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| Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients | Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients |
| (7 days later) | |
| Obesity may be one of the most important predictors of severe coronavirus illness, new studies say. It’s an alarming finding for the United States, which has one of the highest obesity rates in the world. | Obesity may be one of the most important predictors of severe coronavirus illness, new studies say. It’s an alarming finding for the United States, which has one of the highest obesity rates in the world. |
| Though people with obesity frequently have other medical problems, the new studies point to the condition in and of itself as the most significant risk factor, after only older age, for being hospitalized with Covid-19, the illness caused by the coronavirus. Young adults with obesity appear to be at particular risk, studies show. | Though people with obesity frequently have other medical problems, the new studies point to the condition in and of itself as the most significant risk factor, after only older age, for being hospitalized with Covid-19, the illness caused by the coronavirus. Young adults with obesity appear to be at particular risk, studies show. |
| The research is preliminary, and not peer reviewed, but it buttresses anecdotal reports from doctors who say they have been struck by how many seriously ill younger patients of theirs with obesity are otherwise healthy. | The research is preliminary, and not peer reviewed, but it buttresses anecdotal reports from doctors who say they have been struck by how many seriously ill younger patients of theirs with obesity are otherwise healthy. |
| No one knows why obesity makes Covid-19 worse, but hypotheses abound. | No one knows why obesity makes Covid-19 worse, but hypotheses abound. |
| Some coronavirus patients with obesity may already have compromised respiratory function that preceded the infection. Abdominal obesity, more prominent in men, can cause compression of the diaphragm, lungs and chest capacity. Obesity is known to cause chronic, low-grade inflammation and an increase in circulating, pro-inflammatory cytokines, which may play a role in the worst Covid-19 outcomes. | Some coronavirus patients with obesity may already have compromised respiratory function that preceded the infection. Abdominal obesity, more prominent in men, can cause compression of the diaphragm, lungs and chest capacity. Obesity is known to cause chronic, low-grade inflammation and an increase in circulating, pro-inflammatory cytokines, which may play a role in the worst Covid-19 outcomes. |
| Some 42 percent of American adults — nearly 80 million people — live with obesity. That is a prevalence rate far exceeding those of other countries hit hard by the coronavirus, like China and Italy. | Some 42 percent of American adults — nearly 80 million people — live with obesity. That is a prevalence rate far exceeding those of other countries hit hard by the coronavirus, like China and Italy. |
| Obesity is defined by a measure called body mass index, which is based on a formula that divides one’s weight in kilograms by the square of one’s height in meters. Someone who is 5 feet 9 inches tall and weighs 203 pounds would have a B.M.I. of 30, which is considered obese. | Obesity is defined by a measure called body mass index, which is based on a formula that divides one’s weight in kilograms by the square of one’s height in meters. Someone who is 5 feet 9 inches tall and weighs 203 pounds would have a B.M.I. of 30, which is considered obese. |
| The new findings about obesity risks are bad news for all Americans, but particularly for African-Americans and other people of color, who have higher rates of obesity and are already bearing a disproportionate burden of Covid-19 deaths. High rates of obesity are also prevalent among low-income white Americans, who may also be adversely affected, experts say. | The new findings about obesity risks are bad news for all Americans, but particularly for African-Americans and other people of color, who have higher rates of obesity and are already bearing a disproportionate burden of Covid-19 deaths. High rates of obesity are also prevalent among low-income white Americans, who may also be adversely affected, experts say. |
| More than half of Covid-19 deaths in the United States so far have been in New York and New Jersey, but the new findings mean the coronavirus could exact a steep toll in regions like the South and the Midwest, where obesity is more prevalent than in the Northeast. | More than half of Covid-19 deaths in the United States so far have been in New York and New Jersey, but the new findings mean the coronavirus could exact a steep toll in regions like the South and the Midwest, where obesity is more prevalent than in the Northeast. |
| “If obesity does turn out to be an important risk factor for younger people, and we look at the rest of the United States — where obesity rates are higher than in New York — that will be of great concern,” said Dr. Roy Gulick, chief of infectious diseases at Weill Cornell Medicine. “We may see a lot more younger people being hospitalized.” | “If obesity does turn out to be an important risk factor for younger people, and we look at the rest of the United States — where obesity rates are higher than in New York — that will be of great concern,” said Dr. Roy Gulick, chief of infectious diseases at Weill Cornell Medicine. “We may see a lot more younger people being hospitalized.” |
