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The World Health Organization (WHO) has officially declared that the new coronavirus (Covid-19) has reached pandemic levels. Numerous news reports also state that Covid-19 poses the greatest threat to older adults and those with certain medical conditions, including heart disease (also known as cardiovascular disease), high blood pressure, and diabetes. But what is missing from this frightening media coverage is what, exactly, should people with these conditions be doing to protect themselves? And how great is their risk?
How dangerous is Covid-19 to people with CVD and other chronic diseases?
Overall, more than 80 percent of people with Covid-19 experience mild illness from which they can recover without intensive medical intervention, according to a report from the American College of Cardiology (ACC). In early March, WHO’s Director-General reported that the global death rate from the virus is 3.4 percent, up from an earlier WHO report of 2 percent.
More recently, an article in the New England Journal of Medicine coauthored by Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease, and Robert Redfield, MD, Director of the CDC, opined that the true fatality rate of the COVID-19 “may be considerably less” than 1 percent and “may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
However, both death rates and cases of more severe or fatal illness are higher in older adults and those with certain medical conditions. Large-scale case studies by the Chinese CDC indicate that rates of death and very severe illness rise with age, with rates of 8 percent in people ages 70 to 79 and nearly 15 percent in patients over 80. People with certain medical conditions have both a higher risk for getting Covid-19 and a worse prognosis if they do. Up to 50 percent of people who develop the virus have co-existing disorders and for this group of patients, the following death rates from Covid-19 have been reported by the ACC.
Why does Covid-19 pose such a high risk to people with cardiovascular conditions?
There is a lot that is not yet known about the new coronavirus, which infects the lungs, but the ACC reports that in one study of patients hospitalized with Covid-19, 16.7 percent developed heart arrhythmias and 7.2 percent experienced acute injuries to their hearts, along with other Covid-19 related complications. The ACC also reports that, “there have been reports of acute cardiac injury, arrhythmias, hypotension, tachycardia, and a high proportion of concomitant cardiovascular disease in infected individuals, particularly those who require more intensive care.”
Studies from Wuhan, China—the epicenter of the pandemic–have reported that people with the virus have suffered heart attacks, inflammation of the heart, and even cardiac arrest, adds the ACC, which states that the rate of cardiac complications in those with Covid-19 parallels those that occur in people with other types of coronaviruses, such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), as well as people who catch seasonal flu. No studies have yet been done to compare the rates of heart complications in Covid-19 patients with and without pre-existing CVD.
A few factors could explain why people with heart disease are at increased risk for severe illness if they catch Covid-19. First of all, any infectious disease increases inflammation in the body as one of the immune system’s defenses against invading pathogens. The result is a “blood storm” of inflammation coursing through the body’s more than 60,000 miles of blood vessels. In people who have arterial disease (plaque), inflammation can ignite a plaque rupture, much like a volcano erupting. This can lead to the formation of an obstructive blood clot, potentially followed by a heart attack or a stroke. Think of plaque as kindling. Inflammation is what lights the match.
Similarly, we know Influenza is so strongly linked to an increased risk for heart attacks and strokes in people with atherosclerosis that some experts have theorized that flu is a direct cause of these events, largely driven by associated rises of infection-induced inflammation in people with influenza. Right now, the flu season is the U.S. continues to cause high rates of the disease, with about 440,000 Americans hospitalized and almost 8.2 percent of them dying, according to the CDC. Influenza has also been linked to increased risk for heart failure in people with CVD. Indeed, a 2018 study published in New England Journal of Medicine reported that within one week of catching the flu, people are at six times higher risk for a heart attack! COVID-19 also produces an infection-induced inflammation and poses a higher risk for those with heart disease and for inflammatory-induced heart attack.
High blood pressure also contributes to the development of atherosclerosis, while having type 2 diabetes elevates risk for a heart attack as much as having had a prior heart attack does in a non-diabetic person of the same age! Because Covid-19 often causes shortness of breath, which is turn quickens the pulse, both the lungs and the heart have to work harder when people catch the virus. But if your heart is already weakened by CVD or you have narrowing of the arteries, then your heart has to pump much harder than that of a healthy person to circulate blood and oxygen through your body.
What precautions should we all take – especially individuals with vascular disease and/or heart disease take?
Whether you are feeling ill, or have questions or concerns,
I am available for phone or video chat visits.
Dr. Gina Pritchard
To learn more about how Covid-19 affects the heart and other organs, read, “Here’s what coronavirus does to the body” in National Geographic. Additional resources include the following: