From what experts know so far, certain comorbidities place those who have contracted COVID-19 at a higher risk.

According to the World Heart Federation, “non-communicable diseases (NCD), specifically chronic obstructive pulmonary disease, heart disease, hypertension and diabetes, are major risk factors for developing severe symptoms of COVID-19”. This is corroborated by a recent study from China, which reports a higher prevalence in patients with hypertension (30 per cent), diabetes (19 per cent), and coronary heart disease (eight per cent).

To begin with, NCDs are today the world’s biggest killers, leading to 71 per cent of all deaths in 2018, a total of 42 million deaths per year globally. NCD is a habitual/behavioural disease stemming from an unhealthy lifestyle whereby physical inactivity is one of the biggest threats. Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including the world’s major non-communicable diseases (NCDs) of coronary heart disease (CHD), Type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world’s population is inactive, this presents a major public health problem.

Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that results in energy expenditure. According to the World Health Organisation (WHO) guidelines (2010), an adult aged between 18 and 64 years should perform at least 150 min per week of moderate-intensity aerobic PA, or 75 min per week of vigorous-intensity aerobic PA, or an equivalent combination of moderate- and vigorous-intensity PA. Malaysia has 36.9 per cent physically inactive adults. The level of inactivity is higher in females compared to males (50 per cent vs 24.7 per cent).

COVID-19 is highly infectious, unlike the seasonal flu (which some are prone to compare it to). The virus affects persons with a compromised/weakened immune system. An unhealthy lifestyle has been a risk factor to the development of NCDs and associated comorbidities, and calorie deficits are known to weaken the immune system. A viral disease like COVID-19 can spread fast, undetected and kill already immune-compromised populations – like the elderly and those with chronic non-communicable disease.

The Lancet (medical journal) has estimated an overall case fatality rate (CFR) for COVID-19 of three per cent. WHO’s own estimate of the global death rate is 3.4 per cent. For India, it is estimated at two per cent. The CFR tends to vary depending on the number of deaths being recorded real-time and Italy has a high CFR of 7.94 per cent.

Another important factor to note is that coronavirus does not affect all ages equally. A study by the Chinese Center for Disease Control and Prevention concludes that older people with pre-existing health conditions are more prone to getting affected by coronavirus. (Source: Chinese Center for Disease Control and Prevention, February 2020)

More than two-thirds of deaths are of individuals with comorbidities of non-communicable diseases (See Table 1). The death rate tends to vary by age, health conditions, and sex. (See Figure 1).

Table 1: COVID-19 cases and deaths in China with comorbidities

Italy, one of the countries with a reportedly high number of cases after China, is also the second largest in the world in terms of ageing population. Nearly one-fourth (23 per cent) of Italians are over the age of 65 years, with many having pre-existing conditions like hypertension and respiratory ailments; these predispose them to contracting COVID-19.

An analysis of COVID-19 cases in the United States shows the highest CFR in persons aged 65 years and above, indicating risk of disease and death. According to the report of the WHO-China Joint Mission on Coronavirus Disease 2019, at highest risk are people above 60 years of age with comorbidities such as hypertension, diabetes, cardiovascular diseases and chronic respiratory diseases.

A study on COVID-19 hospitalised patients in Wuhan found almost half of the cases (48 per cent) suffering from underlying chronic diseases. Of the total cases, 30 per cent had hypertension, followed by diabetes (19 per cent) and coronary heart disease (eight per cent).

In Malaysia, more than 70 per cent of the overall deaths from COVID19 had comorbidities of NCDs.

The risk to COVID-19 is higher in people with weak immune defences and can further be compromised in chronic conditions like heart disease, lung disease and diabetes. Adding to the burden can be emotional stress, lack of sleep and physical exhaustion, which can further make one prone to diseases by weakening immunity. The presence of risk factors for NCDs like tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol in childhood and adolescence has significant association with development of disease in adulthood. It is known that the shift in dietary patterns and physical activity reflects in the increasing prevalence of non-communicable diseases. Increased consumption of foods with high salt, high sugar, saturated fats and processed foods relate directly to a rise in NCDs.

Maintaining a healthy diet with foods that boost immunity can help fight infections. Physical activity and nutrition have known to boost the immune system. Foods rich in Vitamin C, D, and E improve the immune system by increasing the infection-fighting cells. The antioxidant in Vitamin C and E plays an important role in controlling infections and functioning of the immune system. Also, keeping the body hydrated and having adequate sleep can help in curtailing the disease.

It is important to keep in mind, however, that what works in combating COVID-19 itself is yet unknown.

“Your immune system is (the) best weapon against coronavirus,” said a Turkish scholar.

Strengthening the immune system with healthy nutrition and exercising with low to moderate intensity may help equip people with a defence mechanism against viruses.

-- BERNAMA