| Dr. Gulick’s review of data from the first 393 Covid-19 patients admitted to NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Lower Manhattan Hospital identified obesity as a risk factor for admission. He also found that among adults under the age of 54, half live with obesity, though the New York City obesity rate is only 22 percent. | Dr. Gulick’s review of data from the first 393 Covid-19 patients admitted to NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Lower Manhattan Hospital identified obesity as a risk factor for admission. He also found that among adults under the age of 54, half live with obesity, though the New York City obesity rate is only 22 percent. |
| One of the largest U.S. studies to identify obesity as a prominent risk factor analyzed data from more than 4,000 Covid-19 patients who sought care at NYU Langone Health between March 1 and April 2. | One of the largest U.S. studies to identify obesity as a prominent risk factor analyzed data from more than 4,000 Covid-19 patients who sought care at NYU Langone Health between March 1 and April 2. |
| “Obesity is more important for hospitalization than whether you have high blood pressure or diabetes, though these often go together, and it’s more important than coronary disease or cancer or kidney disease, or even pulmonary disease,” said Dr. Leora Horwitz, the paper’s senior author and director of the Center for Healthcare Innovation and Delivery Science at NYU Langone. | “Obesity is more important for hospitalization than whether you have high blood pressure or diabetes, though these often go together, and it’s more important than coronary disease or cancer or kidney disease, or even pulmonary disease,” said Dr. Leora Horwitz, the paper’s senior author and director of the Center for Healthcare Innovation and Delivery Science at NYU Langone. |
| Obesity also appears to be a factor for higher risk of death from Covid-19, though to a lesser degree, Dr. Horwitz said | Obesity also appears to be a factor for higher risk of death from Covid-19, though to a lesser degree, Dr. Horwitz said |
| She cautioned that the findings were preliminary, noted that some of the data was still incomplete and emphasized that the paper had not been peer reviewed. | She cautioned that the findings were preliminary, noted that some of the data was still incomplete and emphasized that the paper had not been peer reviewed. |
| Scientists are still somewhat puzzled by the impact of obesity on the course of the disease, but Dr. Horwitz said the implications for patient care were clear. | Scientists are still somewhat puzzled by the impact of obesity on the course of the disease, but Dr. Horwitz said the implications for patient care were clear. |
| “It means that as clinicians, we should be thinking a little more carefully about those patients with obesity when they come in — we should worry about them a little bit more,” she said. | “It means that as clinicians, we should be thinking a little more carefully about those patients with obesity when they come in — we should worry about them a little bit more,” she said. |
| Another NYU Langone study, which focused on patients under the age of 60, found that those with obesity were twice as likely to be hospitalized and were at even higher risk of requiring critical care. The association between obesity and more severe disease was not seen in patients over the age of 60. | Another NYU Langone study, which focused on patients under the age of 60, found that those with obesity were twice as likely to be hospitalized and were at even higher risk of requiring critical care. The association between obesity and more severe disease was not seen in patients over the age of 60. |
| The severity of the illness often comes as a surprise to younger adults, and “provides another layer of shock to this disease,” the paper’s author, Dr. Jennifer Lighter, said. | The severity of the illness often comes as a surprise to younger adults, and “provides another layer of shock to this disease,” the paper’s author, Dr. Jennifer Lighter, said. |
| Studies highlighting the risks of obesity have been conducted in other countries as well. | Studies highlighting the risks of obesity have been conducted in other countries as well. |
| Though most of the early reports from China pointed to risk factors like Type 2 diabetes and hypertension, which are common in people with obesity, scientists in Shenzhen, China, posted a preliminary report online this month finding that Covid-19 patients with a high body mass index were at more than double the risk of severe pneumonia than those with a lower B.M.I. | Though most of the early reports from China pointed to risk factors like Type 2 diabetes and hypertension, which are common in people with obesity, scientists in Shenzhen, China, posted a preliminary report online this month finding that Covid-19 patients with a high body mass index were at more than double the risk of severe pneumonia than those with a lower B.M.I. |
| Another study from China, which looked at outcomes among a group of 112 Covid-19 patients, reported that of the 17 patients who died, 15 were either overweight or obese. | Another study from China, which looked at outcomes among a group of 112 Covid-19 patients, reported that of the 17 patients who died, 15 were either overweight or obese. |
| More recently, a French study reported that nearly half of 124 Covid-19 patients in Lille, France, had obesity, twice the rate of a comparison group of intensive care patients hospitalized for other reasons last year. The study also reported that the need for mechanical ventilation increased with higher body weight. | More recently, a French study reported that nearly half of 124 Covid-19 patients in Lille, France, had obesity, twice the rate of a comparison group of intensive care patients hospitalized for other reasons last year. The study also reported that the need for mechanical ventilation increased with higher body weight. |
