Obesity could shift severe COVID-19 disease to younger ages
4 May, 2020News reports and
communications from the US Federal
Government had emphasised that
COVID-19 was a particular problem
for older people, and a resistance to
social distancing and sheltering in
place by younger people might have
been informed by this idea. However,
as the pandemic hit the Johns Hopkins
Hospital in late March, 2020, younger
patients began to be admitted to our
ICU, many of whom were also obese.
An informal survey of colleagues
directing ICUs at other hospitals around
the country yielded similar findings.
At this time, news editorials were
noting obesity as an underappreciated
risk factor for COVID-19.
This risk is
particularly relevant in the USA because
the prevalence of obesity is around
40%, versus a prevalence of 6.2% in
China, 20% in Italy, and 24% in Spain.
Obesity can restrict ventilation
by impeding diaphragm excursion,
impairs immune responses to viral
infection, is pro-inflammatory, and
induces diabetes and oxidant stress
to adversely affect cardiovascular
function. We conclude that in
populations with a high prevalence of
obesity, COVID-19 will affect younger
populations more than previously
reported. Public messaging to younger
adults, reducing the threshold for
virus testing in obese individuals, and
maintaining greater vigilance for this
at-risk population should reduce the
prevalence of severe COVID-19 disease.