Factors that affect Covid-19

[Chuckanut]

The July 25-26 edition of the WSJ contains an interesting article on a study compiled by Johns Hopkins on the factors that increase our vulnerability to CV19.

https://www.wsj.com/articles/covid-...-s-11595595601?mod=searchresults&page=1&pos=1

It's behind a paywall so I will give you the most important information, IMO.

The number below are based on an analysis of 17.3 million adults in the UK between February and May of 2020.

Factors that affect CV19 and increase the risk of dying:

Recently diagnosed blood, lymph cancer (including bone marrow) - 2.82X
Uncontrolled diabetes - 1.95X
Liver disease - 1.75X
Respiratory disease (excluding asthma) - 1.63X
Male - 1.59X
Black - 1.48X
Moderately Obese - 1.40X
Chronic Heart disease - 1.17X

Age was far and away the most significant factor, the authors reported, with patients in their 80s more than 20 times more likely to die of Covid-19 than someone in their 50s, after accounting for all other factors. But those suffering from chronic illnesses were at higher risk of death than those without those conditions, the analysis showed. Diabetics with high blood-sugar levels were found to be almost twice as likely to die as nondiabetics. Disease of the heart, kidney and liver were also associated with a higher mortality risk.

I like the table figures above with numbers for the increased risk. One of the most frustrating things about current CV19 advice is how vague it often is. "Having a left little toe that is longer than 0.8 inches increases the risk of death". OK, but by how much? If it raises the risk of death by 0.2% I won't even bother to get out my ruler. But, if it raises the risk by 25% I will measure my toe several times to get an accurate reading. Sometimes being a numbers kinda of guy can be frustrating.

 

[audreyh1]

I didn’t realize the gender thing was so pronounced. I thought it was slight. Wow!

It’s hard to untangle age from chronic conditions, although I suppose that the age correlation is so much more pronounced, it overrides the underlying health condition effect.

I bet being Hispanic is at least as high if not a greater risk than being Black. For mostly the same reasons but maybe extended family ties are even stronger among Hispanics?

IMO bad outcomes are also correlated to exposure dose. That’s my layman’s interpretation but I thinks it’s justified.

 

[JoeWras]

I bet being Hispanic is at least as high if not a greater risk than being Black. For mostly the same reasons but maybe extended family ties are even stronger among Hispanics?

That data is hard to parse out, at least in my state.

In general, being Hispanic is a risk to GET the disease (42%), but NOT to die from it (11%). There is likely an age element involved that they are not giving enough data for us to understand.

Latest NC data right here...

 

[sengsational]

Interesting that athsma was excluded from the respiratory group. That supports what I heard on a MedCram video about how steroid inhalers may have a protective effect.

 

[jollystomper]

I not nothing amount body chemistry, but since the article mentions diabetics with high blood sugar levels being more likely to die... might there be a relation in getting infected, or the severity of the infection, while engaging in behavior that raises (even temporarily) blood sugar levels? FOr example Drinking at bars does this... and factor in the lack of social distancing and the amount of "droplets" that can be found in the air due to related behavior... it just raises the question in my mind.

 

[CardsFan]

Based on Chuckanut's summary (I can't get past the pay wall, so didn't read the article) a few things jump out at me:

- If the list of co-morbidities is complete, what happened to hypertension?

- The worst co-morbidity increases the chance of death by a factor of less than 3. Significant but not dramatic, since simply being male increases it by 1.59X

- But age alone, correcting for all other factors, can increase the risk by a factor of 20 from age 50 to 80.

The age correlation seems to be the greatest factor for death. I am guessing that the older we get, the weaker our immune system becomes, so that makes a lot of sense.

I can see this locally, as 85% of all deaths in my county were in LTC facilities, and 77% of the deaths in my state were over age 70 (and 52% over age 80)

 

[audreyh1]

I not nothing amount body chemistry, but since the article mentions diabetics with high blood sugar levels being more likely to die... might there be a relation in getting infected, or the severity of the infection, while engaging in behavior that raises (even temporarily) blood sugar levels? FOr example Drinking at bars does this... and factor in the lack of social distancing and the amount of "droplets" that can be found in the air due to related behavior... it just raises the question in my mind.

I would doubt it. I think the study refers to out of control diabetics who would have chronic blood sugar levels far higher than a non-diabetic person even if the latter went on a sugar binge. And it’s referring to how people fare in their disease after becoming infected. It’s probably linked to how easily the virus replicates. Actually getting infected through your respiratory system or mucus membranes would be independent of your blood sugar levels at the time, I would think.

 

[RAE]

The strength of one's immune system almost certainly does weaken somewhat with age (in general), I don't think there is much dispute about that. However, my guess is that many folks in the most elderly age groups also likely have one or more of the underlying health factors mentioned in the WSJ list (and several of those factors fall within the general category of metabolic syndrome). I wish the WSJ would have looked at that, and broken out that information as well.

I don't think being elderly, in itself, is a death sentence if you do contract this virus. Elderly people that are healthy and fit overall, with none of the health conditions on the WSJ list, are probably more likely to survive the virus than someone much younger that has several underlying health issues.

