Most Common Comorbidities in COVID-19
The evidence is now clear that those with pre-existing chronic health conditions or a compromised immune system are at a higher risk of severe symptoms, and death, from COVID-19. Herein I will examine data from a few countries in order to define those ailments which put us most at risk; and I would suggest those who have such conditions, spend their lockdown time working to heal these ailments, this being the most effective way to protect oneself during this pandemic.
For example, since obesity is a major risk factor, it has been pointed out (by Bill Maher) that perhaps doctors should have been strongly recommending that people exercise and eat well in order to shed some pounds while they were stuck at home.
Italy was particularly hard hit by the virus in the first wave, so there might be a good place to begin our research. An Italian study (Aug, 2020) of patients admitted to hospital, who died with the coronavirus infection, “revealed that the majority of cases showed one or more comorbidities”. (Comorbidity means more than one disease or condition is present in the same person at the same time.)
“Hypertension was the most common pre-existing health condition, detected in 66% of patients who died after contracting the virus. Type 2-diabetes, chronic renal failure, and ischemic heart disease were also among the most common comorbidities in COVID-19 patients who lost their lives.” (Study)
Now we will jump over to southwestern Europe, to the country of Romania, which may to some seem rather obscure, but they have done their research, and it is the seventh-most populous member state of the European Union.
Frontiers of Medicine is a peer-reviewed online-only general medical journal. They recently (Sept 09, 2020) published a study which examined 814 deaths caused by COVID-19 as reported by the Ministry of Health. The study analyzed the demographics, number, and prevalence of comorbidities, and calculated the relative risk for each comorbidity.
The results of this study indicated that 90.9% of deaths occurred in people 50+ years, and 97.4% of the patients had at least one comorbidity.
“The most prevalent comorbidities were hypertension (43.1%), diabetes (33.2%), and coronary heart disease (26.0%). The calculated relative risk of death due to COVID-19 was divided into 3 risk categories: high impact comorbidities included diabetes, chronic renal disease and hypertension. The medium impact group comprised chronic pulmonary disease and chronic liver disease and the low impact group –coronary heart disease, cancer and stroke.”
The study concluded that “future policies in Romania should focus on shielding people in the high-risk group and prioritizing them for vaccination, whilst encouraging those in the low risk group to continue seeking treatment for their underlying diseases”. (Study)
Which is the point of this newsletter. In previous newsletters on the subject of COVID, I have looked at natural approaches to preventing and treating this condition. But, perhaps even more important, is that we make every effort to get any pre-existing health conditions under control, for ourselves and any loved ones that we can aid in this endeavour.
In the U.S., as elsewhere, a study of middle-aged and elderly patients with COVID-19 found that “the elderly population is more susceptible to this illness and is more likely to be admitted to the ICU with a higher mortality rate”. “According to the CDC, 8 out of 10 deaths reported in the USA occurred in adults 65 years old and above.”
If we put comorbidity aside for a moment, this study provides an interesting clue as to why the elderly are generally more at risk. Because age is not necessarily a death risk in this case. There have been many people as old as 100 years, who have survived COVID, indicating that general good health is available at any age. (Source)
“The age-related changes in the geriatric population may be due to the changes in lung anatomy and muscle atrophy which results in changes in physiologic function, reduction of lung reserve, reduction of airway clearance, and reduction of the defense barrier function.”
At this point, I would suggest that those concerned with potential changes in lung anatomy and muscle atrophy, may wish to review a few of my earlier newsletters and blogs. Many of the existing newsletters on COVID have to do with protecting the lungs, but the most important nutrients are covered in this older blog: How 3 Nutrients Can Heal Most Ailments. As well, these two newsletters address muscular atrophy: Preserving Muscle Mass as We Age; Vitamin B3 for Muscular Wasting Disease
Now let’s have a look at what the Americans determined to be the most dangerous comorbidities:
In one review examining 180 hospitalized patients, “89.3% of the patients had an underlying comorbidity, and 94.4% aged 65 years and older had at least comorbidity. The most common comorbidities found were obesity, hypertension, and diabetes mellitus.” As well, the risk of contracting COVID-19 in patients with chronic obstructive pulmonary disease (COPD) was found to be 4 times higher than patients without COPD.
