Continued from Page 1 The riskiest health conditions

Put aside age: Underlying health plays a big role. In China, 40 percent of people who required critical care had other chronic health problems. And there, deaths were highest among people who had heart disease, diabetes or chronic lung diseases before they got COVID-19.

Preexisting health problems also can increase risk of infection, such as people who have weak immune systems including from cancer treatment.

Other countries now are seeing how prepandemic health plays a role, and more such threats are likely to be discovered. Italy reported that of the first nine people younger than 40 who died of COVID-19, seven were confirmed to have “grave pathologies” such as heart disease.

The more health problems, the worse they fare. Italy also reports about half of people who died with COVID-19 had three or more underlying conditions, while just 2 percent of deaths

were in people with no preexisting ailments. Heart disease is a very broad term, but so far it looks like those most at risk have significant cardiovascular diseases such as congestive heart failure or severely stiffened and clogged arteries, said Dr Trish Perl, infectious disease chief at UT Southwestern Medical Center.

Any sort of infection tends to make diabetes harder to control, but it’s not clear why diabetics appear to be at particular risk with COVID-19.

Risks in the less healthy may have something to do with how they hold up if their immune systems overreact to the virus. Patients who die often seemed to have been improving after a week or so only to suddenly deteriorate – experiencing organ-damaging inflammation.

As for preexisting lung problems, “this is really happening in people who have less lung capacity,” Perl said, because of diseases such as COPD – chronic obstructive pulmonary disease – or cystic fibrosis.

Asthma also is on the worry list. No one really knows about the risk from very mild asthma, although even routine respiratory infections often leave patients using their inhalers more often and they’ll need monitoring with COVID-19, she said. What about a prior bout of pneumonia? Unless it was severe enough to put you on a ventilator, that alone shouldn’t have caused any significant lingering damage, she said.

The gender mystery

Perhaps the gender imbalance shouldn’t be a surprise: During previous outbreaks of SARS and MERS – cousins to COVID-19 – scientists noticed men seemed more susceptible than women.

This time around, slightly more than half the COVID-19 deaths in China were among men. Other parts of Asia saw similar numbers. Then Europe, too, spotted what Dr Deborah Birx, the White House coronavirus coordinator, labeled a concerning trend.

In Italy, where men so far make up 58 percent of infections, male deaths are outpacing female deaths and the increased risk starts at age 50, according to a report from Italy’s COVID-19 surveillance group.

The US CDC hasn’t yet released details. But one report about the first nearly 200 British patients admitted to critical care found about two-thirds were male.

One suspect: Globally, men are more likely to have smoked more heavily and for longer periods than women. The European Center for Disease Prevention and Control is urging research into smoking’s connection to COVID-19.

Hormones may play a role, too. In 2017, University of Iowa researchers infected mice with SARS and, just like had happened in people, males were more likely to die. Estrogen seemed protective – when their ovaries were removed, deaths among female mice jumped, the team reported in the Journal of Immunology.