Going Viral: Who is really at risk of severe COVID-19?

Like millions of others around the world, Gulf News Foreign Correspondent Mick O’Reilly is currently under COVID-19 lockdown. This is what life is like in social isolation in Ireland, where there are strict rules about who is allowed out, where, and under limited circumstances.

DAY 80

Wednesday June 17, 9am

IS THERE ANYBODY OUT THERE?

ONE IN FIVE PEOPLE HAVE AROUND THE WORLD UNDERLYING CONDITION THAT INCREASES SEVERE COVID-19 RISK’

The first time I ever wrote a word about coronavirus was on January 25 and it contained the following sentences: “The watchword here needs to be caution. The reality is that those who died after contracting the coronavirus already have other serious health issues and their immune systems were already compromised.”

Now comes word that one-in-five people across the world has an underlying health condition that could increase their risk of severe coronavirus if infected, a new study suggests.

Using data from 188 countries, a modelling study estimated 1.7 billion people, 22 per cent of the world population, have at least one underlying health condition that puts them at increased risk.

Researchers say that although estimates give an indication of the number of people who should be prioritised for protective measures, not all of these individuals would go on to develop severe symptoms if infected.

According to the study, 4 per cent of the world’s population would require hospitalisation if infected.

LOOKING FOR WAYS TO PROTECT THE MOST VULNERABLE

The authors say this suggests the increased risk of severe COVID-19 could be quite modest for many with underlying conditions.

Associate Professor Andrew Clark, from the London School of Hygiene and Tropical Medicine (LSHTM), said: “As countries move out of lockdown, governments are looking for ways to protect the most vulnerable from a virus that is still circulating.

“We hope our estimates will provide useful starting points for designing measures to protect those at increased risk of severe disease.

“This might involve advising people with underlying conditions to adopt social distancing measures appropriate to their level of risk, or prioritising them for vaccination in the future.”

The World Health Organisation (WHO) and public health agencies in the UK and US identify cardiovascular disease, chronic kidney disease, diabetes and chronic respiratory disease as risk factors for severe coronavirus.

The new study, in The Lancet Global Health journal, provides global, regional and national estimates for the number of people with underlying health conditions.

The authors caution that they focused on underlying chronic conditions and did not include other possible risk factors that are not yet included in all guidelines, such as ethnicity and socioeconomic deprivation.

STARTING POINT FOR POLICY MAKERS

They say that the estimates are therefore unlikely to be exhaustive, but serve as a starting point for policy-makers.

The authors based their estimates on disease prevalence data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2017, UN population estimates for 2020 and the list of underlying health conditions relevant to COVID-19, as defined by current guidelines.

To help determine the degree of increased risk, the researchers also provided separate estimates of the proportion of all people – with and without underlying conditions – who would require hospitalisation if infected.

They calculated those at high risk using infection hospitalisation ratios for Covid-19 and made adjustments for differences between countries.

Countries and regions with younger populations have fewer people with at least one underlying health condition, while those with older populations have more people with at least one condition.

SIMILAR RATES BETWEEN THE SEXES

Globally, less than 5 per cent of people aged under 20 years, but more than 66 per cent of those aged 70 and above, have at least one underlying condition that could increase their risk of severe coronavirus, researchers say.

Among the working age population (15 to 64 years), 23 per cent are estimated to have at least one underlying condition.

While the prevalence of one or more condition listed on current guidelines is similar between the sexes, the authors assumed males were twice as likely as females to require hospitalisation if infected.

Dr Rosalind Eggo, from LSHTM, said: “Our estimates suggest that age-based thresholds for shielding could play a role in reducing deaths and reducing the number of people who require hospital treatment, but the choice of threshold needs to be balanced against the proportion of people of working age affected, as well as the health and economic consequences that might be associated with long periods of isolation.”

COVID-19 SURVIVOR RECEIVES $1.1M HOSPITAL BILL

A 70-year-old American man who nearly died of COVID-19 has been billed a heart-stopping $1.1 million (Dh4 million) for his hospital expenses, the Seattle Times reported on Saturday Saturday.

Michael Flor was admitted to a hospital in the northwestern city on March 4, and stayed for 62 days – at one point coming so close to death that nurses held up the phone so his wife and children could say goodbye.

But he recovered and was discharged on May 5 to the cheers of nursing staff – only to receive a 181-page bill totalling $1,122,501.04, he told the newspaper.

That includes: $9,736 per day for the intensive care room, nearly $409,000 for its transformation into a sterile room for 42 days, $82,000 for the use of a ventilator for 29 days, and nearly $100,000 for two days when his prognosis was life-threatening.

Flor is covered by Medicare, a government insurance program for the elderly, and should not have to take out his wallet, according to the Times.

