Risk factors for severe COVID-19

Persons most at risk to encounter severe complications have been identified by the Institut national d’excellence en santé et en services sociaux (INESSS, the scientific committee of the department of Health). According to the March 27, 2020 document, they have been identified as:

• Persons of all ages suffering respiratory system diseases

• Persons of all ages suffering from cardiovascular diseases

• Persons of all ages suffering from high blood pressure

• Persons with a disrupted immune system

• Persons over the age of 65

The CDC and the High Council of Public Health (France) have been targeting other groups as well. As a rule, the sicker an individual with numerous out of control conditions prior to being infected by SARS-CoV-2, the greater are the challenges once the infection has been detected.

As of now, obstructive sleep apnea has been the subject of only one research paper demonstrating a 3 fold-increase in severe infection and an increased early mortality (CORONADO study 2020) among diabetic patients.

In the general population, obstructive sleep apnea has been linked to high blood pressure, atherosclerotic cardiac disease, (angina, heart attack), diabetes and obesity and is often encountered in people over the age of 65. Those are the same risk factors for more severe COVID-19. It is expected— without any established proof up to date — that obstructive sleep apnea increases the risk of more serious infections not only among individuals with diabetes but in the general population.

Two drugs were discussed early in the pandemic as some argued that could increase the severity of the infection. Concerning NSAID, at the moment, we do not have proofs of worsened outcome if using it and the experts recommend continuing your treatment (see section on Fever). The angiotensin-converting enzyme inhibitors (ACEi) was discussed at length. Those are used mainly for treating high blood pressure, diabetes related kidney problems and heart failure. Here again, the experts now are asking NOT to dismiss this important medication because of absence of clearly incriminating data. If you take those medication and have concerns, talk to your physician.

Age, regardless of the state of health is a risk factor for more severe infection. Even if the risk is lower in young adults and children, the risk is still present.

Individuals exhibiting one of 3 chronic diseases (diabetes, cardiovascular disease, or chronic lung disease) were 6 times more likely to require hospitalisation for COVID-19 complications. A little under half (45%) of those with one of those 3 chronic diseases required hospitalisation compared to one in 12 (7.8%) among those with none of the 3 chronic conditions (CDC MMWR Weekly / June 19, 2020 / 69(24);759–765. Death occurred 12 times more frequently among those with at least one of those 3 conditions (19.5%) compared to those with none (1.6%). So, poorer chronic health status is a risk factor, but even healthy individuals may struggle with the virus. Obstructive sleep apnea was not considered in that study.

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