• Terry Walker - NutriBro.

Worrying Statistics from COVID-19 ICU Patients

ICNARC have published the descriptive statistics on the first 2249 confirmed patients critically ill in ICU units of UK hospitals

The COVID-19 strain of Coronavirus is basically a bad flu, which can lead to pneumonia among other serious lung conditions. Most infected people appear to suffer normal flu-like symptoms, along with a cough. Where it becomes more serious, people suffer respiratory issues which can hamper breathing to the point of requiring a ventilator machine to provide sufficient oxygen.


Many reports have listed the people at most risk to be those over 60 years old, with co-morbidity conditions such as diabetes, cardiovascular disease, or immune-compromised diseases.


The statistics released show a different picture. (https://www.icnarc.org/About/Latest-News/2020/04/04/Report-On-2249-Patients-Critically-Ill-With-Covid-19)


With the articles and information released from the governments and health organisations

(https://www.nhs.uk/conditions/coronavirus-covid-19/advice-for-people-at-high-risk/),

(https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html),

we should expect to see the descriptive data of people in ICU with these conditions (asthma, diabetes, HIV, and BMI of more than 40). However, of the 2249 people initially admitted to ICU units of NHS trusts across the UK we see:


  • Mean age 60 years old. (Not over 65 as the CDC places higher risk, or 70 as the NHS states).

  • 73% were Male

  • 35.7% Overweight

  • 30.7% Obese

  • 7% BMI over 40

  • 7% very severe existing medical issues pre-existing within 6-months.


Discussion

From these data, we can only make general assumptions. For instance: either Males are more prone to end up in ICU than Females based on gender, or maybe Males suffered a much higher transmission rate and therefore are proportionally misrepresented in ICU.


The age for concern appears to definitely be lower than 70, as written on the NHS website.


73.4% of patients in ICU were overweight to morbidly obese. With only 7% in the BMI>40 category that the NHS and CDC state as high risk. It appears that being BMI>25 has the largest impact on the current data.


Only 7% of patients had a serious pre-existing medical condition. Maybe this category of people was under-represented in the number of infected people across the population, as maybe they went into isolation earlier... or perhaps pre-existing medical issues are not such a burden on the immune and respiratory system.


What is apparent, though needs statistical confirmation, is that being overweight/obese has a correlation to ending up in a very serious condition. Here are some scientific papers that can explain possibly why this is:


  • Overweight / obesity causes inflammations and hampers the immune system (1, 2, 3)

  • Type 2 diabetes is strongly linked with overweight/obesity and causes an inflammatory response leading to reduced immune function / susceptibility to lower respiratory tract infections (4)

  • Obesity causes an impaired immune-response to Flu (vaccinations) (5)

  • Lung performance is related to weight. That is, one's oxygen capacity has more body to distribute the oxygen to when a person is overweight. VO2max will increase simply by losing weight, meaning the lungs have to work less hard to supply oxygen to the body.


If 73.4% of patients were overweight/obese, this could simply be a representation of the population in the UK at the moment. If the people who caught the infection were selected completely at random, we would expect to see 64% of people in ICU as overweight or obese. So maybe 73.4% is not that much higher than a random selection of people. It does however not detract from the point that overweight and obesity increase the risk factors of coronavirus, COVID-19.


On another note, the 2019 NHS statistics compiled by the ONS found that 10,660 hospital admissions in 2017-18 were directly attributable to Obesity (6). And it is not being talked about.


Why is this not being picked up by the government and health organisations? There is a huge taboo around weight. This is systemic and conditioned into us as a culture. We understand the difficulty, and dangers involved in discussing diet on mental health and people's relationship with food, but currently the UK and the USA have very very unhealthy relationships with food.


Maybe if weight was discussed in schools at a young age, stigmatisation could be dealt with, parents and children alike educated about food. If a person was weighed every time they went to see a medical professional, Dr or Dentist, then perhaps the horror of being weighed would be appeased. Something needs to happen, on an individual level, educational level and public health national level. The NHS needs help, and it looks like we can support it by washing our hands, staying home, and eating a lot less, and more nutrient dense foods. There are only so many people that can afford the help of a private online nutritionist, 64% of the UK need help. Although not a public health nutritionist, I think this situation needs awareness. 


References:

1. Karlsson, E. A., & Beck, M. A. (2010). The burden of obesity on infectious disease. Experimental biology and medicine, 235(12), 1412-1424.

2. de Heredia, F. P., Gómez-Martínez, S., & Marcos, A. (2012). Obesity, inflammation and the immune system. Proceedings of the Nutrition Society, 71(2), 332-338.

3. Nikolajczyk, B. S., Jagannathan-Bogdan, M., Shin, H., & Gyurko, R. (2011). State of the union between metabolism and the immune system in type 2 diabetes. Genes & Immunity, 12(4), 239-250.

4. Muller, L. M. A. J., Gorter, K. J., Hak, E., Goudzwaard, W. L., Schellevis, F. G., Hoepelman, A. I. M., & Rutten, G. E. H. M. (2005). Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clinical infectious diseases, 41(3), 281-288.

5. Sheridan, P. A., Paich, H. A., Handy, J., Karlsson, E. A., Hudgens, M. G., Sammon, A. B., ... & Beck, M. A. (2012). Obesity is associated with impaired immune response to influenza vaccination in humans. International journal of obesity, 36(8), 1072-1077.

6. Statistics on Obesity, Physical Activity and Diet, England, 2019. (https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2019)


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