COVID-19 Hospitalized Patients and Underlying Chronic Disease

by Rishma Parpia and Barbara Loe Fisher

Published April 26, 2020 | Health, Inflammation

Story Highlights

• Recent research shows that most hospitalized COVID-19 patients had one or more chronic poor health conditions, such as obesity, hypertension and heart and lung disease.
• Chronic diseases are the leading cause of death and disability in the United States, making the U.S. population susceptible to more severe COVID-19 infections.
• Good nutrition helps reduce susceptibility to chronic illness, which in turn reduces susceptibility to complications from infectious diseases like COVID-19.

A report released this month by the U.S. Centers for Disease Control and Prevention (CDC) on
COVID-19 risk factors found that approximately 90 percent of hospitalized COVID-19 patients had one or more underlying conditions, the most common being obesity, hypertension, chronic lung disease, diabetes mellitus and cardiovascular disease.¹

Co-Morbidities in Hospitalized COVID-19 Patients

Preliminary evidence indicates that obesity may be one of the most important risk factors and predictors of severe COVID-19 illness, particularly among younger patients.^{2 3} Newly published data reveals that among those under 60 years old, obesity was twice as likely to result in hospitalization for COVID-19 infections and also significantly increased the likelihood that a patient would need intensive care.^{3 4}
CDC data also suggests that, although people suffering from any type of diabetes may not necessarily be at a higher risk of contracting COVID-19 infection, if they do, the odds are higher for having a more serious course of the illness.⁵
Research is also pointing to hypertension (high blood pressure) as a risk factor for more severe complications from COVID-19 infections.⁶ In a recent interview with CNN, Maria Carolina Delgado-Lelievre, MD, an assistant professor of medicine at the University of Miami’s Miller School of Medicine explained that people with high blood pressure, which is associated with heart disease, are at higher risk for COVID-19 complications involving multiple organ systems:

If you get an extraordinary viral disease that will damage your lungs, you need a heart that can work with how your body responds to the virus. COVID will cause a systemic reaction in the body of a patient that already has risk.⁶

Chronic Disease Epidemic Affects Half of U.S. Population

According to the CDC, more than half of Americans are suffering with at least one chronic disease:⁷

Six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes. These and other chronic diseases are the leading causes of death and disability in America, and they are also a leading driver of health care costs.

The CDC states, “Obesity affects almost 1 in 5 children and 1 in 3 adults, putting people at risk for chronic diseases such as diabetes, heart disease, and some cancers,”⁸ and estimates that the prevalence of adult obesity in the U.S. was 42.4 percent in 2017-2018 and is increasing.⁹ From 1999–2000 through 2017–2018, the prevalence of obesity increased from 30.5 percent to 42.4 percent, and the prevalence of severe obesity increased from 4.7 percent to 9.2 percent.⁷
Heart disease, cancer, stroke, obesity and diabetes are among the top contributors to death in the U.S.^{10 11 12} At the same time, mounting scientific evidence suggests that chronic inflammation in the body is a marker for most chronic disease,^{13 14} including hypertension,¹⁵ obesity, ¹⁶ and diabetes.¹⁷
According to the Diabetes Research Institute Foundation, 34.1 million adults in the U.S. age 18 years or older have diabetes, which translates to 13 percent of all American adults.¹⁸ The American Heart Association reported that in 2013-2014, $329 billion was used to treat cardiovascular disease and stroke.¹⁹

Chronic Diseases and Susceptibility to Serious COVID-19 Infections

On Apr. 22, 2020, the Journal of the American Medical Association published an article describing the characteristics, clinical presentation and outcomes of 5,700 patients hospitalized with COVID-19 in the New York City area. Researchers confirmed that the most common co-morbidities were hypertension, obesity and diabetes.²⁰
Commenting on the link between chronic diseases and individual susceptibility to infections like COVID-19, author Nicole Saphier, MD, a radiologist at New York’s Memorial Sloan Kettering Cancer Center told the New York Post “About [89 percent] of the [12,192] people who have died in New York of COVID-19 had chronic illness as well.” She said:²¹

This is on us. We left ourselves vulnerable to this epidemic. Our health-care system would not be so overwhelmed right now if it was not already overwhelmed with our preventable chronic illnesses. Obesity is linked to diabetes, high blood pressure and stroke. All of those conditions render us susceptible to infectious illnesses—just what we are seeing with COVID-19… I feared that the fact we lead the world in obesity could put us at risk. And unfortunately I think the data is showing that suspicion to have been correct.

Links Between Poor Nutrition, Infectious Disease and Chronic Disease

The effect of nutrition on the development of the human immune system begins at the embryonic stage in the womb.²² After birth, breast milk provides critical vitamins, minerals and other nutrients to a newborn baby, which has a profound impact on the baby’s health and development of a healthy immune system. A malnourished baby is more vulnerable to infectious diseases.²³
According to a 2011 U.S. Surgeon General’s report:²⁴

Breast milk is uniquely suited to the human infant’s nutritional needs and is a live substance with unparalleled immunological and anti-inflammatory properties that protect against a host of illnesses and diseases for both mothers and children.

Good nutrition in adults, along with proper exercise and managing stress,²⁵ helps reduce susceptibility to chronic disease, which in turn reduces susceptibility to infectious diseases. Pinchas Cohen, MD, dean of the University of Southern California Leonard Davis School of Gerontology was quoted in an American Association of Retired Persons (AARP) article on why chronic health conditions like diabetes increases risks for complications from infections like COVID-19. Dr. Cohen said:²⁶

“With diabetes, the high blood sugar is damaging to a lot of different systems in the body, including your immune system.” He adds that, “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.”

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