 

[6miths]

Overall, it seems that the relative risks, aside from age, are not very high for any given condition. The RR for sex of 1.59 means that roughly 3 males die compared to 2 females. Hardly, a ticket to ride for the fairer sex. And the data from NC (thank you JoeWras) suggests even less difference. And for diabetes it is unimpressive enough that they had to select out only currently, poorly controlled diabetics. Bottom line in my mind is that you don't want to get this at all, especially if you are over 25 (based on the NC data).

 

[Winemaker]

While strength of our immune system is critical, is it possible that by living in an elder care facility one is isolated that their immune system doesn't get enough "practice"? I witness my niece who attends child care for the past 3-4 years years and brought home every runny snot nose cold on planet Earth, DD and DW who are/were teachers, who now don't get the latest bug? I think getting minor exposure to various microbes gets your body more and more into "immune shape". I can only wonder what could possible happen go wrong if we keep ourselves isolated and locked down.

 

[CardsFan]

Overall, it seems that the relative risks, aside from age, are not very high for any given condition. The RR for sex of 1.59 means that roughly 3 males die compared to 2 females. Hardly, a ticket to ride for the fairer sex. And the data from NC (thank you JoeWras) suggests even less difference. And for diabetes it is unimpressive enough that they had to select out only currently, poorly controlled diabetics. Bottom line in my mind is that you don't want to get this at all, especially if you are over 25 (based on the NC data).

Bold by me.

Not sure where you are coming from with the over 25 comment. Of course, no one wants to get it. But the NC data shows that no-one under the age of 25 even has even died.

25-49 account for 44% of the cases, but only 5% of the deaths. Conversely, age 65+ account for 11% of the cases, but 79% of the deaths.

It is clear to me that age is THE single biggest factor contributing to death.

 

[braumeister]

I don't think being elderly, in itself, is a death sentence

Well, that's a relief.

Although I've heard that taxes can be avoided too.

 

[timo2]

IIRC there are already studies regarding which categories of people have what type of health care plan. Someone will eventually try to compare that to these coronavirus statistics. It may be nothing, or there may be some sort of correlation. Does better and more frequent dr. visits before getting COVID-19 mean anything at all? or if one is in a very high deductible plan with the associated fewer maintenance visits does that matter at all?

I started wondering because of the 'uncontrolled diabetes' item. I'm guessing that could include people that don't know they have diabetes because they never go to the doctor for the usual battery of bloodwork. But other 'underlying conditions' may be unknown to COVID-19 patients.

 

[JoeWras]

Feel free to explore the NC data further. Here is the link:

https://covid19.ncdhhs.gov/dashboard/cases

 

[Teacher Terry]

Cards, people under the age of 25 have died in other states.

 

[6miths]

Overall, it seems that the relative risks, aside from age, are not very high for any given condition. The RR for sex of 1.59 means that roughly 3 males die compared to 2 females. Hardly, a ticket to ride for the fairer sex. And the data from NC (thank you JoeWras) suggests even less difference. And for diabetes it is unimpressive enough that they had to select out only currently, poorly controlled diabetics. Bottom line in my mind is that you don't want to get this at all, especially if you are over 25 (based on the NC data).

Bold by me.

Not sure where you are coming from with the over 25 comment. Of course, no one wants to get it. But the NC data shows that no-one under the age of 25 even has even died.

25-49 account for 44% of the cases, but only 5% of the deaths. Conversely, age 65+ account for 11% of the cases, but 79% of the deaths.

It is clear to me that age is THE single biggest factor contributing to death.

My point in picking that age was that there is a not insignificant mortality risk if you are over 25 even in the NC data. But as pointed out there are other data that show that there is a mortality risk even at younger ages and in those that have no pre-existing conditions. And of course a twenty year old runs the risk of being the vector that infects their parent, grandparent, teacher, etc.

 

[CardsFan]

Cards, people under the age of 25 have died in other states.

We were specifically talking about NC. Yes, younger folks have died in most states.

The problem is we are conflating statistics with local experiences. Almost everyone knows someone who has had a tragic experience with something. But, statistically, that is meaningless.

Sorry, I was an engineer. Numbers were not so hard then.

 

[6miths]

We were specifically talking about NC. Yes, younger folks have died in most states.

The problem is we are conflating statistics with local experiences. Almost everyone knows someone who has had a tragic experience with something. But, statistically, that is meaningless.

Sorry, I was an engineer. Numbers were not so hard then.

Numbers aren't that hard now either but emotions are. Some of these 'studies' are giving some people the impression that they are not at risk because there are 'risk factors', most of which are not associated with very high relative risks. Yes, the older you are the higher your risk statistically but no adult is not at some risk of mortality or morbidity or passing the virus on to someone who is at higher risk.

 

[harllee]

Is blood type still a factor for Covid-19? I was hoping that my O negative blood type would give me some protection.

 

[Sojourner]

IMO bad outcomes are also correlated to exposure dose. That’s my layman’s interpretation but I thinks it’s justified.

Absolutely. This is the biggest revelation I'd have about COVID-19 within the past week or so. The viral load appears to be strongly correlated with the severity of the disease, all else being equal. A good, multi-layer, medical grade mask can screen out 85% or more of viral/respiratory particles that one might otherwise inhale, so consistently wearing a good, well-fitted mask when around other people is likely to prevent a "bad" case of COVID.

This has given me some reassurance that I'm going to be pretty well protected from a serious case of COVID, if/when I get exposed. I am very diligent about mask wearing and will continue to be until the pandemic subsides dramatically.

Here's an article with more details. https://www.usatoday.com/story/news/health/2020/07/15/wearing-mask-may-offer-protection-against-catching-severe-covid-19/5431323002/

Quote from the article:

The rationale is based on the medical concept of "viral inoculum," or how much virus someone is exposed to. The evidence about viral, bacterial or fungal exposure affecting how sick someone gets goes back to the 1930s.

“We know this for gastrointestinal viruses, sexually transmitted diseases and respiratory infections. The bigger the load, the more you get in your system, the more severe the disease,” said Dr. Monica Gandhi, a professor of medicine and infectious disease expert at the University of California, San Francisco and co-author on the paper.

Wearing a cloth face covering is estimated to screen out between 65% and 85% of viral particles, said Dr. Chris Beyrer, an epidemiologist at Johns Hopkins Bloomberg School of Public Health and another author.

Depending on how robust the person’s immune system is, a smaller exposure seems to correlate with milder cases of COVID-19. It's probably because with a smaller amount of virus to deal with, the body’s immune system has a better chance of mounting a defense, the paper's authors suggest.

It’s seen in many other diseases, said Otto Yang, a professor of medicine and chief of infectious diseases at the David Geffen School of Medicine at UCLA

“When somebody’s infected with a virus, there’s immediately a race between the virus replicating itself and the immune system. The bigger the inoculum a person gets, the bigger head start the virus has,” he said.

 

[JoeWras]

Absolutely. This is the biggest revelation I'd have about COVID-19 within the past week or so. The viral load appears to be strongly correlated with the severity of the disease, all else being equal. A good, multi-layer, medical grade mask can screen out 85% or more of viral/respiratory particles that one might otherwise inhale, so consistently wearing a good, well-fitted mask when around other people is likely to prevent a "bad" case of COVID.

Good to hear they are confirming it.

Very early in the pandemic, a shout out to ear, eye, nose doctors and optometrists was made. The ear-eye-nose docs were getting really bad cases. Of course, they were seeing sick people and getting dosed right to their face during examinations. So, there was talk about viral load at that time.

 

[Rianne]

The discussion always points to dying. I'm much more concerned about the "Long Haulers" effect of living with constant symptoms that make life miserable. Where are the statistics about long term severe symptoms of the "recovered" who have not been hospitalized? Severe symptoms go beyond the inability to breathe. Extreme lethargy, constant muscle aches, headaches, cycles of feeling fine then inability to get out of bed for days. I fear this more than dying.

 

[6miths]

The discussion always points to dying. I'm much more concerned about the "Long Haulers" effect of living with constant symptoms that make life miserable. Where are the statistics about long term severe symptoms of the "recovered" who have not been hospitalized? Severe symptoms go beyond the inability to breathe. Extreme lethargy, constant muscle aches, headaches, cycles of feeling fine then inability to get out of bed for days. I fear this more than dying.

Largely unknown at this point but experience with other viruses suggest that long term effects are relatively uncommon. It seems that it will be difficult to differentiate from the general malaise that people seem to routinely experience these days.

 

[Another Reader]

Largely unknown at this point but experience with other viruses suggest that long term effects are relatively uncommon. It seems that it will be difficult to differentiate from the general malaise that people seem to routinely experience these days.

Suggest you read some of these stories. Up to 20 percent are suffering long term complications.

https://www.c19recoveryawareness.com/

This will be the most expensive disease we have ever seen.

 

[sengsational]

Absolutely. This is the biggest revelation I'd have about COVID-19 within the past week or so. The viral load appears to be strongly correlated with the severity of the disease, all else being equal.

Also on the "viral load" idea, there's going to be cheap/quick tests that only alert you if you're shedding lots of virus. I scoffed a these tests earlier, because the had a sensitivity of 56%. But I was an idiot. This is exactly what we need: quick cheap "paper" covid antigen tests.

A $2 test that can be read in 10 minutes that shows if you're spewing virus. Think about going to the dentist when those you will interact with have passed this test the day of your visit. That, versus not knowing anything about the status of the staff, or news that's 99% accurate, but 10 days old, and is too costly to repeat test (ie PCR test). Or think of the school model...students are handed a $2 test to be taken the next morning. Don't get on the bus if you test positive. True, there will be kids on the bus that have the virus, but they're not spewing copious quantities, so will likely infect few other kids, or if they do infect them, the cases will be mild (if the viral load theory is true). Or how about using them for airline flights? Seems like the thing that would get more people flying again. At least 2 companies have these tests in development.