But in a country where health care is among the most expensive in the world – and the idea of socialising it remains hugely controversial – he said he feels “guilty” knowing that taxpayers will bear much of the cost.

"It was a million bucks to save my life, and of course I'd say that's money well-spent ... But I also know I might be the only one saying that," the Times quoted him as saying.

A gigantic plan adopted by Congress to keep the American economy afloat through the coronavirus shutdowns includes a $100 million budget to compensate hospitals and private insurance companies that treated COVID-19 patients.

MEME OF THE DAY

There are two types of people in the world: Those who like cates, and those who cats like. If you have a cat, you’ll get this meme I came across recently.

VITAMIN K FOUND IN CERTAIN CHEESES MAY HELP PROTECT AGAINST COVID-19, RESEARCHERS SAY

I touched upon this before about three weeks ago – the days are merging into one long blog now as it is Day 80 – that cheese might help in the fight against coronavirus.

Now Dutch researchers says patients who are deficient in vitamin K, which is found in certain cheeses, spinach, and eggs, might be more likely to be admitted to intensive care or die from COVID-19.

For the study, which is still being peer-reviewed and has not been published yet, the researchers followed 134 patients hospitalised at the Canisius Wilhelmina hospital in the Dutch city of Nijmegen between March 12 and April 11. They then compared them to a control group of 184 age-matched patients who did not have the disease.

The researchers, who worked in collaboration with the Cardiovascular Research Institute Maastricht in the Netherlands, found that patients who had to be admitted to the ICU or died from COVID-19 had lower levels of vitamin K compared to the healthy group of individuals.

DAMAGE TO ORGANS AND BLOOD CLOTTING

While COVID-19 was initially thought to be a respiratory illness, there is increasing evidence to suggest it affects other areas of the body and causes blood clotting.

Blood clots can cause strokes, heart attacks, and dangerous blockages in the legs and lungs. They can also lead to the degradation of elastic fibres in the lungs.

In a press release, pulmonologist Rob Janssen, who is working on the project, explained that COVID-19 can cause inflammation in the lungs, which damages the elastic fibres that allow people to breathe. He said that’s why vitamin K is important because it is needed for the body to produce protective proteins for those elastic fibres.

Vitamin K also plays a role in the production of proteins that regulate clotting in the blood, Janssen said.

According to the US National Institutes of Health (NIH), vitamin K is a fat-soluble vitamin that comes in two forms: vitamin K1 and vitamin K2.

Vitamin K1 is found primarily in green leafy vegetables, such as spinach, kale, broccoli, and collard greens.

The other form, vitamin K2, is present in animal-based and fermented foods, such as eggs, dark chicken, and butter. Vitamin K2 is also found in various hard and soft cheeses, including Gouda, Jarlsberg, and Munster.

TRADITIONAL JAPANESE DISH OF FERMENTED SOYA BEANS

One particularly rich source of vitamin K2 is found in a traditional Japanese dish of fermented soya beans called natto.

In an interview with The Guardian newspaper, Janssen encouraged a healthy intake of foods containing vitamin K for everyone, except those who are on blood-thinning medication.

“My advice would be to take those vitamin K supplements. Even if it does not help against severe COVID-19, it is good for your blood vessels, bones and probably also for the lungs,” he told the paper on Friday.

While the Dutch researchers’ study is still undergoing peer-review, they’re hoping to secure funding for a clinical trial to further their understanding of the relationship between vitamin K and COVID-19.

DELAY CANCER TREATMENT OR RISK COVID-19? DOCTORS AND PATIENTS WEIGH THE RISKS

An international study into the impact of COVID-19 on cancer patients has found an alarming trend: the death rate is more than twice that of other people who contract the virus, leaving doctors searching for answers on how to continue care.

The study, which had early data described in The Lancet in late May, looked at people with both diseases in the US, Spain and Canada. It concluded that cancer patients were much more likely to die from COVID-19 than people without cancer who got the virus.

As elective surgeries and treatments resume, doctors and patients are wrestling with the risks of delaying treatment further, versus the risk of exposing cancer patients to COVID-19 in a hospital setting.

Amid this confusion, a new web-based app developed by researchers at the University of Michigan is hoping to help clinicians weigh those risks.

Called the OncCovid app, it uses mathematical modelling to balance numerous factors, such as the probability of becoming infected within a hospital setting and the patient’s demographics.

“Clinicians will enter the patient's age, how many illnesses, where they live, their cancer, and their treatment plan, if they're chemo or surgery,” Holly Hartman, creator of the app and lead researcher explained to CTV News.

With this information, the OncCovid app then produces a mortality risk assessment based on immediate and delayed treatment.

‘INAPPROPRIATELY DELAYING CANCER TREATMENTS’

“We are inappropriately delaying some people's cancer care and also inappropriately allowing some cancer patients to continue to receive treatment,” Dr. Daniel Spratt, a researcher on the team and radiation oncologist, told CTV News.

