By now we
know that chronic diseases make the COVID-19 infection (caused by the
It is obvious
why something like asthma could complicate COVID-19. If you have heart disease
that is severe enough to cause a breathing problem or to require a diuretic,
that makes some sense too. But what about diabetes? Or high blood pressure?
In China, the
reported fatality rate in patients who reported no other health conditions is
0.9%. It is 10.5% for those with cardiovascular disease, 7.3% for those with
diabetes, 6.3% for people with chronic respiratory diseases, such as COPD or
asthma, and 6.0% for people with high blood pressure. This data poses a very
Why Are Heart Disease
and Diabetes More Dangerous Than Lung Disease?
already know that some chronic diseases go together, sometimes in surprising
ways. For example, people with Type II diabetes are more likely to have heart
disease than people with obesity but no diabetes, and three times as likely to
have heart disease than people who have no other chronic disease.
We also know
that other coronavirus influenzas, like SARS and MERS, also have more severe
symptoms if their sufferers had some other chronic disease, even if it doesn’t
seem directly related to lung disease.
catch avian flu (H7N9) and have an additional chronic disease, are 3.4 times
more likely to need ventilators and other intensive care than patients with
avian flu but no other disease.
So, there seems
to be a relationship between certain chronic diseases and 3 other
kinds of severe influenza, as well as COVID-19.
The diseases and
conditions that have been shown to make COVID-19 more severe include:
lung disease (such as COPD) or moderate to severe asthma
obesity (body mass index [BMI] of 40 or higher)
disease such as hepatitis B
that can weaken the immune system.
And of course, age is a contributor too.
What Is the Connection?
Two problems common for all of the above conditions are chronic low
level inflammation and changes in the immune system. In addition, many are
associated with diet and other lifestyle factors.
Inflammation Is a Healthy Response
Normally, inflammation is part of the healing process. It is
associated with pain and swelling of the affected areas. Cytokines, the
chemical messengers produced by immune cells, surround those cells and guide
their responses. They stimulate white blood
cells to multiply.
The cells then move in to clean up dead and dying tissue and fight
off germs. Damaged areas are patched with connective tissue if the natural tissue
Various cytokines cause fluids to leak into the area, allowing
more white cells to get to the damaged tissues and nutrients to stimulate
faster healing. Other cytokines end this process when it is no longer needed.
Once healing is accomplished, things go back to normal, white
cells go back to where they are needed, cytokine types change and numbers
decrease, fluids decrease, and the process ends.
What’s Different When Inflammation Is Chronic?
But with chronic inflammation, you have some version of this happening
all the time, all over the body. White cells become trigger-happy. They go
where they are not needed and may attack normal cells.
Excess connective tissue may be laid down, causing fibrosis
(similar to scar tissue) of a body organ, interfering with organ function and
sometimes (especially in the liver and kidney) causing organ failure.
The lining of blood vessels gets stiffer, leading to high blood
pressure. In addition, some areas in the blood vessels develop fatty deposits,
which can eventually clog one or more blood vessels in the heart. Blood is more
likely to clot in those areas, making strokes and heart attacks a great concern.
So, inflammation creates substances that cause inflammation, which
then creates more substances that cause more inflammation – in a never-ending loop.
How Does Inflammation Start?
For some conditions, the beginning of inflammation is pretty
obvious: “hepatitis” literally means “inflammation of the liver,” and one
common cause is hepatitis B. Cigarette smoke is famous for causing inflammation
of the lungs.
But others aren’t so obvious. For example, it used to be thought
that fat just sat there in your body, storing up calories, and not much else.
But now we know that fat (especially abdominal fat) is involved in increasing inflammation,
leading to a higher tendency for blood clot formation and atherosclerosis.
Abdominal fat also stimulates the liver to make C-reactive protein,
which leads to creating the type of cytokines that stimulate more inflammation.
Excess carbohydrates in the diet interact with fat cells to
decrease adiponectin (a protective fat hormone). When adiponectin declines, we
see increased blood sugar levels plus insulin resistance which leads to Type II
diabetes. We also see coronary
artery calcification and stroke.
When blood sugar is too high, in metabolic syndrome or in
diabetes, it starts combining with proteins and fats to form abnormal molecules
called Advanced Glycation End-products or AGEs, especially in the walls of
blood vessels. These accumulate and also contribute to hardening of the
AGEs attract the type of white blood cells which contribute to the
inflammatory process. AGEs also stimulate chemical loops that keep producing
more AGEs and more inflammation.
Inflammation Can Spread Throughout the Body
Similar processes happen in other organs of the body, causing the
signs we label as ‘separate diseases’.
In those other organs, various by-products of inflammation can
start a loop, producing more inflammatory products, which cause further
inflammation, and so on. These products in one part of the body can easily get
transferred to other parts of the body, contributing to a disease process
Since this transfer is less dramatic than a normal response to
infection or injury, you are usually not aware of it happening until an organ
weakens. It’s easy, then, to see how chronic inflammation leads to a weakened
What’s an Old Immune System?
Up to 80% of hospitalized patients with COVID-19 have a low white
blood cell count. Combine that effect of the virus with a system that is not working
well anyway, and it can really shut off a body’s defense system.
An old immune system does not work as well. Less antibodies are
produced. Different cells in the immune system don’t “talk” to each other as
much. Their signals are not as clear, more like mumbling rather than actual
When a new disease organism tries to invade, the defense cells
multiply, but total numbers aren’t as high as they used to be. Natural killer
cells are more like natural injury cells. The white blood cells that clean up
dead cells and debris aren’t as active.
But the age of your immune system does not necessarily match your
chronological age. Middle-aged people can have an old immune system, and older
people can have a younger immune system.
It depends in part on your lifestyle and health habits. So does
the severity of any chronic disease that you may have.
What Can a Person Do to Decrease Inflammation?
There are cytokines that can decrease inflammation. White blood
cells are affected by their environment, which is affected by your diet and
lifestyle. The life cycle of white cells in the blood is just a few weeks long,
so you can affect the “age” of your immune system pretty quickly.
A diet rich in fruits and vegetables and low in sugar can favorably affect this balance and decrease chronic
Intestinal health also plays a part. A leaky gut wall can allow
bacteria to leak into the bloodstream, forcing the immune system to be on guard
constantly. Prebiotics and probiotics plus avoiding gluten (even if you don’t
think you have a problem) can help with this issue.
Stress and lack of sleep can weaken the immune system and increase
chronic inflammation. If you stop watching the news in the evening, you are less
likely to be stressed at night and should find it easier to fall asleep.
Meditation in the morning can help as well.
Laughter actually strengthens the immune system. You can watch old
comedies. Play games that make you laugh. Tell knock-knock jokes. Make puns. Subscribe
to daily email jokes.
Finally, exercise can help your immune system and cut down inflammation. Isometrics are a form of strength
exercise you can do in your home. Anything you can do to raise your heart rate,
like jumping in place or stepping on and off of a step, will help with aerobic
capacity. And yoga helps relax your mind and body.
So, there are things you can do to lessen the effects of aging and
chronic disease. All can be done in your home without having to worry about
social distancing. And all of them will benefit you for the rest of your life!
Have you been tempted to eat more desserts in times of stress? Do
you have a chronic disease that could affect your resistance to coronavirus? What
will you do to help your immune system turn younger? What are your favorite
ways to decrease stress? Please share with the community and let’s have a
article is not intended to provide medical advice. Please consult with your
doctor to get specific medical advice for your situation.