Chronic illness and COVID-19

Much attention has been placed on protecting older Australians from COVID-19, but new research shows that anyone of any age with a chronic illness is just as vulnerable as an older person with the same health condition.

Australians of any age with heart disease have a particularly high chance of severe illness, requiring intensive care, if infected by COVID-19, according to a new consensus statement published by the Medical Journal of Australia.

Protecting older people makes sense given evidence published in The Lancet that shows 13 per cent of infected people aged 80 or over will die – and 18 per cent will need to be hospitalised. But anyone of any age living with a chronic illness may also have a similarly elevated risk of severe consequences.

Infection may worsen existing heart conditions, and cause heart failure or increase the risk of a heart attack, says the Heart Foundation.

“The reasons for the link between heart disease and COVID-19 are still being investigated and are likely to be complex,” said the Heart Foundation’s chief medical adviser and cardiologist Professor Garry Jennings.

“The consensus statement sought to spell out what is known so far about COVID-19 and heart disease, and the best ways to treat affected patients.

“One thing we know for sure at this point is that people with heart disease appear to be more vulnerable to the serious complications of COVID-19 compared to the general population.

“We know from experience that when a virus targets the lungs, the heart needs to work harder to pump blood to the body. This can exacerbate problems in people who already have a heart condition, like heart failure. Viral infections can also increase a person’s risk of a heart attack.”

The virus may largely be respiratory disease, says Prof. Jennings, but it could also trigger cardiac complications in people without heart disease and anyone who does become infected with COVID-19 may eventually experience damage to the heart.

“Information about the effects of COVID-19 on the heart is rapidly changing, but international reports indicate that COVID-19 may result in heart problems like injury to the heart muscle and abnormal heart rhythms,” he said.

Newly acquired data from the early stages of the virus shows that three quarters of the people in China infected with coronavirus had no prior chronic health conditions.

Around 13 per cent had high blood pressure, around five per cent had heart disease or chronic lung diseases and just a fraction had cancer, suggesting people with chronic health conditions were no more likely to contract coronavirus than healthier people.

Everyone has the same chance of becoming infected, says infectious diseases epidemiologist Diana Rojas Alvarez, because the virus is new.

“But once you get infected, the probability of getting symptoms and getting severe disease changes among the risk groups,” she said, adding that a person’s risk of death goes up with chronic illness.

According to The Lancet research, the number of people who die in proportion to the number of people infected is currently 1.4 per cent for those under 60 and as high as 4.5 per cent for those over 60 (this number is constantly changing and numbers in Australia could be much lower).

Fewer than one per cent of people with no chronic health conditions died, but the death rate for those with a heart condition was 11 per cent and seven per cent for those with diabetes. Those with hypertension and chronic respiratory disease were also high on the case fatality rate.

Dr Rojas Alvarez said most of the people with respiratory diseases who died would have had chronic obstructive pulmonary disease such as emphysema or chronic bronchitis.

“My guess is anyone with some kind of pulmonary condition, like cystic fibrosis, or people who are smokers or former smokers, they might be at higher risk,” she said.

While many at risk of severe disease or even death are aged 65 and over, there are still millions of younger people who have health conditions that also increase their risk.

Dr Rojas Alvarez said countries such as China and Italy were not able to isolate their elderly populations as quickly as Australia, the US and those in Latin America were doing.

In addition to good hygiene and social distancing, people are advised to maintain their current treatment and medication plan; get the flu vaccine; stay physically active and eat healthily, and seek medical help if their chronic health condition becomes severe or worsens quickly.

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Written by Leon Della Bosca

Leon Della Bosca has worked in publishing and media in one form or another for around 25 years. He's a voracious reader, word spinner and art, writing, design, painting, drawing, travel and photography enthusiast. You'll often find him roaming through galleries or exploring the streets of his beloved Melbourne and surrounding suburbs, sketchpad or notebook in hand, smiling.
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