COVID-19: Why Do Some People Develop Life Threatening Complications?

Since early 2020, medical and public health professionals have been scrambling to understand COVID-19. So far, a majority of those whose infections were confirmed with testing — 80 percent — had mild symptoms and recovered with little medical intervention, which is obviously great news. 

But 15 percent developed serious symptoms and another 5 percent had life-threatening symptoms, which experts attributed to having an underlying condition. According to the CDC, the most common underlying health conditions involved in severe COVID-19 cases are: 

• Cardiovascular disease - 32 percent 
• Diabetes - 30 percent 
• Chronic lung disease - 18 percent

The CDC reported that if you are hospitalized, your chances of being moved into the intensive care unit (ICU) are higher than 50 percent.

(There are risk factors beyond your control that also up your risk for complications: The greatest number of severe cases, requiring hospitalizations, occurred among people older than 50, according to study published in The Lancet Infectious Diseases. And a study published in Nature found that men and racial and ethnic minorities also were more vulnerable.)

If you have cardiovascular disease, diabetes or chronic lung disease like chronic asthma, chronic bronchitis or emphysema, it’s important to understand how complications can arise if you have contracted COVID-19 and some steps you can take to help lower your risk of developing severe complications.  

Cardiovascular Disease and Risk for COVID-19 Complications
If you have cardiovascular disease, your risk for a heart attack hikes seven times following a viral infection. Why? Viruses promote inflammation, which can inflame the heart muscle (myocarditis), disrupting its ability to pump blood and throwing off normal heart rhythm. 

Inflammation also stimulates fatty plaques that have accumulated along the inner surface of heart vessels to dislodge, forming a partial or full blockage of the blood vessel. As a result, oxygen-rich blood is cut off from heart, causing heat cells to die -- which damages the heart -- and raising the risk for a heart attack.  

Inflammation also fosters blood clotting, while restricting body’s ability to dissolve clots. Again, this raises your risk for a heart attack (or stroke).

And inflammation can lead to breathing complications, ultimately making the heart work harder and damaging the heart muscle.

“Managing cardiovascular disease and its risk factors such as high blood pressure, high LDLs and triglycerides, smoking and obesity should be a priority right now,” says Bernard Kaminetsky, MD, medical director, MDVIP. “There are too many serious complications associated with COVID-19 and vascular issues. Make sure you visit your doctor regularly, take your medications as prescribed and live a heart-healthy lifestyle.”

Diabetes and Risk for COVID-19 Complications
People with diabetes, in general, are much more likely to experience life-threatening complications of COVID-19. Whether you have type 2 or type 1 diabetes, the key to lowering your risk for complications from COVID-19 is keeping your diabetes under control, according to the American Diabetes Association. High blood sugar can affect the body’s ability to fight off infection. And viruses can often cause blood sugar spikes, creating diabetic complications and leaving the body weaker in its fight against infection.

Viral infections also cause inflammation in people with diabetes — which can exacerbate complications. Finally, older people with diabetes often have other illnesses like heart disease – the number one complication of diabetes – that put them at additional risk. 

“The best advice I can give people with diabetes is to work with your doctor to keep it under control,” says Kaminetsky. “Well-managed diabetes tends to reduce the risk for severe complications.” 

Lung Disease and Risk for COVID-19 Complications
Chronic lung conditions such as asthma, bronchitis, emphysema, cystic fibrosis and pulmonary fibrosis tend to increase inflammation, lower immunity, trigger lung microbiome imbalances, cause lung damage and produce excessive mucus. And if you contract a respiratory virus like COVID-19, more inflammation is generated and the air sacs of the lungs fill with fluid, raising the risk for acute respiratory distress syndrome — or ARDS — a life-threatening breathing condition. Fluid-filled air sacs also means less oxygen can be transferred into the blood, making the heart work harder to deliver oxygenated blood to organs, potentially damaging the heart muscle. 

Experts also believe ACE2 receptors are to blame. ACE2 receptors are protein that live on the surface of cells throughout the body, including the respiratory tract. SARS-CoV-2, the virus that causes COVID-19, replicates and spreads throughout your body by injecting its genetic material into ACE2 receptors. Some studies have found people who smoke and those with chronic obstructive pulmonary disorder have more ACE2 receptors than people without lung disease, which puts them at greater risk for COVID-19 complications.

“Pulmonary patients should adhere to the standard advice for minimizing their COVID-19 risk, plus follow their treatment plans to the letter and keep their immune systems strong by eating plenty of vegetables and fruit, getting between seven and eight hours of sleep, exercising regularly and managing stress,” Kaminetsky says. 

Work with your primary care physician to diagnose, treat and control chronic conditions. Because they see fewer patients, MDVIP-affiliated physicians have more time to work with patients who have chronic conditions like diabetes, heart disease and chronic lung conditions. If you don’t have a primary care doctor, consider partnering with MDVIP. Find an MDVIP affiliate near you and begin your partnership in health »