Coronavirus: Overweight patients with high BMI more at risk

By | March 24, 2020

Almost two thirds of critically ill coronavirus patients are overweight and 37% are under 60, NHS audit reveals

  • Excess weight against chest makes it harder for muscles to draw in deep breath
  • Weak immune system allows COVID-19 to spread to lungs and cause pneumonia
  • These two factors may explain why two thirds of ICU coronavirus patients obese 
  • Comes as coronavirus death toll in UK rises to 281 and infections sit at 5,600
  • Coronavirus symptoms: what are they and should you see a doctor?

Almost two thirds of patients who fall seriously ill from coronavirus are obese and nearly 40 per cent are under the age of 60, an NHS audit has revealed. 

Sixty-three per cent of patients in intensive care in UK hospitals because of the killer virus are overweight, obese or morbidly obese. 

While the average age of people suffering the most serious symptoms of coronavirus is 64, 37 per cent are under the age of 60. 

The Intensive Care National Audit and Research Centre analysed all admissions to critical care units in the UK up until midnight last Thursday. 

At that time, there were 194 coronavirus patients in ICU. That number is thought to have soared in the last four days.

The document provided the first in-depth look at patients who have needed round-the-clock care and boosted medics’ understanding of the virus that has crippled society.  

Its finding that obese people are at risk of serious complications from COVID-19 will be concerning for health bosses, as two thirds of adults in the country fall into the category. 

A new study from Aarhus University Hospital in Denmark has found that being overweight or obese increases the risk of all cancers, obesity and non-obesity related, by 12% (file image)

Almost two thirds of patients who fall seriously ill from coronavirus are obese, as medics warn being overweight raises the risk of dying from the disease 

People are pictured enjoying fish and chips on a bench in Skegness as crowds flocked to the resort despite warning about Covid-19

People are pictured enjoying fish and chips on a bench in Skegness as crowds flocked to the resort despite warning about COVID-19 

WHAT DO WE KNOW ABOUT CORONAVIRUS PATIENTS IN THE UK? 

The Intensive Care National Audit and Research Centre analysed all admissions to critical care units in the UK up until midnight last Thursday. 

At that time, there were 194 coronavirus patients in ICU. That number is thought to have soared in the last four days.

The document provided the first in-depth look at patients who have needed round-the-clock care and boosted medics’ understanding of the virus that has crippled society. 

So, what did it show?

Average age of admission: 64

Sex

Men: 139 (70.9%)

Woman: 57 (29.1%)

BMI

<18.5

18.5-25

25-30

30-40

>40 

1 (0.6%)

49 (27.7%)

56 (31.6%)

58 (32.8%)

13 (7.3%) 

Dependency level

Independent

Some assistance

Total assistance 

155 (87.1%)

23 (12.9%)

0(0%)

No clear details were given about the breakdown of what other conditions the patients had, such as asthma, high blood pressure or diabetes. 

And more than a third of critically ill patients being under 60 shows it is not only the very elderly who are at risk. 

The report also found that most coronavirus patients in intensive care were male, 71 per cent of all cases, and only 18 patients (9 per cent) had ‘severe co-morbidities’, such as underlying heart conditions or lung disease; while two patients had been pregnant within the last six weeks. 

Studies have shown obese people are more likely to suffer serious complications or die from infections, such as the flu. 

Doctors say the immune systems of fat people are constantly ramped up as they try to protect and repair the damage inflammation causes to cells. 

Using all its energy fending off inflammation means the body’s defence system has few resources left to defend against a new infection like COVID-19. 

Obese people also tend to eat a diet with very little fiber and antioxidants – which keep the immune system healthy – such as fruit and vegetables.   

Excess weight makes it more difficult for the diaphragm and lungs to expand and inhale oxygen. Starved of oxygen, organs will begin to fail. 

These factors may explain why obese people’s lungs tend to deteriorate faster when the new coronavirus strikes, compared to a healthy person. 

COVID-19, which has infected more than 300,000 people worldwide, kills by spreading deep into the lungs and causing complications such as pneumonia. 

There are several other factors that may increase an obese person’s chance of falling seriously ill with coronavirus, including a lack of exercise.

People packed Bournemouth esplanade this morning (Sunday). Paddle boarders and swimmers braved the cold temperatures despite fears over the global coronavirus outbreak

People packed Bournemouth esplanade this morning (Sunday). Paddle boarders and swimmers braved the cold temperatures despite fears over the global coronavirus outbreak

Studies have shown that physical activity increases the numbers of certain immune cells that help to bolster immune activity.  

Clogged up arteries also make it hard for blood carrying immune cells to circulate and travel to various parts of the body to defeat infections. 

So far the coronavirus outbreak in the UK has claimed 281 lives, while the official infection toll is more than 5,600. 
But experts say the true number of cases is likely to be almost 300,000 because for every death there are roughly 1,000 cases.   
The finding that obese people are more likely to fall critically ill from COVID-19 will be worrying for health bosses, as more than two thirds of people in the UK fall into the category. 

It comes after thousands of Britons flouted social distancing restrictions and flocked to beeches, parks and town centres on Mother’s Day.  

