covid-19, risk factors, metabolic health

I was just reading some studies on covid-19 risk factors and came upon some interesting facts.

First... I was floored by the stat that only 12% of Americans are considered to be metabolically healthy.  What does that mean?  The study defines metabolically healthy as:

1) optimal levels of waist circumference (WC <102/88 cm for men/women)
2) glucose (fasting glucose <100 mg/dL and hemoglobin A1c <5.7%)
3) blood pressure (systolic <120 and diastolic <80 mmHg)
4) triglycerides (<150 mg/dL)
5) high-density lipoprotein cholesterol (≥40/50 mg/dL for men/women)
6) not taking any related medication.

Obviously, metabolically healthy people are by nature more disease resistant.   Next, a British publication released some alarming stats of risk factors of death from covid-19:

Obesity - #1 risk factor:  Data from the first 2204 patients admitted to 286 NHS ICU’s with COVID- 19 reveal that 72.7% of them were overweight or obese. Elderly often suffer from sarcopenic obesity:

"excess body fat induces immune dysregulation and chronic inflammation which is directly linked to the cytokine storm that is responsible for Acute Respiratory Distress Syndrome seen in influenza and other respiratory viruses.  For example, in 2009 61% of patients admitted to hospital in California that died from H1N1 Influenza A were obese, which was 2.2 times more than the prevalence of obesity within the state population. Multivariate analysis suggested obesity was a novel risk factor for mortality from the virus.  Furthermore, obese adults shed influenza A virus 42% longer than non-obese individuals suggesting an additional role in transmission."

Interestingly, only 1/3 of 'normal weight' people are considered metabolically healthy:

"normal weight metabolically unhealthy have a more than three-fold risk of all-cause mortality and cardiovascular events than those who are normal weight and metabolically healthy. "

 Diabetes, metabolic disease, high blood pressure, smoking - other risk factors:

"Type 2 diabetes and metabolic syndrome may have to up 10 times greater risk of death when they contract COVID-19”

"China concluding that smokers were 14 times more likely to get severe disease after contracting COVID-19."

Obesity and metabolic disease affect minorities at a much higher rate than caucasians, which explains the alarmingly high death rate among minority covid-19 patients.
CNN article
Full article here

While it looks like the major NE areas maybe close to turning the corner with daily US deaths around 2500, southern and midwestern states slow to adopt distancing measures are beginning to see a spike.  Unfortunately, this pandemic was mismanaged from day one by the US federal response, and there still is no coordinated federal testing program.

Bottom line, America is a grossly unhealthy nation and is getting worse. We are on the way to 50% of population being diabetic and prediabetic by 2025, 75% obese and significantly overweight.  Pandemics will take a greater toll on such a population.