Why Covid-19 Kills More Over-50s And How To Reduce The Risk

1/9/2020

COVID flicks a self-destruct switch - here's your best chance to stop it

For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die. Studies reveal that age is by far the strongest predictor of a COVID-19-infected person's risk of dying.

To know that fact is to have information but to lack knowledge - you cannot alter your chronological age. I suspect age is the strongest predictor of anyone dying, i.e. to know that is not actionable.

In this post, I will explain to you the reasons that your mortality risk is higher from COVID-19 when you are older, and what you can do about it. There are concrete actions that you can take once you appreciate the underlying reasons. I'll bet that this has not been explained to you before.

"COVID-19 is not just hazardous for elderly people, it is extremely dangerous for people in their mid-fifties, sixties and seventies," says Andrew Levin, an economist at Dartmouth College in Hanover, New Hampshire. Levin estimates that getting COVID-19 is more than 50 times more likely to be fatal for a 60-year-old than is driving a car.

Therefore, if you are over 50, this post is for you.

Age isn't causation, it is just there

First of all, let's unpack the logic of the statement that "age is by far the strongest predictor of a COVID-19-infected person's risk of dying". By doing this, you will develop a much better understanding of how factors other than "age" drive COVID mortality.

Let's say that research showed that older men who cycled regularly died significantly younger than older men who ran regularly. So the strongest predictor of which group of 70-year-olds would die first would be whether they were runners or cyclists.

So the headline on Popsugar would be: "The four things that you must stop doing now if you want to live longer - cycling is one of them".

If you dug a little deeper, you might find that most of the older cyclists rode in heavy traffic on main roads. For decades they had inhaled tens of millions of toxic nanoparticles with each breath. These toxins were the underlying cause of their shorter lifespan - nothing to do with the exercise of cycling.

With COVID-19 it is not age per se which is the main reason people in their 50s, 60s and 70s are dying - it is the toxins which they are allowing to build up in their bodies. And many of these are reversible - you can start today.

The following four charts indicate why our metabolism mostly contains COVID-19, and why other times it wreaks havoc.

The usual course of infection - below the line

Chart One shows the usual course of infection. Over time the coronavirus spreads and strengthens, and then our body catches up and defeats the invader.

While our body maintains the level of infection below the red area at the top of the chart, then our immune system will win the battle against COVID-19.

When things go wrong - above the line

The infection causes inflammation in our body. Think of inflammation as being the redness around a scratch. This inflammation has to be stopped from spreading and poisoning our blood and organs. Stopping it is the job of our immune system.

Coronavirus causes inflammation throughout our body, including our vascular system, lungs, heart, gut, muscles, and brain. Here's all you need to know, if the sum total of all the inflammation exceeds a threshold, then things quickly spiral out of control.

Chart 2 shows this trajectory. When things "cross the line" there is a rapid deterioration in our body's ability to function. You have no doubt seen ICU staff on TV expressing disbelief at how suddenly patients decline after hanging on for weeks in a semi-stable state.

What is "the line" and why does it matter?

When the total load of inflammation in our body passes a threshold - represented by the brown line on Chart 2 - our immune system overloads and breaks down.

It's even worse. Our immune system starts to attack our metabolism instead of protecting it. A pro-inflammatory storm is triggered, which showers our metabolism with cytokines and reactive oxygen and nitrogen species that exacerbate the damage caused by COVID-19.

The complex reactions of microglia, our brain's endogenous immune cells, start to break down and begin to destroy their cellular mitochondria. This reaction is known as an inflammatory mitochondrial dysfunction.

Our body starts to eat itself. You are now on life-support.

To have the best chance of surviving COVID-19, you have to give yourself the best possible odds of not crossing that meta-inflammation threshold.

Aging works against us - but we can fight back

For those of us over-50 aging works against us. But not because of age per se.

What works against us are the choices we make about our lifestyle and in particular those choices which lead to diabetes, obesity, and hypertension.

Here is why these diseases matter - since the beginning of the SARS-CoV-2 outbreak, diabetes and hypertension were present in ∼25% and 35% of fatal cases in China (here) and 36.5% and 48% in Korea, respectively.

Diabetes was also present in 35% of fatal cases in Italy and 58% of critically ill patients in Seattle. As of 12 May 2020, the New York State Department of Health reported that diabetes and hypertension were present in 36% and 55% of fatal cases, respectively. In Louisiana, the epicentre of death rates per capita in the U.S. in April 2020, diabetes, obesity, and hypertension were present in 35%, 19%, and 57% of fatal cases, respectively (21).

In summary, "among severe and deadly COVID-19 cases, diabetes, obesity, and metabolic syndrome are generally present in a higher proportion than any other comorbidities".

Each of diabetes, obesity and hypertension places our body in a constant state of low-grade chronic inflammation. Our blood vessels, our lungs, our heart, our brain, is constantly having to fight against that chronic inflammation. Perhaps the most frightening outcome is the deterioration of our brain, leading to dementia and Alzheimer's Disease.

If we are already suffering from chronic inflammation, then a COVID-19 infection starts from this baseload and adds to it. Chart 3 illustrates these baseloads for diabetes, obesity and hypertension relative to their reported impact on COVID-19 mortality (best estimate).

Age comes into the picture because each of diabetes, obesity and hypertension is more common in older people than younger people. These diseases typically worsen with age. But age per se is not the cause of the leap in COVID-19 mortality rates - the conditions are.

Obesity, diabetes and hypertension give coronavirus a head start

Chart 4 shows how obesity gives coronavirus a massive head start in jumping over the inflammatory storm threshold. If we are obese, then our metabolism is already carrying a load of chronic inflammation. Coronavirus fully loads it, and suddenly we are in deep trouble.

It is this problem - that we are pre-loaded with inflammation - which is why older people are more vulnerable to the coronavirus. Men are more susceptible because up to this time, the metabolic syndrome has been more prevalent in men than in women.

You can reduce your chronic inflammation

Suppose you are as free as possible of obesity, hypertension, and diabetes. In that case, your levels of chronic inflammation will be lower, and your chances of coronavirus pushing you over the threshold are less likely.

You already know this. You know that you should get going to lose weight, to eat better and exercise better to lower your blood pressure and to avoid excess sugary foods to prevent developing diabetes.

If it were easy, you would have done it. If you were motivated enough, you might take action. I wasn't motivated enough to take action until I developed diabetes 22 years ago. Then, too late, I took action.

I hope that this post gives you the insight and the motivation to see your doctor and get advice which will lower your systemic inflammation. That way, you have the best chance of surviving coronavirus.

COVID-19 is "Corona Virus 2019" for a reason - there will be many more in the future - COVID-20, 21, 22, 23.

Be prepared; your family will thank you.

Good luck.

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