The Connection Between Chronic Diseases and the Coronavirus Epidemic
By now we know that chronic diseases make the COVID-19 infection (caused by the Coronavirus) worse.
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 important question.
Why Are Heart Disease and Diabetes More Dangerous Than Lung Disease?
Doctors 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.
People who 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:
- Heart disease
- Chronic lung disease (such as COPD) or moderate to severe asthma
- High blood pressure
- Severe obesity (body mass index [BMI] of 40 or higher)
- Chronic kidney disease
- Liver disease such as hepatitis B
- Anything 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 can’t re-grow.
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 arteries.
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 there.
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 immune system.
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 words.
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 inflammation.
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 conversation!
Disclaimer: This article is not intended to provide medical advice. Please consult with your doctor to get specific medical advice for your situation.