Professional societies advise against a general classification. Which diseases are possible risk factors.
from dpa
June 05, 2020, 10:20 am
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Berlin | Most people are mildly infected with the Sars-CoV-2 coronavirus. You get a cough and a fever. But those who belong to so-called risk groups are more likely to get seriously ill with Covid-19. According to the latest data from the Robert Koch Institute (RKI), 18 percent of the infections detected are so severe that those affected are taken to a hospital. But who is a risk patient anyway?
The RKI counts on its website a number of diseases that appear to increase the risk of serious disease. Specialist societies advocate differentiating more precisely.
More on the subject:
An overview of the risk factors
It is known that the risk of a severe course of Covid-19 increases noticeably from the age of around 50 to 60 years. Almost nine out of ten patients who died with Covid-19 (86 percent) were 70 years of age or older, according to the RKI. Because of the less responsive immune system, older people can become seriously ill after infection. Experts see an even higher risk if there are previous illnesses in addition to old age.
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The Central Institute for Statutory Health Insurance (Zi) rates patients aged 80 and over with at least one high-risk disease and patients aged 60 to 79 years with at least three high-risk diseases as “highly at risk”. “If you add up these risk groups and extrapolate them to the population, there are around 5.5 million people nationwide who have a high risk of developing a severe course of Covid-19,” says Jörg Bätzing, head of the study, summarizing the Zi analysis. The distribution of the risk groups varies regionally, in some cases considerably.
The coronavirus mainly affects the lungs. Patients with chronic respiratory and lung diseases are particularly at risk, says the spokesman for the German Lung Day, Marek Lommatzsch. Depending on the disease, however, gradations can be made. Accordingly, well-treated asthma patients do not have an increased risk of severe Covid-19 courses.
The situation is different for people with the chronic lung disease COPD: “From the data available so far, there are indications that patients with COPD have a higher risk of severe Covid-19 courses,” says Lommatzsch. Cigarette smoking is also treated as a risk factor – even if the data situation is still “thin”, as the German Society for Pneumology writes.
- Cardiovascular diseases
Patients with pre-existing heart diseases are clearly assigned to the risk group for severe disease courses. An infection with a virus is an additional burden on the heart and can lead to excessive demands, warns the German Center for Cardiovascular Research. It is also known that the coronavirus can trigger thrombosis, heart muscle inflammation and cardiac arrhythmias.
The RKI list also includes hypertension as a risk factor. However, the chairman of the German Hypertension League, Ulrich Wenzel, believes that severe Covid 19 cases in high blood pressure patients are only too common at first glance. It is known that high blood pressure occurs mainly in older people. “It is therefore not surprising that the rate of high blood pressure illnesses is also high in the generally older patients with severe Covid-19 courses.” A general risk assessment cannot yet be made.
This factor is increasingly becoming the focus of medical professionals. “A number of studies have shown that obesity can actually complicate and complicate the course of Covid-19 disease,” explains Jens Aberle, endocrinologist at the Hamburg University Hospital.
Preliminary studies from France recently showed a connection between the body mass index (BMI) and the Covid 19 complication rate. “From this it is clear: the higher the BMI, the more often severe Covid-19 courses occur and the more often patients have died,” explains the specialist in metabolism. One theory is that the immune system is basically activated by the increased body weight and, as a result, can be overloaded in the event of a viral infection, explains Aberle.
“To date, too few connections with diabetes are known to be able to conclusively assess the risk of severe Covid 19 disease,” says the spokesman for the German Diabetes Society, Baptist Gallwitz. Instead of classifying diabetes patients across the board as a risk group, the Tübingen professor advocates differentiating according to age and previous illnesses.
Older patients with so-called type 2 diabetes often also had other risk factors. “These are certainly patients who have a higher risk of a severe course from a coronavirus infection.” With a well-controlled type 1 diabetes, which occurs mainly in childhood, no increased risk can be identified. “The same applies to younger people with type 2 diabetes without any other concomitant disease,” stresses Gallwitz.
There are different assessments of this. The RKI counts patients with chronic liver disease in the risk group. The German Liver Aid is more cautious: “So far it is unclear whether liver patients generally have a higher risk of severe Covid-19 courses,” it says in a current statement. However, there are initial indications that fatty liver diseases could increase the risk of severe disease.
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