What makes COVID-19 fatal?

Perhaps the biggest issue that the healthcare community faces is that 80% of COVID-19 patients do not have any symptoms. Only 15% of the infected develop severe symptoms and 5% become critical. It is just these 20% of coronavirus patients that need care in the hospital.

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The first data on COVID -19 from Wuhan, China published in Lancet revealed that 48% of who died, had an associated medical issue like hypertension, diabetes or heart disease. The median age of those who died was 56 years. Similarly, the latest data from New York revealed that 94% of those who died had an associated medical problem and 88% had more than one associated medical problem. The median age of those who died was 63 yrs. Indian data follows a similar trend. In Delhi, out of the total number of deaths, 88% had an associated medical issue. The median age of those who died was 60 yrs. In Mumbai, 79% of those who died had an associated medical problem (hypertension, diabetes, lung or kidney disease) Maximum death was seen in the age group of 61 to 70 yrs.

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Further, data shows that 88% of patients who need a ventilator for breathing assistance die. The cause of death is acute respiratory distress syndrome and multiple-organ failure.

The big learning so far is this: if you are elderly, obese and suffering from hypertension or diabetes or heart disease or lung and kidney disease you are likely to have a near-fatal problem with COVID-19.

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So, how do different comorbid conditions make COVID-19 so fatal?

In the Acute respiratory distress syndrome, there is an inability of the lungs to absorb oxygen and excrete carbon dioxide. This leads to a severe lack of oxygen in the blood and dysfunction of vital organs like the heart, lungs, kidney and liver, ultimately resulting in death.

In the case of heart conditions, the coronavirus infection activates the chemical reaction leading to inflammation and rupture of the atherosclerotic plaques in the coronary arteries and formation of blood clots on the ruptured plaque. All these ultimately result in heart injury and low blood pressure and death.

Coronavirus could also lead to heart muscle getting directly infected (myocarditis) leading to low blood pressure and death. This is supported by the findings of raised Trop I test in 50% of the patients who died in the Wuhan study.

Either of these mechanisms could kill a person independently or in combination (this is more likely).

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How can the elderly and those with comorbidities protect themselves?

First, avoid exposure strictly by staying at home. and do not stop or skip your regular medicines. Seek medical help immediately if any new symptoms develop, be in touch with your doctor. Take the help of family or friends for daily essentials.

Lastly, exercise, eat a healthy diet and sleep well.

(Dr Vijay DSilva is the Medical Director at Asian Heart Institute, Mumbai)

Disclaimer: The views expressed above are the author’s own. They do not necessarily reflect the views of DH.