What has been rather apparent right from the early days in a little-known disease is that persons with co-morbidities — hypertension, diabetes, cancer, cardiac ailments, chronic kidney disease, obesity and respiratory ailments — are at risk of contracting COVID-19. That uncontrolled levels sometimes also lead to poor outcomes, even death, has also been documented globally. In Tamil Nadu, a total of 81.8% of the deaths due to COVID-19 have occurred among people with co-morbidities.
Data from the Health Department on deaths in the State until July 29 reflect the fact that cause-wise, the same bunch of factors are leading to death. While diabetes and hypertension caused 33.36% of the 3,297 deaths (until July 29), diabetes alone caused 24.29% of the deaths, hypertension 12.59% of the deaths, and other co-morbidities accounted for 11.56%. Just over 18% of the deaths were in people who had no co-morbidities.
A further age-wise distribution of these deaths indicates that age, 60-plus years, is a definite additive risk factor. 38.8% of the deaths occurred in senior citizens who had both diabetes and hypertension. That risk shrinks with a younger population, and other co-morbidities play a significant role. A further delineation of ‘other co-morbidities’ would help in arriving at a better understanding of the nature of risk of infection, and if positive, deterioration and death. “These figures pretty much reflect the global trend, with regard to COVID-19 and co-morbidities,” says V. Mohan, chairman, Dr. Mohan’s Diabetes Specialities Centre. There have been a few Type 1 diabetes deaths among the younger population, but there were other complicating co-morbidities in those cases, he adds. “Old age itself is a factor for sure. Anyone over 60 years must be careful not to expose themselves to transmission. Also, there is emerging evidence to show that a HbA1c (three month average of blood sugar) level of over 8.5 seems to lead to complications, and death. The lower the HbA1C is, the better the patient seems to be doing.”
“Uncontrolled diabetes and hypertension is what is causing the problem. Doctors in the ICU struggle to help patients whose blood sugars or BP is way over the limit. Add obesity to this mix, and it becomes nearly lethal,” says Health Secretary J. Radhakrishnan. He says the advice to people with co-morbidities is to reduce risk, and keep their metabolic parameters well within control.
“We are not out of sync with what the U.S. Centers for Disease Control lists for the co-morbidities. But there are variations, across populations, age, ethnicity and several other factors,” explains V. Ramasubramanian, senior infectious diseases consultant, Apollo Hospitals. He re-emphasises the need to ensure protection for the vulnerable population, and the implicit need to follow COVID etiquette to avoid infections.
Dr. Mohan adds: “If, for some reason, not staying at home is not possible, then just make sure you wear a mask when you go out, avoid crowded places and maintain distance from others. This is how it works: If 80% of people wear masks, then 90% of the population is protected. If only 40% wear masks, no one is protected.”