| Updated June 22, 2020 | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| At Ochsner Health, a system with 41 hospitals in Louisiana and southern Mississippi, Dr. Leo Seoane, the company’s senior vice president, said that 60 percent of patients hospitalized with Covid-19 had obesity and that obesity appeared to nearly double their risk of requiring a ventilator. | |
| “We in the U.S. have not always identified obesity as a disease, and some people think it’s a lifestyle choice. But it’s not,” said Dr. Matthew Hutter, director of the Weight Center at Massachusetts General Hospital and president of the American Society for Metabolic and Bariatric Surgery. “It makes people sick, and we’re realizing that now.” | “We in the U.S. have not always identified obesity as a disease, and some people think it’s a lifestyle choice. But it’s not,” said Dr. Matthew Hutter, director of the Weight Center at Massachusetts General Hospital and president of the American Society for Metabolic and Bariatric Surgery. “It makes people sick, and we’re realizing that now.” |
| Conventional wisdom has traditionally explained excess weight as a simple caloric imbalance that can be addressed by eating less and exercising more. Prominent medical groups have reconsidered their approach, however, and now recognize obesity as a medical disorder caused by a complex web of underlying factors, which in turn predisposes people to other serious medical problems. | Conventional wisdom has traditionally explained excess weight as a simple caloric imbalance that can be addressed by eating less and exercising more. Prominent medical groups have reconsidered their approach, however, and now recognize obesity as a medical disorder caused by a complex web of underlying factors, which in turn predisposes people to other serious medical problems. |
| Some doctors consider obesity a marker of poor health associated with poverty, reflecting a combination of social and economic factors, from inadequate education and limited job opportunities to impoverished neighborhoods where access to healthy food, medical care and opportunities for exercise are scarce. | Some doctors consider obesity a marker of poor health associated with poverty, reflecting a combination of social and economic factors, from inadequate education and limited job opportunities to impoverished neighborhoods where access to healthy food, medical care and opportunities for exercise are scarce. |
| Obesity’s link to chronic diseases is well known, but the experience with H1N1 influenza in 2009 revealed that people with obesity are also more vulnerable to infectious diseases. Studies have also shown that they do not get the same protection from influenza vaccinations that others do. | Obesity’s link to chronic diseases is well known, but the experience with H1N1 influenza in 2009 revealed that people with obesity are also more vulnerable to infectious diseases. Studies have also shown that they do not get the same protection from influenza vaccinations that others do. |
| Physicians say patients with obesity can be harder to manage in the hospital setting. They require special beds and imaging equipment, and they are harder to intubate and harder to assess when removing a ventilator. | Physicians say patients with obesity can be harder to manage in the hospital setting. They require special beds and imaging equipment, and they are harder to intubate and harder to assess when removing a ventilator. |
| Advocates for people with obesity say they may also delay seeking care, deterred because they have been treated poorly by health care providers in the past. | Advocates for people with obesity say they may also delay seeking care, deterred because they have been treated poorly by health care providers in the past. |
| “They worry: ‘If I go to the hospital, am I going to be triaged based on my body mass index? Is the skinny person next to me going to get the ventilator, not me?’” said Dr. Donna Ryan, associate editor in chief of the journal Obesity. | “They worry: ‘If I go to the hospital, am I going to be triaged based on my body mass index? Is the skinny person next to me going to get the ventilator, not me?’” said Dr. Donna Ryan, associate editor in chief of the journal Obesity. |
| Doctors in the trenches treating critically ill coronavirus patients say they expected to see old and elderly patients become acutely and critically ill, but the young patients becoming severely sick have unnerved them. | Doctors in the trenches treating critically ill coronavirus patients say they expected to see old and elderly patients become acutely and critically ill, but the young patients becoming severely sick have unnerved them. |
| Of the 14 Covid-19 patients recently in Dr. Sanam Ahmed’s critical care unit at Mount Sinai on the Upper East Side, she said, 12 were at least 50 years old and had complex medical problems. The two younger patients, who were in their 30s, had obesity and no other diseases. | Of the 14 Covid-19 patients recently in Dr. Sanam Ahmed’s critical care unit at Mount Sinai on the Upper East Side, she said, 12 were at least 50 years old and had complex medical problems. The two younger patients, who were in their 30s, had obesity and no other diseases. |
| “It looks like, for them, obesity is the risk factor,” Dr. Ahmed said. | “It looks like, for them, obesity is the risk factor,” Dr. Ahmed said. |
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