Covid the new reality as lockdown exit gets closer

OLDER PEOPLE, MEN, OBESE PEOPLE, THOSE LIVING IN DENSELY POPULATED AREAS, PEOPLE WITH CHRONIC KIDNEY DISEASES ARE MOST VULNERABLE

positive for Covid-19.

Unlike previous studies that have established trends from hospital data for the people with severe symptoms, the study, published in The Lancet Infectious Diseases journal, analyses electronic health records of 3,802 people who visited doctors’ clinics in England between January 28 and April 4.

“The risk of infection among the general population remains a grey area. It’s important to know which groups in the wider community are most at risk of infection so that we can better understand SARS-COV-2 transmission and how to prevent new cases,” said study author professor Simon de Lusignan from the University of Oxford, and director of the Royal College of GPS Surveillance Centre, UK.

Hospital-based studies have found that being older, male, and having underlying diseases like hypertension and diabetes cause more severe disease and death. The Lancet study has found that most underlying diseases such as hypertension, diabetes and heart disease did not raise susceptibility to infection, as neither did household size.

The only clinical conditions associated with higher susceptibility to infection was chronic kidney disease and obesity. Of 207 people with chronic kidney disease, 32.9% tested positive, compared with 14.4% without kidney disease. Around 20.9% people who were obese tested positive, compared with 13.2% people with healthy weight.

The study also found smokers were less likely to test positive than non-smokers, which study authors said was due to confounding factors and because of a protective effect of smoking. “This result does not indicate that smoking protects against infection, and there are many potential alternative explanations – such as smoking hampering the sensitivity of the Sarscov-2 test, or smokers being more likely to have chronic cough so being more likely to be tested despite not having the virus. Apart from the welldocumented health damage from smoking, smoking increases the severity of Covid-19, and so our findings should not be used to conclude that smoking prevents Sarscov-2 infection, or to encourage smoking,” said professor de Lusignan.

The study confirmed earlier findings of older people and men being at higher risk of disease. People between the ages of 40 and 64 years were at the greatest risk of testing positive (18.5%), compared with children younger than 17 (4.6%). Around 18.4% men tested positive, compared with 13.3% of women, which suggests that gender differences in poor outcomes are in part related to differential infection susceptibility.

Two preprint studies that examined population level risks showed increased risks of Covid-19 deaths in hospitals with older age, male sex, obesity, and poverty. Underlying diseases such as hypertension and diabetes and smoking play a more important role in disease progression and poor outcomes in hospital studies than in developing infection, The Lancet study suggests. The study did not measure socioeconomic factors that raise infection risk, including high-risk jobs such as health and municipal workers.

Going out with protection and social distancing is safer than being in a closed environment with infected people because the wind disperses the virus and the sun and humidity make it less transferable in sparsely populated areas.

The chances of getting infected from contaminated surfaces such as doors, railings, elevator buttons, table tops and shelves in shops and public places is high, as washing hands and avoiding touching your mouth, nose, eyes or the part of the mask that covers your face is crucial.

What works in India’s favour is its demography. “Most of India’s workforce, including the migrants going home, is predominantly young and are likely to recover and become non-infective very quickly. In countries like Italy and Spain, the deaths have been predominantly in older people in care homes,” said Dutta.

“The challenge for India will be preventing infection in public transport, retail markets and wholesale markets, which can seed large outbreaks, as evident from Chennai and Delhi wholesale mandis,” he said.