Chronic Conditions Tied to Severe COVID-19 More Common in Southeast, Rural Areas
Obesity. Diabetes. Heart disease. COPD. Kidney disease. These chronic medical conditions all raise the risk of suffering a severe case of COVID-19, but a new government report shows some parts of the United States are far more vulnerable to these risks than others.
In a review of more than 3,000 U.S. counties, researchers from the U.S. Centers for Disease Control and Prevention found that "the median county prevalence of any of five underlying medical conditions that increase the risk for severe COVID-19-associated illness was 47.2%, and prevalences were higher in counties in the southeastern United States and in more rural counties."
It's not surprising that the pandemic is hitting the southeast and rural communities particularly hard, because so many people in these areas suffer from obesity and the other medical conditions that can make COVID-19 severe, said Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City.
"What's also clear is that we must allocate increased resources to populations in rural communities, which have a disproportionately larger percentage of chronic medical conditions. These communities are at higher risk for adverse outcomes and death from COVID-19 as transmission rates continue to increase," Glatter added.
The CDC team acknowledged that in its report. "Health care in rural counties is often under-resourced, and rural communities might have limited access to adequate care, which could further increase risk for poor COVID-19-associated outcomes," the study authors stressed.
The report, by Hilda Razzaghi of the CDC COVID-19 Response Team, and colleagues, was published July 24 in the CDC's Morbidity and Mortality Weekly Report.
"We know that underlying medical conditions, especially obesity, increases the risk for adverse outcomes in patients with COVID-19," Glatter said.
Studies specifically point out that obesity is a significant risk factor for severe disease, hospitalization and intensive care unit admission, particularly in younger patients with COVID-19, Glatter noted.
The most common condition tied to severe disease was indeed obesity, with a median county prevalence of 35%. This was followed by diabetes at nearly 13%, COPD at 9%, heart disease at 9% and chronic kidney disease at 3%, the CDC team found.
"As the pandemic continues, we must continue to focus not only on treatment but prevention of chronic medical disease, such as obesity, since this ultimately increases the risk of death and disability in those afflicted with COVID-19," Glatter said.
"It also signals the importance of staying engaged with health care providers via telehealth or in-person visits to help monitor and evaluate people who may be at higher risk for poor outcomes," he said.
The importance of preventive care -- like wellness visits, immunizations, blood pressure screenings, blood sugar and cholesterol monitoring and depression -- is more important than ever as the pandemic continues, Glatter said.
Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, said the United States is in the grip of not only the coronavirus pandemic, but an obesity epidemic.
"We don't have proof why obesity makes COVID-19 worse, but there's several suppositions," said Siegel.
"One is that when you have obesity, you're making inflammatory chemicals. Those inflammatory chemicals may very well trigger or be associated with cytokine storm or the other inflammatory responses we see in COVID-19, including blood clotting," he said. "And the other part of it is that you can't fully inflate your lungs when you're obese, and that could be playing a role."
Also, obesity can increase the risk for the other conditions that appear to make COVID-19 severe, Siegel said. "Obesity is definitely related to hospitalization at any age," he noted.
For more on COVID-19, head to the U.S. Centers for Disease Control and Prevention.
SOURCES: Robert Glatter, MD, emergency medicine physician, Lenox Hill Hospital, New York City; Marc Siegel, MD, professor, medicine, NYU Langone Medical Center, New York City; Morbidity and Mortality Weekly Report, July 24, 2020