The question of whether to delay treatment or not is one with real life consequences.

Just as the pandemic was on the rise, Cara Heitmann was diagnosed with breast cancer. She planned to get a mastectomy, but as hospitals prepared to treat COVID-19 patients, her surgery was delayed.

“I felt like a number, not a person,” Heitmann told CTV News.

“The question in my head was, ‘Are you trading one life for another?’ and ‘Who’s making that decision?’”

By the time she underwent a mastectomy, Heitmann said, the cancer had spread to the lymph nodes. She’s considered a priority patient now, but is worried about being exposed to the virus while she undergoes chemotherapy.

A weakened immune system puts Heitmann at a greater risk of dying from COVID-19 than patients who aren’t going through cancer treatment or don’t have cancer.

“It’s definitely on my mind,” she said. “It needs to be on my mind, because if I get the virus, I'm probably going to die.”

The decision to treat cancer patients now or wait until the virus is less of a threat weighs on doctors.

‘SPENDING A LOT OF TIME THINKING ABOUT THIS’

Dr. Monika Krzyzanowska, a medical oncologist, said that “it’s very difficult decision that we need to make for our patients.

“And we're really spending a lot of time thinking about this.”

Spratt said that researchers developing the OncCovid app are hoping that their tool can take some of the burden off of doctors and help make things clearer to patients.

“It’s nice to have some type of metric to explain to them why,” he explained.

The study described in the Lancet that shows the risks cancer patients are facing during the pandemic draws from a database called the COVID-19 and Cancer Consortium, which collects data from more than 100 cancer centres and other organisations.

The database is still tracking this information, meaning the picture of how COVID-19 impacts cancer patients will become clearer as time goes on.

Researchers with the University of Michigan are also planning how to improve the methodology of their app as a tool in cancer care – all in the aim of being prepared for a second wave of the virus.

TAKING STOCK

HOW I’M PRETENDING TO GROW £10,000 IN PLAY MONEY

That’s better! A gain of £484 on Monday and the first positive news in more than a week of dismal trading.

A reminder that this is all pretend, I started out in lockdown with £10,000 – about Dh45,000 to invest on the London Stock Exchange, I don’t pay for trades and I can only buy or sell when the market is closed. There’s no minimum on the amount of On Sunday, I rebalanced my portfolio to try and stem then recuperate some of the losses from last week. It didn’t quite work out as planned as markets across Europe continued their downward trend on Monday, but things took off on Tuesday.

Net worth £13180.63

Dignity, 700 shares: £1945.50

Halfords, 1500 shares: £2661.00

PowerHouse, 1200 shares: £4380.00

Ryanair, 375 shares: £4181.25

Cash in hand: £8.88

£ gain on last trading day: £484.00

% gain overall: 31.8 per cent

£ Gain overall: £3,180.63

SPAIN MAY IMPOSE TIT-FOR-TAT QUARANTINE ON BRITS

Spain is considering imposing a quarantine on British travellers when it reopens its borders next week, the foreign minister said, in response to a similar policy at London’s end.

Arancha Gonzalez Laya told the BBC she hoped Britain would lift its restriction, making a reciprocal Spanish one unnecessary.

“We will be in a dialogue with the UK to see whether or not we should be introducing reciprocity as they have different measures than the rest of the European Union,” she said in an advance excerpt from current affairs programme HARDtalk.

Britain, with more than 41,000 documented coronavirus-linked deaths, and Spain, with more than 27,000, have been two of the countries hardest hit by the pandemic.

Both, along with other European countries, are now easing lockdown restrictions, including border closures.

Spanish officials gave no mention of any quarantine curbs on Sunday, when the government moved forward the date for allowing European visitors back into the country to June 21 from July 1.

MADRID CHANGES DATES AND CONDITIONS

In recent weeks, Spain has caused confusion in neighbouring countries and exasperation in the travel industry by repeatedly changing the date and conditions for lifting the ban on foreign visitors it imposed in mid-March.

“I still don’t know what I will do with my staff and it’s June 16,” Jorge Marichal, CEO of Canary Islands hotel group Inversiones Marylanza, said at a business event.

“We cannot work this way.”

Spain counts on tourism for about 12 percent of its economy and more than one in eight jobs, making it essential to try and salvage some of the summer holiday season.

Britain’s Finance Minister Rishi Sunak said on Sunday the quarantine was among measures it would review, saying the government could make changes such as introducing travel corridors with specific countries.

WHO SAYS ENGLAND NEEDS TO IMPOSE CONTACT-TRACING

England’s coronavirus lockdown should not be further lifted until the government’s contact-tracing system has proven to be “robust and effective”, WHO has said after widespread criticism of the first results of the new tracking operation.