A Younger Demographic
Let’s take a moment to examine some statistics on those who are not elderly. (Still looking at American data.)
A meta-analysis study on COVID-19 comorbidities, examined 1786 patients, of which 1044 were male and 742 were female, with a mean age of 41 years old.
“The most common comorbidities identified in these patients were hypertension (15.8%), cardiovascular and cerebrovascular conditions (11.7%), and diabetes (9.4%). The less common comorbidities were coexisting infection with HIV and hepatitis B (1.5%), malignancy (1.5%), respiratory illnesses (1.4%), renal disorders (0.8%), and immunodeficiencies (0.01%).”
The relationship between COVID and respiratory illnesses at first glance seems low (1.4%), however 34.6% of patients hospitalized for COVID, aged 18 to 49 years old, have an underlying chronic lung disease (such as asthma).
Furthermore, among clinical data on 1478 patients hospitalized with COVID-19, 12% of adults showed underlying medical conditions. These patients were not all elderly, nor did they have a high death rate, but had symptoms severe enough to require hospitalization. Within this group the most prevalent pre-existing medical condition was “hypertension (49.7%) and with obesity coming in second (48.3%), followed by chronic lung disease (such as asthma) (34.6%), diabetes mellitus (28.3%), and cardiovascular diseases (27.8%)”.
This meta-analysis the above U.S. data is derived from, also pointed out that “roughly 80% of COVID-19-positive cases result in full recovery from the illness without any hospitalizations or interventions”. (Source)
Back to Europe for a moment; in order to take a closer look at diabetes. In the U.K., much of the focus on protecting citizens from death by COVID is focussing on getting diabetes under control.
A Lancet (medical journal) Diabetes & Endocrinology study concluded that “30% of COVID-19 deaths occurred in people with diabetes. After accounting for potentially relevant risk factors such as social deprivation, ethnicity, and other chronic medical conditions, the risk of dying from COVID-19 was still almost three times higher for people with type 1 diabetes and almost twice as high for type 2, versus those without diabetes.” Also; “among people younger than 65 who died from the infection, about half had diabetes”.
All of which led this British source to advise that “controlling blood sugar through diet, exercise, monitoring, and medication, is the leading tactic to protect people, until a successful vaccine proven to work in people with diabetes”. (Source)
Here I would like to point out that the herbal extract “berberine” is as effective as metformin for helping to control pre-diabetic conditions. (More info on berberine and insulin regulation can be found in this older blog of mine.)
As you can see, the comorbidities we need to be concerned about are fairly consistent no matter what country we examine, with hypertension and diabetes being the most common. Nonetheless, let’s bring it home and see what Canadian statistics tell us:
“Of the over 9,500 COVID-involved deaths between March and July, the majority (90%) had at least one other cause, condition or complication reported on the certificate.”
It was also noted that Alzheimer’s disease or dementia were found to be present in 33% of the men, and 42% of the women, in COVID-related deaths. However, this is no surprise, since “during the first wave of the pandemic and up to the end of May, long-term care facilities and retirement homes accounted for more than 80% of all COVID-19 deaths in the country.” And, while about “one in four Canadians aged 85 or older live with dementia or Alzheimer's, more than half of seniors aged 80 or older who reside in long-term health care facilities live with dementia”.
Thus, we probably should not consider Alzheimer’s or dementia to constitute comorbidities, and they are likely correlated with COVID, but not causative.
However, those comorbidities we should be concerned about, listed on COVID-related death certificates, include “pneumonia (33%), hypertensive diseases (15%), ischemic heart disease (13%), respiratory failure (13%), renal failure (12%), diabetes (12%), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (11%), chronic lower respiratory diseases (10%), nervous system disorders (excluding Alzheimer's) (8%), and cancer (8%)”.
And, of course, “many of these conditions are significantly more prevalent among Canadians aged 65 or older, who accounted for 94% of all COVID-involved deaths in the first wave”. (Source)
For future reference, once this particular pandemic is over and we return to regularly scheduled broadcasting, you should be aware that good old fashioned influenza has the same comorbidities as those recorded for COVID-19. Thus, for all of us, all the time, keeping our lungs healthy, our blood pressure regulated, and our insulin levels stable, is a necessity for good health going forward.