One in four patients who died in Tamil Nadu due to COVID-19 had diabetes or hypertension, or both, prior to being diagnosed with the disease. As of Thursday, 220 persons have died while undergoing treatment for coronavirus in the state.
The government of Tamil Nadu began publishing details of comorbidities of COVID-19 patients from May 10.
According to data available in the public domain, 26% of patientsâ€” ie 57 out of 220â€” who died of COVID-19 till June 4 had diabetes or hypertension or both as comorbidities. Apart from this, 67 patients (30% of 220) who died of COVID-19 had diabetes or hypertension or both along with other comorbidities like coronary artery disease or asthma or cancer. Thus 56% of the total patients who died in Tamil Nadu due to COVID-19 had either one or both of these health conditions.
Higher risk of disease among persons with diabetes or hypertension has been made clear by top officials in the state as well.
Recently, the stateâ€™s Minister for Health and Family Welfare C Vijayabaskar advised people to be regular in taking their medication for pre-existing health conditions like diabetes and high blood pressure. Authorities have also emphasised that people with pre-existing conditions and those above the age of 60 must take extra precautions to keep themselves safe from contracting coronavirus.
Tamil Naduâ€™s burden of diabetes and hypertension
A National Family Health Survey by the Union Ministry of Health and Family Welfare in 2015-16 reported that per 1,00,000 population in Tamil Nadu, 3,687 women and 3,572 men between the ages of 15 to 49 have diabetes. â€śThe prevalence of diabetes is particularly high among older women and men,â€ť the report stated.
Similarly, 12% of women aged between 15 and 49 years in Tamil Nadu have reported having hypertension, which is a blood pressure of above 140/90 mmHg. Apart from these women, two percent of women, who generally have normal blood pressure, are on medications to keep their BP levels within check.
Men, meanwhile, have a higher prevalence of hypertension when compared with women: 18% of men aged between 15 and 49 years reported having hypertension.
SARS-CoV-2 and comorbidities
Speaking to TNM, Dr Usha Sriram, Head of Diabetes and Endocrinology at The Voluntary Health Services (VHS) hospital in Chennai, said that it is an established fact that people with non-communicable diseases (NCDs), especially hypertension and diabetes, are at major risk for serious COVID-19 outcomes, including death. The enzymes present in the human body play a major role in facilitating the entry of SARS-CoV-2 into the system and the subsequent progression of the infection.
Experts across the globe have stated that the SARS-CoV-2 virus binds itself to the Angiotensin-converting enzyme 2 (ACE2) protein present in many types of body cells. This protein acts as the first checkpoint for SARS-CoV-2 when it enters the human body, which then travels across the body, causing damage to the organ system.
Dr Usha believes that the effect of the medication, consumed by patients with diabetes and hypertension to control their blood sugar and blood pressure, could also make them vulnerable to fatal outcomes due to COVID-19.
â€śIt is a combination of many things. Diabetic people are immune compromised, more prone to infections. They tend to have other comorbidities like obesity, hypertension, etc. Both diseases are often treated with angiotensin-converting enzymes (ACE) inhibitors,â€ť she said. Adding that this strain of virus is new to many physicians and experts across the globe, Dr Usha explained that SARS-CoV-2 seems to be affecting a lot of vascular, blood vessel related problems like clots. It seems to affect the heart and lungs severely due to its relationship with ACE and ACE2 proteins.
â€śThough there is no clear picture on the impact of diabetes and hypertension medication on COVID-19, I think it is safe to say that patients with these diseases might go through a cytokine storm, which is the inflammatory response of the internal organs, thus making their conditions worse. However, since the role of ACE inhibitors and ARB in patients with COVID is being studied, people with diabetes and hypertension should not stop taking their medications,â€ť she added. Cytokine storms can be either due to the virus itself or due to the bodyâ€™s efforts in fighting the virus infecting it.
Dr Anant Bhan, a medical doctor and a researcher in global health, bioethics and policy, agreed with Dr Usha that the reasons behind this increased risk (or vulnerability) is still being investigated. â€śI don't think we have definitive reasons that have been spelt out. The pathology is still being studied,â€ť he said.
Dr Anant, however, added that the impairment in access to doctors and medications for those who are diabetic or have hypertension could be a factor in the high mortality rates of these patients due to COVID-19.
â€śThe other thing is also that in some cases, access to medical care â€” like medicines, physician visits â€” might have been impacted due to the lockdown, in addition to the anxiety and stress. In those cases, there is a possibility that some of their blood pressure, sugar levels might have been out of limits which they would normally have had under control with proper medication and physician care,â€ť he pointed out, indicating that this would have put them more at risk of contracting the infection as well as deteriorating due to the virus.
Time to attend to NCDs?
According to a report by health journalist Ramya Kannan in The Hindu, India has the second highest number of diabetic patients in the world. The news report stated that the International Diabetes Foundation (IDF), recently, projected that India will add around 134 million more people into its diabetes tally in the next 25 years. This sparks an important question around these diseases: are we talking enough about them?
â€śMy big grouse with the government and public health messaging is that we are talking about mask, hand-washing, etc (in relation to protecting oneself from COVID-19) but we are not talking about any of this (diabetic or hypertension patients being at higher risk of COVID-19). We are not telling people that if your sugar levels are high, keep it under control. We are not telling people with comorbidities like diabetes and hypertension to be more careful in safeguarding themselves from exposure,â€ť lamented Dr Usha.
She added that the COVID-19 pandemic is a chance to emphasise on the grave concerns around NCDs in the country.
â€śThis is also a window of opportunity to take the prevention of NCDs to the public's conscience. But that's not being done,â€ť she said.