Risk Factors Associated with COVID-19
While the number of new COVID-19 cases reported worldwide may be declining or leveling off, the number of new cases in the US has sharply risen over the last 30 days. This sharp rise has put an increasing burden on our medical facilities and material resources. Identifying risk factors that are discernible at presentation has been the subject of numerous scientific articles. An awareness of the critical risk factors would be valuable to the physician and other healthcare workers in deciding appropriate treatment options. Additionally, it would facilitate intra- and inter-hospital patient transfers.
According to the Centers for Disease Control [https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html], the following are at increased risk for COVID-19 patients:
Chronic kidney disease
COPD (chronic obstructive pulmonary disease)
Immunocompromised state (weakened immune system) from solid organ transplant
Obesity (body mass index [BMI] of 30 or higher)
Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
Sickle cell disease
Type 2 diabetes mellitus
The CDC has said that an individual with the following conditions might be at risk for contracting COVID-19:
Cerebrovascular disease (affects blood vessels and blood supply to the brain)
Hypertension or high blood pressure
Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
Neurologic conditions, such as dementia
Pulmonary fibrosis (having damaged or scarred lung tissues)
Thalassemia (a type of blood disorder)
Type 1 diabetes mellitus
Identifying and quantifying known risk factors is necessary. Abnormal levels of the following conditions have been shown to be associated with poor patient prognosis: age, lymphopenia, serum ferritin, D-dimer levels, cardiac troponin 1, LDH and Interleukin-6 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177098/]. Additionally, cardiovascular disease, obesity [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228389/] , diabetes, smoking, chronic obstructive pulmonary disease, and gender have also been implicated as risk factors. Not surprisingly, poor oxygen saturation, high respiratory rate, low blood lymphocyte/leukocyte count predicted poor clinical outcomes.
In Italy, data from the Istituto Superiore di Sanità (ISS) indicated that the most common chronic preexisting disease in the patients who died was arterial hypertension (76%), followed by ischemic heart disease (37%), atrial fibrillation (26%), and active cancer within the previous 5 years (19%). [ https://www.frontiersin.org/articles/10.3389/fmed.2020.00140/full].
In other reports, cardiovascular disease has been identified as a critical risk factor in patients diagnosed with COVID-19 [ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264604/]. Indeed, cardiovascular diseases are also associated with worse prognosis and more severe progression of COVID‐19.
Typically the common clinical manifestations of COVID-19 patients are fever, cough and sputum. When the patient’s immune response is low, it may manifest as normal body temperature. Shortness of breath or dyspnea suggests poor lung function and lack of oxygen. It was concluded when the patient is found to have difficulty in breathing and/or no fever, it is necessary to be alert for further deterioration of the patient’s condition [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext].
Interestingly, the use of stimulants such as methamphetamine in HIV carriers may be a double jeopardy for those people exposed to COVID-19 [https://www.scholars.northwestern.edu/en/publications/double-jeopardy-methamphetamine-use-and-hiv-as-risk-factors-for-c]. As an example, viral suppression was more slowly achieved in a San Francisco hospital who specifically treated this cohort of patients.
More needs to be done to “flatten the curve” of COVID-19 infections. Identifying critical risk factors and determining what new methodology might be applied to mitigate the mortality rate in high risk populations is critical to achieving that goal.
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