What are comorbidities: How do they impact Coronavirus?

What are comorbidities?

The medical definition of Comorbidities is when a person has more than one underlying health-related conditions present in them at once. Each condition is considered as comorbidity, and sometimes comorbidities could be present in the form of physical or mental conditions. The best examples of comorbidities are when a person is suffering from Asthma and diabetes, or when the person is suffering from clinical depression and Hypertension.

Comorbidities are generally non-communicable and contribute to nearly two-thirds of the annual deaths around the world. That is over 36 million deaths annually. Prominent forms of comorbidities are high blood pressure, diabetes, cardiovascular diseases, arthritis, stroke, and cancerous conditions.

How do comorbidities impact Coronavirus infection:

People who have a weak immune system are more susceptible to contract coronavirus. Studies have shown that people with pre-existing conditions face a higher mortality rate when compared to people affected with no comorbidities.

To understand the nature of the pandemic, positive adversity cases from 29 hospitals in Wuhan were studied and along with Bayes’ Theorem, Pearson’s chi-squared test, univariate and multivariate regression methods, comorbidities were included as a variable to understand the impact.

The studies showed that Hypertension, as comorbidity, contributed significantly to the poor clinical outcome secondary to coronavirus infection.

Comorbidities that could put you at risk of contracting coronavirus:

Doctors around the world treating the affected individuals during the pandemic, in their findings have said that over 48% of the patients who passed away after the treatment had underlying comorbidities. Out of the 48%, more than thirty percent were diagnosed with Hypertension, nineteen percent with diabetes, and close to eight percent with cardiovascular conditions.

On a larger purview of things and limited understanding of this fever, we can say that Hypertension, Diabetes, and cardiovascular diseases are comorbidities that could aggravate the rate at which the Coronavirus could affect the body and hamper recovery.

Hypertension:

If you are suffering from Hypertension, it is imperative that you take extra care to ensure that you are not affected by the pandemic. Having comorbidity like Hypertension increases the chances of you getting infected by corona fever, it brings out adverse symptoms and increases the chances of mortality by corona fever significantly.

Hypertension reduces the immunity of a person significantly, thereby, making it easier for the virus to enter your body and cause fatal damage. Some receptors in the body called ACE2 receptors are already down-regulated in hypertensive patients, coronavirus has interaction with these receptors through its protein called spike protein, this further brings down the level of ACE2 receptors. ACE2 receptors are having a major beneficial physiological role in the body like anti-inflammatory and immune system modulation in a favorable way, when the receptor level gets down-regulated because of coronavirus infection, lots of adverse effects happen in the body. 

Currently, advice is to continue their medication regime as discontinuation may lead to an acceleration of the blood pressure and its consequences.

Diabetes:

People with Type-2 diabetes and uncontrolled levels of sugar were more susceptible to corona fever in Wuhan and Italy. Poor glycemic levels adversely impact the body’s capability to fight off infections, and it also causes secondary bacterial infections in the lung and abdomen.

Complications like diabetic nephropathy can impair the body’s ability to produce effective antibodies against coronavirus infection. In this condition, the body’s ability to dispose of toxins from the blood is impaired and can lead to severe conditions that could need acute dialysis as a form of treatment.

People with Type-2 diabetes are more susceptible to Obesity, and ischemic heart disease. People with Obesity are also susceptible to conditions like obstructive sleep apnea and obesity hypoventilation syndrome. These comorbidities could further increase your chances of severe manifestation and poor outcome with coronavirus infection.

Cardiovascular diseases:

Corona fever can cause myocarditis (inflammation of heart muscle) and this may manifest as difficulty in breathing and results in severe acute respiratory failure in adverse cases. The symptoms of mainstream cardiovascular conditions are very similar to those of corona fever.

They are:

• Difficulty in breathing
• Congestion in the  lungs and acute cough (pulmonary edema)
• Coronavirus in a few cases has also contributed to causing acute Hypoxia and sever lung injury (ARDS).

Patients with preexisting cardiovascular comorbidities have shown significant myocardial damage and increased cases of cardiovascular collapse in context with myocarditis. Studies across have shown that people with coronary heart disease are more likely to witness supply-demand mismatch of oxygen to cardiac musculature which will further worsen the scenario and leads to severe cardiomyopathy and poor outcome. 

While there is no vaccination available for COVID-19 right now, there are many precautionary steps one could take to ensure that they stop the onset of said infection. They are:

Stay Indoors:

Corona fever spreads through droplets and aerosols, so to ensure that you are not contracting this infection from an infected source, it is advised to stay indoors as much as possible. When stepping outdoors, ensure that you wear a mask and gloves. After coming home, it is recommended to wash your hands for 20 seconds either with soap or with an alcohol-based hand sanitizer.

Disinfect common areas:

The Coronavirus can survive for 3-8 days on solids. To ensure that you don’t contract this infection, ensure that you regularly clean common touchpoints like doorknobs, door handles, and vehicles. If you are living with a person, who is infected by the virus, ensure that he/she is allotted a separate room with access to a private bathroom.

It is advisable to maintain separate toiletry and cutlery for them until they recover. Ensure that you constantly disinfect common areas like the floor, countertops, and kitchen to ensure that the condition does not spread to other healthy people in your family.

Boost your immunity:

Corona fever has mostly affected those people who have been immuno-compromised. The best way to fight off this condition is to maintain stable immunity levels. There are a variety of fruits and vegetables you could include in your diet to ensure that your immunity is sustained.

As an alternative, you could also rely on medicinal supplements(after consulting appropriate medical consultation) that boost the level of Vitamin D, Vitamin A, and Vitamin C, along with protein and zinc. These vitamins and minerals help build a robust immune system.

Dr. Harish MM, Consultant Anaesthesia & Critical Care, Mazumdar Shaw Medical Center, Bommasandra, Bangalore