I have not personally been infected with COVID but one of my patients died of it early on after being hospitalized for unrelated reasons. Obviously I can't share details but they were in the hospital for a few weeks then became unexpectedly sick. We suspected COVID early, began aggressive treatment even before testing confirmed it, yet he still died. Shortly afterwards our hospital ICUs started to fill up with COVID patients, many of whom did not leave alive. The hardest moment was calling his son the last time and giving him the news. I remember it vividly because though I have been a bearer of bad news many times, everyone in that ICU room was making the same call to a different family. And the alarms were going off in every room. Code carts were scattered about, empty. Afterwards I stepped outside and saw people restaurant-hopping as if this disease would not touch them, and the next day saw one person dragged out in handcuffs shouting conspiracy theories at our staff as we left the hospital. Afterwards we had police guarding the exits and walkways to the parking decks. The physical scars may be short-lived (or for some, not) but the mental scars will take longer. I did not appreciate this until recently, when another patient was close to death and I was talking to his son.
For me it was a turning point where I realized that the only people who are looking out for my family when s* hits the fan were my family and close friends. It showed how easily the fabric of society frays, and any trust I had in it was lost then. As a healthcare worker I realized that my duty to my patients was sacred, but I could not afford to risk joining the dead and leaving my child fatherless in a society that is so uncaring and cruel. Since then I have been very cautious with COVID patients, and though I don't think their care has suffered needlessly, it is probably not the best due to all the extra precautions that are necessary. That also weighs on me. Though I did not ultimately get COVID, that time waiting for it after such close exposures and the fecklessness I saw outside of the hospital hardened my heart in a way I did not appreciate until later, and would have previously thought impossible. For those who have suffered - you are not alone and I am here to talk if you want.
Can you, as a medical professional, describe typical patients who get very sick and die from Covid? The problem is that what we read on the internet these days is mostly biased: it's either "they are all fat boomers with diabetes" or "a healthy 20 yo died from Covid so based on this anecdotal evidence you should be very afraid too". In your opinion, are there any patterns in terms of their age and preexisting conditions?
These are the known risk factors for death from COVID-19, based on data from the England National Health Service records of 17 million people, of whom approximately 11,000 died through May 15th.
Sorted by risk compared to not having a co-morbidity/characteristic:
Age was the biggest independent risk factor:
Absolute risk of death by age was <0.01% in the 18-39 year old group, and 0.44-0.67% in the >80yo group. The denominator is total population in each age group, not population with COVID.
Compared to 50-59 year olds, 60-69 year olds had a 2.4x risk of dying, 70-79yo had a 6.1x risk, and >80yo had a 21x risk of dying after adjusting for other factors. 40-49yo had a 0.3x risk, and 18-39 had a 0.06x risk.
Independent of age, risks by co-morbidity were:Organ transplant was the second-biggest risk (3.5x)
Leukemia/lymphoma within the last 5 years was the third-biggest risk (2.5-2.8x)
Neurologic disease other than stroke or dementia (2.6x)
Severe chronic kidney disease was fourth (2.5x)
Stroke or dementia (2.2x)
Immunosuppression other than transplant (i.e. HIV): 2.2x
Diabetes: 2x risk if uncontrolled, 1.3x if controlled
Recent solid-organ cancer (1.8x)
Liver disease: 1.75x risk
Men have a 1.6x risk of dying compared to women.
COPD or emphysema (1.6x)
Morbid obesity (BMI >35, i.e. 5ft person weighing >180lb, 5'6" person weighing >210lb, or 6ft person weighing 250+ pounds) carried a risk of 1.4x
Mild chronic kidney disease (1.3x)
Things that increased risk 10-20% are:
Chronic heart disease
Asthma
Smoking
Auto-immune diseases (e.g. rheumatoid arthritis, lupus or psoriasis)
Socioeconomic risks (adjusted for in above figures):
Non-white ethnicity (1.3-1.5x)
Less wealthy (1.1-1.8x risk)
Hypertension and asthma not requiring inhalers had no increased risk.
HOWEVER, hypertension was associated with increased risk in <60yo (3x risk in the 18-39 group, 2.7x risk in the 40-49 group, 1.3x risk in the 50-59 group).
The risks are additive (roughly): so two <40yo both have low risk, but the one with uncontrolled diabetes, hypertension and/or obesity is more likely to die. Those three tend to go together in that age group, so you can see how that can quickly add up.
TLDR: age >60 (37.5% of English population), transplant (0.1%), cancer (2%), neurologic disease (1%), severe kidney disease (0.5%), immunosuppression (0.3%), diabetes (3%), liver disease (0.6%), non-asthma respiratory disease (4%), male gender (50%), and morbid obesity (5%) increase risk in roughly that order, in an additive fashion. These have been identified in the US, Italian and Asian populations also. Hope that helps!
Ref:
https://www.nature.com/articles/s41586-020-2521-4