Prime Minister Boris Johnson has warned people who weren’t following Government advice that they have just 24 hours to take the measure seriously. 

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He threatened to exert stricter controls to help fight the outbreak and has not ruled out police officers roaming the streets and arresting those who fall foul of the rules.

Oh I do like to be beside the seaside! Visitors continued to flock to seaside resorts today including this one in West Bay, Dorset

Oh I do like to be beside the seaside! Visitors continued to flock to seaside resorts today including this one in West Bay, Dorset

Pen y Pass near Llanberis in Gwynedd on Sunday morning as visitors ignore requests to stay away on Snowdonia today

Pen y Pass near Llanberis in Gwynedd on Sunday morning as visitors ignore requests to stay away on Snowdonia today

Obese people are more contagious than slim people when they have the flu, 2018 study 

Obese people risk spreading the flu to family, friends and strangers for up to twice as long as those of a normal weight, the US study found. 

Researchers suggest these people should be targeted for flu prevention, which might include the winter flu jab. 

The study of 1,800 people over three flu seasons, led by the University of Michigan, found obese adults with flu symptoms shed the influenza A virus for 42 per cent longer than those who were not obese.

While researchers still need to discover if people remain contagious over this period, it suggests obese people run the risk of spreading the flu for longer.

This may be because obesity alters the body’s immune response and causes chronic inflammation, which may allow a virus like the flu to hang around for longer.

Dr Aubree Gordon, from the University of Michigan School of Public Health, said: ‘This is the first real evidence that obesity might impact more than just disease severity. It might directly impact transmission as well.’

With 281 people now known to have died from the virus in the UK, the PM used his daily press conference yesterday to warn there was ‘no doubt’ he would act to close open spaces and limit all movement outside homes if people continued to act foolishly, but stopped short of immediate action.  

He later added: ‘I don’t think you need to use your imagination very much to see where we might have to go, and we will think about this very very actively in the next 24 hours.’

Mr Johnson told the nation it was only ‘two or three’ weeks behind Italy where the death toll has already risen above 4,000 making it the worst outbreak anywhere in the world. 

There were 47 new cases identified in the UK on Sunday alone, with Britain’s youngest victim to date dying at University Hospital, Coventry.  

Mr Johnson said that unless the UK could control the spread of the virus through social distancing, the NHS would be ‘overwhelmed’ in the same way that the Italian healthcare system had been. 

The surge in cases of the virus comes on the day Mr Johnson urged families to stay apart and instead celebrate Mother’s Day via Skype and other remote communications.

In a tough message to the public from Downing Street this afternoon, Mr Johnson said that even though he understood the physical and mental health benefits of open spaces, he would take drastic steps to protect health.

Ministers are considering following other countries such as Italy and Spain that have banned people from leaving their homes unless they need to go to work or to buy essential food and supplies.

Spanish police arrested 157 people for disobeying the rules in just the first five days, while Italian authorities have the power to fine anyone caught entering or leaving the area of the country worst hit by the virus. Germany has banned gatherings of more than two people outside people’s homes.

Mr Johnson said: ‘I don’t think you need to use your imagination very much to see where we might have to go, and we will think about this very, very actively in the next 24 hours.’

Communities Secretary Robert Jenrick said people need to realise it ‘isn’t a game’.

London Mayor Sadiq Khan said the police and Army may soon be required to enforce social distancing, as he warned that unless people stay at home ‘more people will die’.

WHY ARE OBESE PEOPLE MORE AT RISK OF BECOMING VERY ILL FROM COVID-19? 

Studies have shown obese people are more likely to suffer serious complications or die from infections, such as the flu. 

Doctors say the immune systems of fat people are constantly ramped up as they try to protect and repair the damage inflammation causes to cells. 

Using all its energy fending off inflammation means the body’s defence system has few resources left to defend against a new infection like COVID-19. 

Obese people also tend to eat a diet with very little fiber and antioxidants – which keep the immune system healthy – such as fruit and vegetables.  

Most patients with a BMI of over 40 suffer from breathing problems that range from simple shortness of breath to a potentially life-threatening condition known as obesity hypoventilation syndrome (OHS), 

Excess weight also makes it more difficult for the diaphragm and lungs to expand and inhale oxygen. Starved of oxygen, organs will begin to fail.

These factors may explain why obese people’s lungs tend to fail faster when the new coronavirus strikes, compared to a healthy person. 

COVID-19, which has infected more than 300,000 people worldwide, kills by spreading deep into the lungs and causing complications such as pneumonia.  

There are several other factors that may increase an obese person’s chance of falling seriously ill with coronavirus, including a lack of exercise.

Studies have shown that physical activity increases the numbers of certain immune cells that help to bolster immune activity.  

Clogged up arteries also make it hard for blood carrying immune cells to pass through and repair cells around the body. 

Obese people are also more likely to suffer diabetes and heart disease – two chronic conditions that drive up coronavirus risk.

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At that time, there were 194 coronavirus patients in ICU. That number is thought to have soared by hundreds more int he last four days. 

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

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How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.


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