The risk of death from COVID-19 significantly increases in people with comorbidities. At least that is what the evidence from Kerala suggests.

Of the 15 deaths in Kerala due to COVID-19 most of the cases had an associated illness or old age working against them. Although uncontrolled diabetes or hypertension was present in most of the fatalities, this aspect needs a deeper analysis, says Dr Chandni Radhakrishnan, State Medical Board member, COVID-19 Management, Kerala.

The simultaneous presence of one or more health disorders than the presenting condition in a person is known as comorbidity. These disorders may exist independent of each other, or may be interlinked due to the same underlying causes. For example, a person with obesity often suffers from heart disease and/or diabetes, explains Dr Chandni, who is the Professor of Medicine and HOD of Emergency Medicine at the Government Medical College, Kozhikode, affiliated to Kerala University of Health Sciences.

According to a study published in The Lancet medical journal and several other experts, COVID-19 is more likely to be fatal in people who already have hypertension, diabetes or heart disease.

In Kerala diabetes, hypertension, COPD (chronic obstructive pulmonary disease) and CAD (coronary artery disease), chronic liver diseases and cancers are the main comorbidities of the population. All these groups stand a higher risk during these COVID times, she says adding that there have been instances of elderly patients without any comorbidity having survived COVID.

The term comorbidity was first coined by Alvan R. Feinstein, a researcher at Yale University, US, in a research paper published in 1970. He explained that not taking comorbid diseases into account skewed medical statistics, creating misleading data in mortality rates for a general population, and in fatality rates for an individual disease.

Explaining how comorbidity works against patients, she says, when people with diabetes develop an infection, it is often difficult to treat them due to fluctuations in their blood glucose levels and the presence of diabetes complications. Diabetes works against them as their immune system is compromised through different mechanisms. “Uncontrolled diabetes and longer duration of diabetes therefore, present a bad prognosis.”

Stress due to the illness and other contributing factors also play a big factor in worsening the condition as they lead to the production of certain hormones that worsen diabetes.

Similarly, people who have CAD or a stent implanted in their arteries may be more vulnerable to COVID-19 related complications, as the virus infection can cause inflammation in a patient’s blood vessels. There is an excessive risk of blood clotting because of the hypercoagulable state existing in COVID-19 and this may be bad in patients with CAD.

COVID-19 may induce myocarditis, pericarditis and cardiac diseases due to the release of the stress related hormone. This disease presents a high risk for thrombosis, which increases the chances of a heart attack.

So, people with comorbidities must follow a disciplined lifestyle, eat a healthy meal, take without fail their medications, closely monitor their blood sugar and blood pressure, workout regularly and report immediately to a health centre if they notice any abnormality. For the elderly, and those with advanced co-morbidities reverse quarantine is advised.

By Manoj

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