San Diego Union-Tribune (Sunday)
COVID-19 IS NOT FATAL TO ONLY THE CHRONICALLY ILL
Experts dispute discussion of ‘pure’ coronavirus deaths
Most people dying of COVID-19 have chronic health problems, a fact that has generated endless skepticism as the number of deaths attributed to the disease climbs closer to 200,000 nationwide.
From the beginning, some have repeatedly noted that there are few “pure” COVID-19 deaths where no other contributing conditions present. The vast majority who have died are struggling with chronic health conditions such as hypertension, diabetes, heart disease and obesity.
There has also been a growing mantra that deaths said to be caused by COVID-19, because they occur so often among those with other serious health problems, were inevitable.
Ousted former Fox News host Bill O’reilly, for
example, said on a radio show in early April that “many people who are dying, both here and around the world, were on their last legs anyway,” suggesting that, had it not been for the coronavirus, their chronic illnesses would have done the job soon enough.
But the numbers tell a different story.
The National Center for Health Statistics tracks “excess deaths” associated with COVID-19, releasing weekly totals of all deaths observed in the United States alongside totals of the number that would be expected given the numbers observed during the same weeks in previous years.
Though the dataset is perennially incomplete due to processing lags for the newly issued death certificates that are the main data source, information
listed through Aug. 29 shows that there were 2.1 million deaths observed compared to an expected number of roughly 1.9 million.
The difference is about 181,000 more deaths this year — about 16,500 of them in California — than would have been expected, a number that correlates closely with the number of deaths nationwide attributed to COVID-19. The excess number of deaths detected this year, statisticians say, strongly suggests that the virus is killing those who otherwise might have had a long time left to live despite their ongoing struggles with chronic diseases.
It makes sense to Dr. Rodney Hood, a respected San Diego primary care physician who has made it his life's work to help those in some of the region's most disadvantaged communities cope with and prevent the kinds of conditions most often present in those who die after testing positive for the novel coronavirus.
Suggesting that those with chronic illnesses were soon to die regardless of their encounters with the novel coronavirus, and suggestions that those who die with chronic diseases as well as COVID-19 somehow should not count, he said, is simply flabbergasting.
“I think it's ridiculous. It doesn't make logical sense; it doesn't make scientific sense,” Hood said.
Yet the narrative continues as recently as this month.
On Sept. 1, when the president retweeted a nowremoved tweet from Qanon leader “Mel Q” claiming that only about 6 percent of those listed as COVID-19 deaths “actually died from COVID” while the remainder “had 2-3 other serious illnesses.”
What's missing from the
Covid-related death conversation, physicians say, is a basic understanding of how chronic diseases increase the odds of death from any type of infection.
The virus now rampaging across the globe is known to attack the cardiovascular system, triggering serious inflammation in a minority of patients that makes it significantly more difficult for the body to move oxygen from the air, through the lungs and into the blood.
Surviving this scenario, noted Dr. Duane Pinto, an interventional cardiologist with Harvard University, amounts to a serious fight for all of the body's systems.
“You're going into a battle that really is about you having to fight to breathe, you having to fight to clear the toxins from your blood, to metabolize the acids that are being built up,” Pinto said.
Speaking during a recent media symposium on the cardiovascular effects of COVID-19 convened by the medical device company Abiomed, Pinto explained that the presence of chronic disease at the time of infection means many start this vital fight already behind.
“These systemic illnesses leave you less prepared to deal with a very severe ailment,” Pinto said. “It is not that just having diabetes is making you sick. It is that having the diabetes meant that you came into this firing on five of your six cylinders when you need seven cylinders to get past this, and you're not going to do as well.”
Hood, too, favors a good car metaphor when explaining the situation.
Even for otherwise healthy people, he noted, the body becomes less robust with age. The human immune system becomes less powerful, making it tougher to fight off new infections, kidneys become less able to effectively filter the blood, muscle mass decreases, dropping the odds of surviving a long hospital stay.
“As your tires wear down, you may drive over a nail and get a blow out. Had you had new tires, you might have driven over the same nail and not have even noticed it,” Hood said.
Hypertension, the most common of the co-occurring health problems in those who die after coronavirus infection, is a good example, Hood said. Otherwise known as high blood pressure, the condition puts additional stress on the blood vessels of the body over many years, causing insidious damage that puts a person at a disadvantage when a viral fight for their life suddenly materializes.
“Hypertension is an indication that you have underlying damage to your blood vessels and, as we know, one of the things that happens with COVID is that it can attack the blood vessels,” Hood said.
Type 2 diabetes, another chronic condition at the top of the list of diseases present in those who die after pandemic coronavirus infection, involves an insufficiency of or resistance to insulin, the hormone the body needs to properly process glucose, a sugar in the blood that all cells need to function.
In addition to causing vascular damage that affects many organs, diabetes also is known to impair the immune system, making infection more likely and more difficult to fight off, Hood said.
Though there are similar direct links with the other co-occurring illnesses on the COVID-19 mortality list, some have continued to say that these deaths would have happened anyway.