COVID-19 and comorbidity — you may see it the bad way

Many people think that people with comorbidities in the COVID-19 pandemic are some terminal patients, which were under End-of-life care. But the fact is, that almost half of the American population has some kind of disease that classifies them as a comorbidity

Photo by Jair Lázaro on Unsplash

During the COVID-19 pandemic, the term “comorbidity” started to be used frequently and attaching the risk of complications only to the very old or very sick. But the truth behind the term is far different than you could be thought.

Indeed people with some underlying conditions are at higher risk of developing a fatal response to the COVID-19 infection in comparison to the people without any health condition [1]. But the question is how many people have such conditions and could government just be more protective against them?

Let the first talk about who are people who are considered to be with comorbidities? One such definition could be “the presence of more than 1 distinct condition in an individual. Although always used as a person-level construct” [2]. So if someone has a co-existing disease, together with SARS-COV-2, then he could be considered under the definition. The most recognizable comorbidities are cardiovascular disease, diabetes, chronic respiratory disease, hypertension, or cancer. They significantly increase the risk of fatal response to the SARS-COV2 disease, as shown below.

Epidemiological data based on the 2019–2020 China COVID-19 outbreak. People with underlying condition have higher chance of fatal response to the COVID-19 infection.

The problem with those diseases is that they are common, many people have them and, thus many are at higher risk of getting a fatal response to the SARS-COV2 infection. If we ask how common they are and we take into account only diseases previously described, then the answer is about 50% based on the American population [3] (the paper is still under review, yet the data are based on a reliable source). This a lot of people and considering it as a minority is a big mistake.

Comorbidities by age for American population based on the population of 444,649 people (White, Black, Hispanic, American-Indian/Alaska Native, Asian/Pacific and Other)in 2017 from Behavioural Risk Factor Surveillance System. Data are from the publication cited in the [1]. The interesting fact is that, the age more-less corresponds to the percentage of people with at least one comorbidity.

Then if walk a street or go to work, university, you meet with your friends or family, then about every second person such a condition. Further, adding to it that more common conditions are considered as comorbidity, for example obesity or rheumatoid arthritis, then the numbers are increasing [4][5].

Photo by Toa Heftiba on Unsplash. Half of the people that you see here, may have an underlying health condition like hypertension or diabetes.

So the people you used to meet, may have such health condition. When infected with COVID-19 and unfortunately one of them dies, then they are going to be classified as a person with comorbidities.

The conclusion is that people with underlying health conditions are most probably widespread among the population, at least in the United States [3], nevertheless, it can be extended to other developed countries. Furthermore, classifying people who died due to SARS-COV2 by governments is misleading without proper explanation and examples, leading to discrimination of the people by uninformed people.

References:

[1] Espinosa, O. A., Zanetti, A. D. S., Antunes, E. F., Longhi, F. G., Matos, T. A. D., & Battaglini, P. F. (2020). Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Revista do Instituto de Medicina Tropical de São Paulo, 62.

[2] Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., & Roland, M. (2009). Defining comorbidity: implications for understanding health and health services. The Annals of Family Medicine, 7(4), 357–363.

[3] Adams, M. L., Katz, D. L., & Grandpre, J. (2020). Population based estimates of comorbidities affecting risk for complications from COVID-19 in the US. medRxiv.

[4] Kang, Z., Luo, S., Gui, Y., Zhou, H., Zhang, Z., Tian, C., … & Hu, D. (2020). Obesity is a potential risk factor contributing to clinical manifestations of COVID-19. International Journal of Obesity, 1–7.

[5] Favalli, Ennio Giulio, et al. “COVID-19 infection and rheumatoid arthritis: Faraway, so close!.” Autoimmunity reviews (2020): 102523.