 and because of COVID-19 are two very different things. I have been dismayed, but unfortunately not surprised, by the lack of journalistic integrity and quality shown by the media on this absolutely critical subject. It appears fear is great for ratings.

Underlying Conditions: Italy did a case-by-case analysis on underlying health conditions of the deceased. These included diabetes, obesity, chronic lung disease, cardiovascular disease, cancer and other severe conditions. The average patient who passed away was 79-years-old and had 2.3 conditions. Only 0.9% had no underlying conditions. This does not mean healthy people cannot get extremely sick, or even die from COVID-19, but the odds are exceptionally low.

Multiple Conditions.GIF 

Number of Conditions.GIF

I had not seen much data from the media on underlying conditions with US deaths or hospitalizations until the CDC published data on March 31, 2020. Of the 122,653 COVID-19 cases reported in the United States to the CDC by March 28, there were 7,162 with underlying conditions (5.8%). Of those requiring hospitalization, 71% had underlying conditions. Of those requiring ICU, 78% had underlying conditions. To date, 94% of the deaths reported to the CDC had at least one underlying condition.

New York published their data on April 1, 2020. Check out the “No Underlying Conditions” column. It is at 1.7% of the determined cases.

NY April1 Numbers.jfif

ACE inhibitors: ACE inhibitors, medicine commonly used to treat to treat high blood pressure or kidney pressure, seems to cause a very powerful negative reaction for COVID-19 patients, per observations by clinical staff treating the most severe patients.

Dr. Leo Galland believes COVID-19 enters human cells by attaching to a protein on the cell surface called ACE-2. Per Dr. Galland, the pattern of COVID-19 pneumonia on CT scan matches the distribution of ACE-2 in the lungs. ACE-2 is actually an enzyme with strong beneficial effects in the organs that produce it. When coronavirus binds to ACE-2, the protein loses its enzyme activity. In the words of one scientist, COVID-19 produces “ACE-2 exhaustion”. Some scientists believe that ACE-2 exhaustion is responsible for the severity of pneumonia and for catastrophic effects like heart failure, blood clots and circulatory collapse. Dr. Galland stated, “I believe that all the clinical manifestations of COVID-19 can be traced to ACE-2 destruction by the virus.”

ACE inhibitors also block the production of angiotensin II (ACE-2). Taking a drug that actually exacerbates what COVID-19 appears to be doing could create a negative compounding effect. COVID-19 patients who typically take ACE inhibitors need to be carefully monitored until more is learned.

Men:  Men seem much more susceptible to having severe conditions from COVID-19. When I first saw this data from China and Italy, it also correlated with men smoking more, so I attributed the disparity in the sexes primarily to smoking. Turns out, males are almost always hit harder by respiratory disease.  Men also were disproportionately affected during the SARS and MERS outbreaks, which were caused by coronaviruses. More women than men were infected by SARS in Hong Kong in 2003, but the death rate among men was 50% higher, according to a study published in the Annals of Internal Medicine. When it comes to mounting an immune response against infections, men are the weaker sex. “This is a pattern we’ve seen with many viral infections of the respiratory tract — men can have worse outcomes,” said Sabra Klein, a scientist who studies sex differences in viral infections and vaccination responses at the Johns Hopkins Bloomberg School of Public Health. Women also produce stronger immune responses after vaccinations, and have enhanced memory immune responses, which protect adults from pathogens they were exposed to as children. A stew of biological factors may be responsible, including the female sex hormone estrogen, which appears to play a role in immunity, and the fact that women carry two X chromosomes, which contain immune-related genes. Men, of course, carry only one. One hypothesis is that women’s stronger immune systems confer a survival advantage to their offspring, who imbibe antibodies from mothers’ breast milk that help ward off disease while the infants’ immune systems are still developing. Regardless of the reason, it does appear men are more susceptible to being hit harder by COVID-19 than women.

New York is seeing the same pattern.

Deaths by Sex 20200401.GIF

Smokers: It’s no surprise smoking and a respiratory tract diseases tend not to go well together. COVID-19 is no exception.

Blood Type A: Chinese researchers took blood samples from more than 2,100 patients infected with COVID-19. After comparing the blood types with those of healthy populations, the researchers noticed that those with Type A blood were more susceptible to infection and had a higher mortality rate than other blood types. Those with Type O were less likely to get infected and, if infected, less likely to progress to severe or critical stages. These findings applied to all genders and age groups. There were 63% more fatalities related to the novel coronavirus among individuals with blood Type A compared to blood Type O.

Ibuprofen: France Health Minister Olivier Véran claims that ibuprofen aggravates symptoms. Some doctors are warning the drug’s anti-inflammatory effects may dampen the body’s response to infection, slowing recovery. England’s chief scientific advisor has also recommended Britons with COVID-19 not take the drug. Acetaminophen (Tylenol) is recommended instead.

Please note, there has not been time enough for all of these factors to be properly peer reviewed. Many COVID-19 patients will have overlapping factors and it is unknown which one(s) may play a larger role in influencing the disease. The data we do have does shows correlation between risk factors and severity of symptoms. In time, I’m sure more factors will be discovered, some emerging data may be refuted while other data verified by further study.

Until then, those of you or your loved ones that have a few of the factors on this list are the people for whom social distancing is especially important.

Stay safe, stay strong!