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How Chronic Conditions Complicate Coronavirus Infections

Diabetes and heart disease puts Americans more at risk for severe illness from COVID-19

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Public health experts have warned for several weeks that older adults are more likely to experience severe symptoms of COVID-19, the respiratory disease caused by the coronavirus. And a lot of that has to do with “a gradual deterioration of their immune system” that happens as we age, says Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC).

But people of all ages with common, chronic health conditions — such as diabetes and heart disease — also are in danger of becoming seriously ill if they contract the virus that's spreading across the globe.

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The reason for this elevated risk? The body's organs all “work in tandem together” to keep things going and to fight off infections, explains Stephen Kopecky, a cardiologist and professor in the department of cardiovascular medicine at the Mayo Clinic. And “as you start to stress one end of the system, the other part of the system has more trouble,” he adds.

Controlling diabetes critical during outbreak

Over time, high blood sugar, a defining characteristic of diabetes, can damage the body's blood vessels, says George Rutherford, a physician and epidemiologist at the University of California, San Francisco. And damaged blood vessels can compromise an individual's lung function, which could make a person with a respiratory infection like COVID-19 “more susceptible to complications,” he adds.

Viral infections also can increase inflammation in people with diabetes and raise the risk for a life-threatening condition where the blood becomes too acidic, the American Diabetes Association (ADA) says. Both can be life-threatening.

The key, experts say, is to keep your diabetes under control. If it is well managed, a diabetic's risk for serious illness from a coronavirus infection is similar to that of the general population, according to the ADA.

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Chronic Conditions and COVID-19

New data from the CDC released March 31 shows Americans with chronic medical conditions face an increased risk of severe illness from COVID-19, consistent with earlier reports from China and Italy. Researchers looked at more than 7,000 U.S. cases where data was available on underlying health conditions and other potential risk factors and found:

  • Among people hospitalized for COVID-19, about 71 percent had at least one underlying condition.
  • Among people admitted into intensive care for COVID-19, about 78 percent had at least one underlying condition.
  • About 27 percent of people with at least one underlying health condition did not require hospitalization for COVID-19.
  • The most commonly reported conditions among people sick with COVID-19 were diabetes, lung disease and heart disease.

Persons with underlying health conditions who have symptoms of COVID-19, including fever, cough or shortness of breath, should immediately contact their health care provider, the CDC says in its report.

That is why it's especially important that all people with diabetes — both type 1 and type 2 — keep adequate supplies of insulin and other diabetes medications on hand to limit extra trips to the pharmacy during the spread of the virus. The ADA also recommends keeping simple carbs (regular soda, honey, jam, hard candies, etc.) stocked “to help keep your blood sugar up if you are at risk for lows and too ill to eat."

"With diabetes, the high blood sugar is damaging to a lot of different systems in the body, including your immune system,” says Pinchas Cohen, dean of the University of Southern California Leonard Davis School of Gerontology and a member of the advisory board for the Milken Institute Center for the Future of Aging. “So by getting your diabetes under control, you're actually leading to improved immune function. It's really uncontrolled diabetes that puts you at risk for secondary infections, including coronavirus.”

Heart patients could face complications

Underlying heart conditions can escalate the seriousness of any infection, including COVID-19. That's because someone who has had a heart attack or has chronic high blood pressure can also have a weak heart muscle, the Mayo Clinic's Kopecky explains.

And when someone with those conditions gets an infection, it can “do a double whammy,” Kopecky says. In the case of the coronavirus, the infection could affect the heart and the lungs. The heart muscle may have to work harder because the lungs, which are primarily affected by the virus, may not be able to get enough oxygen to the heart.

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All of this can lead to added stress on the heart, which then can have a ripple effect on other organs, such as the kidneys, and even cause multi-organ failure.

Diabetes and heart disease are not the only underlying health conditions that can complicate a coronavirus infection. People with compromised immune systems also are more likely to experience severe illness if infected. So are those with kidney disease and lung ailments.

How to reduce your risk

For the high-risk population, the most important thing to do is practice social isolation and to stay away from sick people, Cohen says. Continue to exercise at home, if you can, and take care of your primary medical problems, “particularly diabetes,” he stresses.

Public health experts also recommend every day precautions as a way to lower risk of serious illness from the coronavirus: Wash your hands with soap and water for at least 20 seconds and use alcohol-based hand sanitizer when soap is not an option. Wipe down frequently touched surfaces and avoid touching your face, nose and eyes.

Editor’s note: This article, originally published March 20, has been updated to reflect new information.


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