It’s not just age that makes peo­ple vul­ner­a­ble to the coro­n­avirus.

Peo­ple in good gen­eral health be­fore be­ing hit by dis­ease fare the best

Richmond Times-Dispatch - - FRONT PAGE - BY LAU­RAN NEER­GAARD

WASH­ING­TON — Older peo­ple re­main most at risk of dy­ing as the new coro­n­avirus con­tin­ues its ram­page around the globe, but they’re far from the only ones vul­ner­a­ble. One of many mys­ter­ies: Men seem to be far­ing worse than women.

And as cases sky­rocket in the U.S. and Europe, it’s be­com­ing more clear that how healthy you were be­fore the pan­demic be­gan plays a key role in how you fare re­gard­less of how old you are.

The ma­jor­ity of peo­ple who get COVID-19 have mild or mod­er­ate symp­toms. But “ma­jor­ity” doesn’t mean “all,” and that raises an im­por­tant ques­tion: Who should worry most that they’ll be among the se­ri­ously ill? While it will be months be­fore sci­en­tists have enough data to say for sure who is most at risk and why, pre­lim­i­nary num­bers from early cases around the world are start­ing to of­fer hints.

Se­nior cit­i­zens un­doubt­edly are the hard­est hit by COVID19. In China, 80% of deaths were among peo­ple in their 60s or older, and that gen­eral trend is play­ing out else­where.

The gray­ing of the pop­u­la­tion means some coun­tries face par­tic­u­lar risk. Italy has the world’s sec­ond-old­est pop­u­la­tion af­ter Ja­pan. While death rates fluc­tu­ate wildly early in an out­break, Italy has re­ported more than 80% of deaths so far were among those 70 or older.

But, “the idea that this is purely a dis­ease that causes death in older peo­ple we need to be very, very care­ful with,” Dr. Mike Ryan, the World Health Or­ga­ni­za­tion’s emer­gen­cies chief, warned.

As much as 10% to 15% of peo­ple un­der 50 have mod­er­ate to se­vere in­fec­tion, he said Fri­day.

Even if they sur­vive, the mid­dle-aged can spend weeks in the hos­pi­tal. In France, more than half of the first 300 peo­ple ad­mit­ted to in­ten­sive care units were un­der 60.

“Young peo­ple are not in­vin­ci­ble,” WHO’s Maria Van Kerkhove added, say­ing more in­for­ma­tion is needed about the dis­ease in all age groups.

Italy re­ported that a quar­ter of its cases so far were among peo­ple ages 19 to 50. In Spain, a third are un­der age 44. In the U.S., the Cen­ters for Dis­ease Con­trol and Preven­tion’s first snapshot of cases found 29% were ages 20 to 44.

Then there’s the puz­zle of chil­dren, who have made up a small frac­tion of the world’s case counts to date. But while most ap­pear only mildly ill, in the jour­nal Pe­di­atrics re­searchers traced 2,100 in­fected chil­dren in China and noted one death, a 14-year-old, and that

The gray­ing of the pop­u­la­tion means some coun­tries face par­tic­u­lar risk. Italy has the world’s sec­ond-old­est pop­u­la­tion af­ter Ja­pan. While death rates fluc­tu­ate wildly early in an out­break, Italy has re­ported that more than 80% of deaths so far were among those 70 or older. But, “The idea that this is purely a dis­ease that causes death in older peo­ple we need to be very, very care­ful with,” Dr. Mike Ryan, the World Health Or­ga­ni­za­tion’s emer­gen­cies chief, warned.

nearly 6% were se­ri­ously ill.

An­other ques­tion is what role kids have in spread­ing the virus: “There is an ur­gent need for fur­ther in­ves­ti­ga­tion of the role chil­dren have in the chain of trans­mis­sion,” re­searchers at Canada’s Dal­housie Uni­ver­sity wrote in The Lancet In­fec­tious Dis­eases.

Put aside age: Un­der­ly­ing health plays a big role. In China, 40% 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 pre-pan­demic 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% 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 pre-ex­ist­ing 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.

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% 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 U.S. CDC hasn’t yet re­leased de­tails. But one re­port about the first nearly 200 Bri­tish pa­tients ad­mit­ted to crit­i­cal care found about twothirds 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.

THE AS­SO­CI­ATED PRESS

Med­i­cal per­son­nel are sil­hou­et­ted against the back of a tent be­fore the start of coro­n­avirus test­ing in the park­ing lot out­side Ray­mond James Sta­dium in Tampa, Fla. Most who get COVID-19 have mild or mod­er­ate symp­toms, but “ma­jor­ity” doesn’t mean “all.”

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