Clinical Determinants for Severe COVID-19 Outcomes

Anton Gulko for Health Empowerment Coalition

In their most recent report, the Centers for Disease Control and Prevention (CDC) assessed the frequency of and risk factors for developing severe COVID-19 outcomes in fully vaccinated (two doses of Pfizer/Moderna or a single dose of Johnson & Johnson) adults. Of 1,228,664 people who completed their primary vaccination during December 2020 - October 2021, 0.015% had severe COVID-19-associated outcomes requiring temporary hospitalization. About 0.0033% of this number died from COVID-19-associated conditions.¹ After normalizing the data to account for age, sex, and race/ethnicity, identified risk factors for severe COVID-19 outcomes were being over the age of 65, having immunosuppression, pulmonary disease, chronic kidney disease, liver disease, diabetes, or cardiac disease.¹ The report also states that ~78% of those who died had at least four of the listed risk factors.¹

The findings in this report suggest a strong link between severe COVID-19 outcomes and patients’ health. Moreover, obesity is directly linked to most identified risk factors (chronic kidney diseases, liver diseases, diabetes, and cardiac diseases).²'³'⁴'⁵ This makes obesity the major preventable risk factor for severe COVID-19 outcomes in the U.S. While several interventions are available for those at risk, including booster shots and monoclonal antibody treatment, there are several lifestyle changes people should make to take control of their health and lower their risk factors for severe COVID-19 outcomes.

The Mediterranean diet has long been the gold standard for weight loss and management of diabetes and cardiac diseases. The diet is described as:

• High on plant-based foods, such as whole grains, vegetables, fruits, nuts, and olive oil.

• Low on red meat (beef and pork), sweets, and junk food.

• Includes fatty fish (salmon, mackerel, albacore tuna), seafood, dairy, and poultry (chicken and turkey).

• Limited on smoking and drinking.⁶

Additionally, several studies showed that deficiency of vitamin D3 is associated with the severity of COVID-19.⁷ For more information on how to start and plan out your diet, visit the Harvard School of Public Health “Healthy Eating Plate” page.

Another essential lifestyle change is regular physical exercise. The U.S. Department of Health and Human Services published Physical Activity Guidelines to outline minimum recommendations and tips on how to meet them. The major points include:

• For children a minimum of 180 minutes of aerobic exercise, 180 minutes of muscle-strengthening, and 180 minutes of bone-strengthening every week.

• For adults a minimum of 150 minutes of aerobic exercise and 120 minutes of muscle strengthening every week.

• Older adults should determine their level of effort for physical activity relative to their level of fitness.

• Aerobic exercises include brisk walking, running, biking, swimming, and jumping rope.

• Muscle-strengthening activities include weight lifting and using bodyweight, like in push-ups, pull-ups, and squats.

• Bone-strengthening activities include jumping jacks, running, and weight lifting.

To explore a range of recreation and enrichment programs in Boston’s network of community centers visit the City of Boston website.

Health means more than just a number of circulating cholesterol or BMI; our physical, mental, and social wellbeing all depend on the state of our health. This truth has become more apparent now that we saw the disproportional impact that COVID-19 had on individuals and communities with poor health. While ‘getting healthy’ may seem like a broad and trivial slogan, there are clear steps everyone could and should take to strengthen their body and health.

References:

1. Yek C, Warner S, Wiltz JL, et al. Risk Factors for Severe COVID-19 Outcomes Among Persons Aged ≥18 Years Who Completed a Primary COVID-19 Vaccination Series — 465 Health Care Facilities, United States, December 2020–October 2021. MMWR Morb Mortal Wkly Rep 2022;71:19–25. DOI: http://dx.doi.org/10.15585/mmwr.mm7101a4

2. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Causes of Chronic Kidney Disease. https://www.niddk.nih.gov/health-information/kidney-disease/ chronic-kidney-disease-ckd/causes

3. Andre Paquin. NASH Definition & Prevalence. American Liver Foundation. https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/nonalcoholic-steatohepatitis-information-center/nash-definition-prevalence/

4. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Symptoms & Causes of Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/ symptoms-causes

5. Mayo Clinic. (n.d.). Heart disease - Symptoms and causes. https://www.mayoclinic.org/ diseases-conditions/heart-disease/symptoms-causes/syc-20353118

6. Mayo Clinic. (n.d.). Mediterranean diet for heart health. https://www.mayoclinic.org /healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

7. Demir M, Demir F, Aygun H. Vitamin D deficiency is associated with COVID-19 positivity and severity of the disease. J Med Virol. 2021 May ;93(5):2992-2999. DOI: 10.1002/jmv.26832.

Author: Anton Gulko

Edited by: Athena Wang, Annaleigh Burgess, and Michelle Pan

The Health Empowerment Coalition is a student-led organization that aims to empower individuals across the United States to improve their health literacy and take charge of their health. The views expressed in this article are the authors’ own and do not reflect the official opinions of the institutions at which they work and study. Additionally, the content in this article is not intended to provide medical advice.