The experience from Kerala has shown that the risk of death from Covid-19 is indeed higher in people with co-morbidity, a term used to refer to the presence of one or more additional conditions often co-occurring (concomitant or concurrent with) with a primary condition.

Co-morbidity or advanced age

Of the 18 deaths due to Covid-19 in the State reported till Thursday morning, most had an associated illness or old age working against them, says Chandni Radhakrishnan, State Medical Board member, Covid-19 Management, Kerala. Uncontrolled diabetes or hypertension was identified with most of the fatalities, but this aspect needs a deeper analysis, she said.

These disorders may exist independent of each other, or may be interlinked due to the same underlying causes. For example, a person with obesity often suffers from heart disease and/or diabetes, explains this Professor of Medicine and HOD of Emergency Medicine at the Government Medical College, Kozhikode, affiliated to Kerala University of Health Sciences.

In Kerala, diabetes, hypertension, COPD (chronic obstructive pulmonary disease) and CAD (coronary artery disease), chronic liver diseases and cancers constitute the main co-morbidity. All these groups stand a higher risk from the virus. Having said that one must not forget that there have been instances of elderly patients without any co-morbidity having survived Covid-19.

When people with diabetes develop an infection, it is often difficult to treat them due to fluctuations in their blood glucose levels and the presence of diabetes complications. Diabetes works against them as their immune system is compromised through different mechanisms. Uncontrolled diabetes and longer duration of diabetes therefore, present a bad prognosis, the doctor says.

Disciplined lifestyle must

Stress due to the illness and other contributing factors also play a big factor in worsening the condition as they lead to the production of certain hormones that worsen diabetes. Similarly, people who have CAD or a stent implanted may be more vulnerable as the virus infection can cause inflammation in a patient’s blood vessels.

There is an excessive risk of blood clotting because of the hypercoagulable state triggered by the virus and this may be bad in patients with CAD. The virus may also induce myocarditis, pericarditis and cardiac diseases due to the release of the stress related hormone, Chandni Radhakrishnan said. This disease presents a high risk for thrombosis which increases the chances of a heart attack.

People with co-morbidity must follow a disciplined lifestyle, eat a healthy meal, take their medications without fail, closely monitor their blood sugar and blood pressure, workout regularly and report immediately to a health centre if they notice any abnormality, warns the doctor. For the elderly, and those with advanced co-morbidity, reverse quarantine is advised.

Reverse quarantine refers to a practice of isolating the most vulnerable people - those of advanced age and under treatment for existing ailments - from the rest of the population and monitoring their health closely to protect them from infection. Kerala has an estimated 70 lakh people who are above 65 years of age and suffer from diabetes, cancer, blood pressure, heart ailments, kidney disease and respiratory tract infections.

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