Hello Dr. Smith. I hope you are doing well. This is a great information source and I appreciate the effort you put into it. I debate with friends all the time, and it seems like some are very worried and some are not concerned at all! Two simple questions that with maybe not a simple answer. Should middle-aged (45-60) healthy individuals be worried about COVID? Should parents be worried about sending kids to college? A better way to ask might be “are you worried and would/do you sent your kids to college?
Thanks! Stephen
BTW, more and more docs are accepting the quite obvious linkage b/t severe Covid-19 and obesity. However, they still seem reluctant to accept the "just as clear" linkage b/t diabetes and severe Covid-19.
Btw, obesity's main side effect physiologically is insulin-resistance or prediabetes.
Severely obese people, who don't have overt diabetes, are not at increased risk for serious influenza. They sure as hell are at risk for severe Covid-19.
We have had over 20 cases of DKA (diabetic ketoacidosis) and another 20 pts present with "New Onset" diabetes, like juvenile diabetics present.
And I am talking about a cohort of 400+ pts.
I have no idea why docs have been so slow to see the obvious.
A buddy asked me a few months ago why I am seeing what others aren't.
I have no idea was my answer, but these data are from pts' charts.
I didn't make them up.
We never see DKA or new onset diabetes in pts with bad flu or influenza.
This relationship is quite obvious and unique in the history of viral infections.
So, obese pts and those with diabetes are the ones at risk for serious Covid-19. These data amazingly consistent.
I think that's one of the things that perplexed me. These groups were not immediately recognized by other countries and by other US physicians.
Honestly, I have no idea why.
It is more than obvious.
We published these data early on.
I have collected data on several hundred more pts and the data are ridiculously consistent.
This relationship b/t diabetes/obesity and a viral infection is novel.
I guess that's why docs have been slow to accept the obvious.
Remember, obesity, esp. severe obesity, means problems with glucose metabolism and insulin resistance, even if the person isn't frankly diabetic.
Amongst the immunocompromised pts, we haven't seen much anything, unless you were diabetic and had a kidney transplant. When those pts get Covid, it gets very bad, very quick.
But we haven't seen other immunocompromised groups come in with severe Covid.
No other solid organ transplants.
No AIDS pts.
Not even Sickle Cell Disease pts.
And only ONE Lupus pt, who did very well, btw.
I do think that pts on one of certain immunosuppressive drugs, tacrolimus, sirolimus and everolimus, might be at increased risk for severe disease as well, but that's just a hunch.
So back to your first question, obese middle aged people should be worried and should get screened for the presence of diabetes or prediabetes. Ironically and maybe not coincidentally, HCQ is used to treat prediabetes.
As for you second question, Please, for God's sake, send your kids back to college, unless they are diabetic or severely obese or or have some other immunosuppression.
https://onlinelibrary.wiley.com/doi/10.1002/jmv.26227