Comorbidity is the buzzword of 2020…. So, what does it mean?
“the presence of one or more medical conditions, often concurring with a primary medical condition.”

Due to a rise in sedentary lifestyles, poor diet and lack of exercise, it has become the norm for individuals to have multiple co-existing diseases. “In the US 80% of Medicare spending is devoted to patients with 4 or more chronic conditions, with costs increasing exponentially as the number of chronic conditions increases.”
The pandemic has shone a light on a problem that has existed for a while, and so as we all begin to examine our health more closely, let us look at some common comorbidities, and what they mean for us generally, and in the context of COVID-19.

Looking at COVID-19, which comorbidities matter and what can we do about them?

Hypertension

The facts: The NICD surveillance report showed that the top 3 co-morbidities associated with serious illness from COVID-19 are hypertension, diabetes, and cardiac disease. This is suggested to be because hypertension is caused by the “activation of the renin angiotensin system in the kidneys that can also increase lung injury”.

The solution: The good thing about hypertension, is that it is largely controllable. If your blood pressure is controlled, you are at far lower risk of COVID-19 complications. In fact, it was found that there was a twofold increase in mortality with untreated hypertension compared to treated. This is done through exercise, weight loss, reduction in salt intake and medication. When last did you have your BP checked?

Chronic Cardiac Disease

The facts: The WHO estimated in April that the risk of death from COVID-19 is 10% in patients with cardiac disease, and 1-2% in the general population. In addition to this, patients with cardiac disease are at an increased risk of needing ICU admissions if diagnosed with COVID-19.

The solution: Do not ignore cardiovascular disease, plan to visit your cardiologist and optimise your treatment.

Obesity

The facts: +70% of South African women and +30% of South African men are unhealthily overweight or obese (A BMI of >30). Obesity causes a chronic, active pro-inflammatory state, which affects immunity and makes one more likely to contract infections. Furthermore, living with obesity puts you at a higher risk of experiencing severe symptoms of COVID-19, and more quickly.

The solution: Take extra precautions to reduce your risk, only leaving home when essential if you are overweight. Secondly, begin a reduced calorie diet and increase physical activity.

Diabetes

The facts: 13 % of all South Africans have diabetes- that is over 4.5 million people, Patients with diabetes have a 3 x greater risk of death from COVID-19 than those unaffected. This is due to the effect that diabetes has on the immune system and the response to infection.

The solution: A recent study has shown that well controlled sugar is correlated with improved outcomes in COVID-19 infections. Therefore, glucose control is vital. Aim for an Hba1c level lower than 7%. This is done through a balanced diet, medication and exercise.

Asthma

The facts: Initially believed to be the worst co-morbidity for COVID-19, it seems that the response for asthmatics is similar to the general population.

The solution: Uncontrolled asthma requires more visits to the hospital and doctor and more opportunity for exposure. The best thing to do it continue to use inhalers, including inhaled steroid sprays if that is what you use, as it does not increase risk for COVID-19.

HIV

The facts: “The Department of Health, Western Cape, presented the findings from a widespread study that HIV positive patients are 2.5 times more likely to die of COVID-19 than HIV negative patients. Interestingly, though, the findings suggest that control of HIV (i.e. viral suppression) is not protective.”

The solution: Stopping ARVs will have a big effect on HIV and so it is vital to continue your HIV medication. As well as taking extra caution to prevent infection.

Auto-immune conditions and Cancers

The facts: These conditions do not directly increase the mortality rate themselves. However, patients with cancers have a 13% mortality rate with COVID-19 compared to the 1-2% normal mortality rate. This can be attributed to the overall health of cancer patients and those undergoing cancer treatments. Similarly, patients with auto-immune conditions are not at significant increased risk of complications of COVID-19, but immuno-suppressant therapies may worsen the outcome if the virus is contracted.

The solution: Patients should continue their treatment regimens and discuss with their oncologist or rheumatologist if they suspect they have contracted the virus.

Final Points

COVID-19 is here and will be for a while. Comorbidities do not necessarily put you at higher risk of contracting the virus, as all people are at equal risk of becoming infected, so we need to do our part in reducing transmission through masks, sanitising and social distancing
While there are implications for specific illnesses, the more important overarching message, is that now is the time to get your health on track. For most people contracting this virus is a mild disease, and to increase your chance of being most people, any chronic conditions need to be well controlled.

Some ways to protect yourself from the severity of COVID-19:

  • Maintain a healthy lifestyle, maintain good eating habits and exercise regularly.
  • Boost your immune system with the supplements Vitamin C, D and Zinc.
  • Continue with your usual treatments for any conditions
  • Get sufficient sleep, stay hydrated and take care of your mental health.

Your health is in your hands. Control what you can and take care of yourself.

References
Dr D Israel. 2020.https://www.facebook.com/groups/682514432554314/permalink/764212984384458/
JM Valderas, B Starfield et. al. 2009. Defining Comorbidity: Implications for Understanding Health and Health Services.
Dr H Bacus, Dr F Amod, Dr RS Mistry, Physician. 2020. https://www.lenmed.co.za/everything-you-want-to-know-about-comorbidities-and-covid-19/