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Beneath the Surface: Underlying conditions can make COVID infections worse

COVID-19 has shown itself to be America’s public health perfect storm: it’s incredibly contagious, incredibly deadly and highly infectious. It’s shown every crack and imperfection in our healthcare systems and society. While it’s hard to predict the impact of a coronavirus infection on any individual, our available data on underlying conditions gives a glimpse into how a person might handle it.

Two chronic conditions impact Rhode Island’s insured population the most: diabetes and hypertension. Hypertension, or high blood pressure, is the most common, according to the latest available data from the state department of health. There are at least 165,000 insured Rhode Islanders with the condition. The second highest underlying chronic condition is diabetes, impacting 83,000 insured Rhode Islanders. 

Although people with these conditions are not more likely to contract COVID, they’re most at-risk for serious bouts of COVID-19 infection or death. Type 2 diabetes is linked with 29.8% of coronavirus-associated deaths. Hypertension, and by extension heart disease, is the most prevalent underlying condition, present in two-thirds of coronavirus-associated deaths.

While scientists have no definitive answer of what links COVID to these underlying health conditions, they think that it has something to do with inflammation. Both diabetes and hypertension can cause inflammation in the body, which can lead to a weakened response to infections or viral invaders.

According to a new study last month from doctors at the University of Pennsylvania’s radiology department, COVID-19 patients with these two major health conditions have an increased risk of neurological complications as a result of the disease. Of the thousands of patients at the university admitted for COVID-19 who received brain scans, 81 patients’ scans revealed conditions such as strokes, brain bleeds and blocked brain vessels. According to a press release from the Radiological Society of North America, half of these patients had past histories of hypertension or diabetes.

Inflammation is a popular hypothesis for the culprit because it can induce a cytokine storm. Cytokines are part of the immune system that can be overproduced in the face of chronic inflammation. Cytokine storms are still pretty rare, but trials of anti-inflammatory medications in COVID patients are ongoing and awaiting peer review.

One underlying condition that seems to have little impact on the severity of coronavirus is asthma. During the summer, scientists at Rutgers University released a study that found very little correlation between asthma and severe COVID infections. The why is still unknown, and most data on asthma and COVID-19, like pretty much all data and studies from this year, is broadly preliminary. The CDC lists it as an at-risk health condition on their website, but no one has found any data to back it up.  

Hypertension, diabetes and heart disease all are prevalent underlying conditions found in Rhode Islanders. These also are conditions found in the nation’s poor; the lower you are on the socio-economic ladder, the more likely you are to have one of these conditions and to have it poorly managed. In addition, minority populations are more likely than white people to be poor or lack adequate healthcare and to work a frontline job that can’t be done from home. As a result, CDC studies of COVID deaths show that the nation’s minority populations are doing most of the dying. Nonwhite Hispanics make up 51% of the deaths, Hispanics make up 24.2% of deaths, and African Americans make up 18.7%. These figures are much higher than their proportion of the country’s population. Hispanics’ share of COVID deaths is increasing, and no one can predict what the next few months will bring.

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