March 31, 2020

The Importance of Underlying Issues in Tackling COVID-19

What Are the Functions of the Cardiovascular System

The Importance of Underlying Issues in Tackling COVID-19

As the world fights to protect itself from COVID-19, the biggest focus is to protect the people who are most vulnerable. Although most attention has gone to the elderly, perhaps it’s more important to consider the specific underlying conditions that can put people at high risk for complications, at any age.

Chronic illness such as cardiovascular disease (CVD), diabetes, high blood pressure and respiratory conditions all have the potential to exacerbate the dangerous progression of COVID-19. The percentage of fatalities for patients with these conditions is staggering.

To best protect those who are at most risk for COVID-19 complications, it’s important to understand how these underlying issues pose a risk for those infected and how to best protect these patients if they do become infected.

The common denominators between coronavirus and underlying illness

Although chronic illness like diabetes, hypertension or respiratory illness are all very different, they all put stress on the body in similar ways. These chronic underlying diseases all directly affect oxidative stress, hypoxia (inadequate oxygen in the tissue) and nitric oxide regulation.

These factors play a huge role in the way our body fights infection and disease. When the body can’t fight the virus quickly, it can attack more areas of the body with more power. These are the patients who are more likely to decline rapidly and develop serious complications such as pneumonia and organ failure.

The added stress from chronic illness also puts these patients at higher risk for contracting COVID-19 (and other illnesses) more easily in the first place. Oxidative stress and chronic inflammation due to chronic illness causes a weakened immune system. If a person with chronic illness is exposed, they are much more likely to become ill.

High blood pressure seems to be the biggest risk for COVID-19 complications

Of all of the underlying illnesses associated with severe symptoms, high blood pressure (hypertension), seems to be the biggest risk factor. In fact, of the first wave of severe patients in Wuhan, China, around 50% had hypertension. These patients would decline quickly and required ventilation most often. This is especially concerning in the US, because almost half of American adults have some form of hypertension.

Hypertension is especially dangerous with COVID-19 for many reasons. First, hypertension damages your arteries and makes the heart work much harder. This causes weakness over time. COVID-19 can cause further damage to the heart, causing inflammation and further stress on an already weakened heart.

Second, pneumonia poses a serious risk for COVID-19 patients with hypertension. Not only does pneumonia damage the lungs, but it also damages the circulatory system. Because patients with hypertension have already suffered damage to the arteries and heart, they are at much higher risk for deadly cardiovascular complications if pneumonia develops.

Lastly, patients with high blood pressure usually have plaque buildup in the arteries. COVID-19 can cause plaque to break up, which can cause a heart attack.

The potential link between ACE inhibitors and COVID-19

Patients with diabetes and hypertension are often treated with a type of medication called ACE inhibitors. These drugs cause increased expression of an enzyme called ACE2, which is already more rapidly expressed in people with diabetes. However, COVID-19 uses ACE2 to attack and bind to cells in the body. Therefore, people with higher ACE2 expression due to diabetes and/or the use of ACE inhibitors to treat diabetes or hypertension are actually facilitating COVID-19 infection in the body.

Although this theory has not been proven, it does suggest that ACE2 expression could specifically put patients with underlying conditions at risk.

How those with underlying issues can protect themselves

If you have one or more of these underlying conditions, it’s important that you stay safe. Social distancing and practicing good hygiene are crucial to staying healthy at this time.

Focus on hydration and eating a healthy diet with plenty of vitamin-rich fruits and vegetables. Not only will these foods support the immune system with antioxidants, but some also support nitric oxide (NO) production. Some of these foods include:

  • Raw beets
  • Spinach
  • Arugula
  • Bok Choy
  • Citrus fruits

NO directly works with the immune system to improve blood flow to the cells and help intercept and kill viruses and bacteria.

A healthy diet is also key to manage underlying conditions like diabetes, cardiovascular and hypertension. A healthy diet will help manage blood sugar, decreasing inflammation and optimizing the immune system. Nitrate-rich foods help reduce blood pressure by relaxing smooth muscle that lines the arteries and allowing better blood flow.

Most importantly, anyone who contracts COVID-19 with a history of underlying conditions should seek medical attention quickly to control symptoms and slow the progression of the illness. Awareness and action will improve the outcome for these patients significantly.