Welcome to our series of posts on COVID 19. In this series we will focus on comorbidities, overlapping risk factors of COVID and chronic disease, nutritional status and covid 19, blood biomarker patterns, and what we can do to encourage long-term risk reduction.
The coronavirus disease 2019 pandemic (COVID-19) has brought significant morbidity and mortality to populations around the globe. It is caused by the novel SARS-CoV-2 virus (severe respiratory syndrome coronavirus-2).
COVID-19 was declared a pandemic in March of 2020. According to Johns Hopkins Coronavirus Resource Center: [1]
The SARS-CoV-2 virus belongs to the family Coronaviridae, named for the crown-shaped spikes on its surface.[2] It appears those spike proteins facilitate adhesion to epithelial tissue, making this novel coronavirus extremely contagious.
Early in the pandemic, clinicians and researchers noted that the most severe cases and fatalities due to COVID-19 tend to be older and have underlying chronic disorders such as cardiovascular disease, diabetes, hypertension, obesity, respiratory compromise, cancer, liver disease, or kidney disease. Notably, these same disorders are characterized by nutrient imbalances and insufficiencies.[3] Early nutrition intervention appears to reduce the risk of severe disease and mortality.
A systemic review and meta-analysis of studies from January 1 to April 6, 2020 revealed that severe disease occurs in approximately 23% of infected patients, who in turn had a mortality rate of ~6%. Severity was statistically significantly higher in those with immunosuppression, malignancy, and chronic diseases such as diabetes, heart disease, hypertension, lung, liver, and kidney disease. Inflammatory markers were significantly higher in those with severe disease as well.[4]
Comorbidities and characteristics associated with symptomatic and severe COVID-19 include:[5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]
Fatality rate comparison[19]
The elderly appear to be particularly susceptible to severe COVID-19 for many of the reasons they are susceptible to nutrient deficiencies and complications:[20]
The bad news is that the COVID-19 pandemic has entered its second year globally. The good news is that known risk factors can be mitigated with many of the same strategies that reduce the risk and severity of chronic diseases associated with COVID-19, including optimizing nutritional status and lifestyle. There is much more to come regarding these simple yet necessary steps.
[1]Johns Hopkins University of Medicine Coronavirus Resource Center.
[2] Souza, Ana Carolina Remondi, et al. "Zinc, Vitamin D and Vitamin C: Perspectives for COVID-19 With a Focus on Physical Tissue Barrier Integrity." Frontiers in Nutrition 7 (2020): 295.
[3] Caccialanza, Riccardo et al. “Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol.” Nutrition (Burbank, Los Angeles County, Calif.) vol. 74 (2020): 110835.
[4] Li, Jie et al. “Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes.” Journal of medical virology, 10.1002/jmv.26424. 13 Aug. 2020.
[5] Williamson, Elizabeth J et al. “Factors associated with COVID-19-related death using OpenSAFELY.” Nature vol. 584,7821 (2020): 430-436.
[6] Ejaz, Hasan et al. “COVID-19 and comorbidities: Deleterious impact on infected patients.” Journal of infection and public health vol. 13,12 (2020): 1833-1839.
[7] Gallo Marin, Benjamin et al. “Predictors of COVID-19 severity: A literature review.” Reviews in medical virology, e2146. 30 Jul. 2020.
[8] Richardson, David P, and Julie A Lovegrove. “Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective.” The British journal of nutrition, 1-7. 20 Aug. 2020.
[9] Wu, X et al. “Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis.” Science advances vol. 6,45 eabd4049. 4 Nov. 2020.
[10] Nandy, Kunal et al. “Coronavirus disease (COVID-19): A systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events.” Diabetes & metabolic syndrome vol. 14,5 (2020): 1017-1025.
[11] Albitar, Orwa et al. “Risk factors for mortality among COVID-19 patients.” Diabetes research and clinical practice vol. 166 (2020): 108293.
[12] Zheng, Zhaohai et al. “Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis.” The Journal of infection vol. 81,2 (2020): e16-e25.
[13] Hernández-Galdamez, Diego Rolando et al. “Increased Risk of Hospitalization and Death in Patients with COVID-19 and Pre-existing Noncommunicable Diseases and Modifiable Risk Factors in Mexico.” Archives of medical research vol. 51,7 (2020): 683-689.
[14] Matsushita, Kunihiro et al. “The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis.” Global heart vol. 15,1 64. 22 Sep. 2020.
[15] Baradaran, Ashkan et al. “Prevalence of Comorbidities in COVID-19 Patients: A Systematic Review and Meta-Analysis.” The archives of bone and joint surgery vol. 8,Suppl 1 (2020): 247-255.
[16] Cao, Xuetao. “COVID-19: immunopathology and its implications for therapy.” Nature reviews. Immunology vol. 20,5 (2020): 269-270.
[17] Diabetes.co.uk. HBA1c converter
[18] Gallo Marin, Benjamin et al. “Predictors of COVID-19 severity: A literature review.” Reviews in medical virology, e2146. 30 Jul. 2020.
[19] Gallo Marin, Benjamin et al. “Predictors of COVID-19 severity: A literature review.” Reviews in medical virology, e2146. 30 Jul. 2020.
[20] Richardson, David P, and Julie A Lovegrove. “Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective.” The British journal of nutrition, 1-7. 20 Aug. 2020.
[21] Donati Zeppa, Sabrina et al. “Gut Microbiota Status in COVID-19: An Unrecognized Player?.” Frontiers in cellular and infection microbiology vol. 10 576551. 26 Nov. 2020.