As shops across England prepared to reopen, and people were encouraged by the government to come out of their homes and on to the high street, Dr Hans Kluge, the WHO’s director for Europe, cautioned that the UK remained in a “very active phase of the pandemic”.

His remarks came as ministers confirmed a review on the 2-metre social distancing rule, with the government coming under pressure from business leaders, Tory backbenchers and rightwing media to further ease the lockdown. Boris Johnson said on Sunday that the falling numbers of coronavirus cases has given the government “more margin for manoeuvre” in easing the 2-metre physical distancing rule.

In response to data showing the government had failed to trace the contacts of a third of those testing positive in the first week of the new system, Kluge warned in an interview with the Guardian against rushing into reopening the economy.

The WHO official said the tracking in England of about 31,000 contacts of 8,000 infected people was encouraging and a cause for congratulations. But he added that Downing Street needed to be convinced it could “aggressively” track infections as the prime minister looks to reopen the economy.

FEWER DEATHS FROM EARLIER LOCKDOWNS

Governments who locked down early in the pandemic, in the face of public criticism, had recorded fewer deaths during the pandemic, Kluge said, but European leaders would now be judged on their management of their exit from the restrictions.

“We know that early lockdowns saved lives and bought some time for the health system to be ready,” Kluge said when asked about the British government’s record. “But I would rather than instead of looking to the past, jump to the future and say that the question of lifting the lockdown is as important as going to the lockdown. The key words here are to do it gradually. Do it carefully.

“Contact tracing is key especially as the UK starts to relax the social and physical distancing measures. There has to be a robust track-and-trace system in place of operation. I would like to reply [to questions about the first results of the system] and say we need an effective tracking system in place, it is one of the measures that we recommend that are in place now. One certainty is that a country has to decide themselves on that one.”

NEED TO IMPROVE TRACK-AND-TRACE SYSTEM

Of the 8,117 positive cases referred to contact tracers, 5,407 had been willing to hand over the names and phone numbers of people they had met in the previous two days.

Kluge said international comparisons were difficult but that the pandemic had shown the importance of governments being able to communicate effectively with the public to convince them of the necessity of respecting the unprecedented nature of the requests being made.

Noting that Downing Street had delayed going into lockdown in early March for fear that the population would fail to follow the rules with rigour as the restrictions dragged on, Kluge said: “What is the lesson there? Keep people engaged.”

Kluge said he could understand the government’s caution despite calls from senior Conservatives, including the former leader, Iain Duncan Smith, for a rethink on the 2-metre guidance. Johnson has ordered a review of the policy to be completed by July.

ACTIVE PHASE IN THE PANDEMIC

“Every country has their own context, based on a risk assessment. In the UK I would say this is a very active phase in the pandemic so, more let’s say, careful,” he said. “There is no right or wrong. Of course, ideally, it would be everywhere the same but countries are doing this based on their own risk assessment …

“Whether it’s one or two metre is less important than the fact that people will adhere to the measures, to the physical distancing, to the handwashing, to the respiratory hygiene, and that they understand that it’s not over. This is the key issue.”

With Europeans eyeing up the potential of summer holidays, Kluge said Europe as a whole could not be complacent, with infection rates increasing in the past fortnight in Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, and North Macedonia. The Europe region within Kluge’s remit is made up of 53 countries: the UK, the member states of the EU, and the countries of central and eastern Europe including Turkey and Russia.

CORONAVIRUS AND FLU IN THE AUTUMN

The reopening of schools had led to some local flare-ups in Europe that were swiftly contained, Kluge said, and the continent could face a deadly combination of a second wave of coronavirus and an influenza pandemic in the autumn.

“We call it when ‘Covid will meet the flu’,” Kluge said. “The issue is that several epidemics can go together and how do you have policies in place? We put an expert group together to look at that because no one has the ideal answer.”

Kluge said it would be crucial for governments to distribute the influenza vaccine among the groups most vulnerable to Covid-19: older people, men, and generally people with underlying conditions such as cardiovascular disease, diabetes and renal disease.

There are 135 potential vaccine candidates for COVID-19, of which 10 are in clinical trial. Kluge said it “may well take a year, a year and a half now” before a vaccine could be ready. “My understanding is that it’s still a bit early in the day. Of course one thing is efficacy, but then the other one is safety … We are hopeful and there’s a lot of effort. But, until that moment, let’s implement what we know works.”

QUESTIONS AND ANSWERS

I’m not an expert, but I might be able to help you make a bit of sense of this. And we can all get through it together. Isn’t this what this is all about.

Send your questions for me to Readers@gulfnews.com.

That’s it for now. Let’s check in with each other tomorrow. I have used files from Reuters, AP, DW, Sky News, Twitter and other European and North American media outlets in today’s blog. And remember to stay safe.

Mick O’Reilly is the Gulf News Foreign Correspondent based in Europe