Comorbidities and COVID-19

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Open article published on MedShr: 3rd February 2021
Last updated: 3rd February 2021

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Obesity and COVID-19 severity

There is a well-recognised association between the risks of increasingly severe COVID-19 infection and having other co-morbidities. Many studies have reported that many of the sickest COVID-19 patients have specifically been obese. For example a metanalysis published in Obesity Reviews in August 2020, analysed outcomes in 399,000 patients. They found that people with obesity who contracted SARS-CoV-2 were 113% more likely than people of healthy weight to be admitted to hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die [1].

Further details on the association can be found in this editorial in Science: ‘Why COVID-19 is more deadly in people with obesity—even if they’re young’ [2]. Moreover, there have been significant changes in the presentation of patients with chronic conditions and NCDs, and admittance to hospital patterns [3].

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NCDs in Low- and Middle-income Countries

In developing and low-middle income countries, this association is also seen: for example, there is increasing evidence that Africans living with noncommunicable diseases (NCDs) such as hypertension and diabetes are more likely to suffer severe cases of COVID-19 and die. In South Africa, which accounts for nearly half of all cases and deaths on the continent, 61% of the COVID-19 patients in hospitals had hypertension and 52% had diabetes. And 45% of people aged 60–69 who died from COVID-19 also had hypertension. In Kenya, around half of COVID-19 deaths occurred in people with NCDs, while in the Democratic Republic of the Congo, such patients accounted for 85% of all COVID-19 deaths [4].

According to a World Health Organization (WHO) preliminary analysis of 14 countries in the African region, hypertension, diabetes, cardiovascular disease and asthma are the co-morbidities most associated with COVID-19 patients. These chronic conditions require continuous treatment, but as governments address the ongoing pandemic, health services for NCDs have been severely disrupted.

The closure or slowdown in services is likely to further aggravate the underlying conditions of patients, leading to more severe cases of NCDs. It also exacerbates the susceptibility of people living with chronic conditions to COVID-19.

In moving forward, WHO recommends controlling the use of tobacco and alcohol because both increase the risk of NCDs. This approach is important from a public health perspective [5], and may be particularly important in the context of the pandemic when many people may be more motivated to attempt to stop [6]. Other important measures include quality primary care and referral systems to help people obtain the right treatment at the right time. There should also be a range of medicines and techniques available to support early diagnosis and treatment of NCDs.

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[1] Popkin BM, Du S, Green WD, et al. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128. doi:10.1111/obr.13128

[2] Why COVID-19 is more deadly in people with obesity—even if they’re young. Available from:

[3] Blecker S, Jones SA, Petrilli CM, et al. Hospitalizations for Chronic Disease and Acute Conditions in the Time of COVID-19. JAMA Intern Med. 2020;e203978. doi:10.1001/jamainternmed.2020.3978

[4] NCDs Africa: Noncommunicable diseases increase risk of dying from COVID-19 in Africa. Available from:

[5] Ahluwalia IB, Myers M, Cohen JE. COVID-19 pandemic: an opportunity for tobacco use cessation. Lancet Public Health. 2020;5(11):e577. doi:10.1016/S2468-2667(20)30236-X

[6] World Health Organization. WHO: COVID-19 must not derail tobacco cessation efforts [internet]. Available from:

Article by Dr Adam Ali, MedShr Open Editorial Team, Medical Education Fellow

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