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Monday, May 25, 2020

Age is not the only risk for severe coronavirus disease

WASHINGTON (AP) – Older people remain at greater risk of death as the new coronavirus continues to rage across the world, but they are far from the only vulnerable. One of many mysteries: men seem to be worse than women.

And as cases skyrocket in the U.S. and Europe, it’s becoming clearer that how healthy you were before the pandemic started plays a key role in how you pay regardless of how old you are.

Most people taking COVID-19 have mild or moderate symptoms. But “majority” does not mean “everything”, and this raises an important question: who should worry more about being among the seriously ill? As months go by before scientists have enough data to say for sure who is most at risk and why, preliminary numbers of the first cases around the world are starting to offer suggestions.

Not just the old man who gets sick

The elderly are undoubtedly the most affected by COVID-19. In China, 80% of the deaths were among people aged 60 and over, and this general trend is spreading elsewhere.

Population greed means that some countries face a particular risk. Italy has the second oldest population in the world after Japan. While mortality rates fluctuate wildly at the start of an outbreak, Italy has reported that over 80% of deaths so far have been between 70 years of age or older.

But “the idea that this is purely a disease that causes death in older people we need to be very, very careful,” warned Dr. Mike Ryan, head of EMS emergencies.

10% to 15% of people under 50 have a moderate to severe infection, said Friday.

Even if they survive, middle age can spend weeks in hospital. In France, more than half of the first 300 people hospitalized in intensive care units were under 60 years old.

“Young people are not invincible,” added WHO’s Maria Van Kerkhove, stating that more information is needed on the disease in all age groups.

Italy has reported that a quarter of its cases have so far involved people aged between 19 and 50. In Spain, one third are under 44 years old. In the United States, the first snapshot of the Centers for Disease Control and Prevention cases found that 29% were between the ages of 20 and 20 44.

Then there is the riddle of children, who have so far made up a small part of the number of cases in the world. But while most appear only mildly ill, Pediatrics researchers tracked 2,100 infected children in China in the journal and noted one death, a 14-year-old who nearly 6% was seriously ill.

Another question is what role children play in the spread of the virus: “There is an urgent need for further investigation into the role children have in the transmission chain,” researchers from Canadian Dalhousie University wrote in The Lancet Infectious. Diseases.

THE MOST RISKY HEALTH CONDITIONS

Set aside age: basic health plays an important role. In China, 40% of people in need of critical care had other chronic health problems. And there, the deaths were highest among people who had heart disease, diabetes or chronic lung disease before they took COVID-19.

Pre-existing health problems can also increase the risk of infection, such as people who have weak immune systems, including cancer treatment.

Other countries are now seeing how pre-pandemic health plays a role, and these threats are more likely to be discovered. Italy reported that of the first nine people under the age of 40 who died of COVID-19, seven were confirmed to have “serious medical conditions” such as heart disease.

More health problems, all the worse. Italy also reports that about half of the people who died with COVID-19 had three or more underlying conditions, while only 2% of the deaths concerned people without pre-existing disturbances.

Heart disease is a very broad term, but so far it appears that people most at risk have significant cardiovascular disease such as congestive heart failure or severely clogged and clogged arteries, said Dr Trish Perl, head of infectious diseases at UT Southwestern. Medical Center.

Any type of infection tends to make diabetes more difficult to control, but it is unclear why diabetics appear to be particularly at risk with COVID-19.

The risks in less healthy individuals may have to do with how they claim if their immune systems overreact to the virus. Patients who die often seem to have improved after a week or so only to suddenly worsen, experiencing inflammation harmful to the organs.

As for pre-existing lung problems, “this is really happening in people who have lower lung capacity,” Perl said, due to diseases such as COPD – chronic obstructive pulmonary disease – or cystic fibrosis.

Asthma is also on the list of concerns. Nobody really knows about the risk of very mild asthma, although even routine respiratory infections often leave patients using their inhalers more often and will have to monitor with COVID-19, he said. What about a previous attack of pneumonia? Unless it was serious enough to put you on a fan, which alone shouldn’t have caused significant permanent damage, he said.

THE MYSTERY OF GENDER

Perhaps gender imbalance shouldn’t be a surprise: during previous SARS and MERS outbreaks – cousins ​​of COVID-19 – scientists noted that men seemed more sensitive than women.

This time, just over half of COVID-19 deaths in China were among men. Other parts of Asia have seen similar numbers. So Europe has also noticed what Dr. Deborah Birx, the White House coronavirus coordinator, called a worrying trend.

In Italy, where men represent 58% of infections so far, male deaths are outweighing female deaths and the increased risk begins at the age of 50, according to a report by the Italian surveillance group COVID-19.

The United States CDC has not yet released the details. But a report on the first nearly 200 British ICU patients found that around two thirds were male.

One suspect: globally, men are more likely to have smoked more heavily and for longer periods than women. The European Center for Disease Prevention and Control is urging research on the connection of smoking with COVID-19.

Hormones can also play a role. In 2017, researchers from the University of Iowa infected mice with SARS and, just as had happened in people, males were more likely to die. Estrogens seemed protective: when their ovaries were removed, deaths among female mice jumped, the team reported in the Journal of Immunology.

AP authors Nicole Winfield in Rome, Maria Cheng in London and Angela Charlton in Paris contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science Department. The AP is solely responsible for all content.

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