Probably the biggest fear to come out of the COVID-19 pandemic is the fear of the unknown. This is understandable since we are dealing with a virus which is largely alien to humans.

But as the virus has spread around the globe, so scientists have started finding answers to their questions, one of which has become an absolute certainty:

If you have a chronic or underlying disease that has compromised your immune system, you are at a higher risk of developing severe symptoms or complications if you become infected with COVID-19.

In this article, we address the questions people often ask about the link between chronic diseases (comorbidities) and COVID-19. We focus on the most common comorbidities that people need to be aware of. But the principles apply to any person who is living with a chronic disease, whether it is a rare or common one. Similarly, all elderly people are more vulnerable, because typically the immune system does not function as well when you grow old.

Frequently Asked Questions

1. What is a comorbidity?

Comorbidity is the presence of one or more additional medical conditions often co-occurring or co-existing with a primary condition. In the context of COVID-19 it refers to existing chronic diseases that could put people at a higher risk of developing complications if they are infected with the Coronavirus.

People across all ages with existing comorbidities like diabetes and hypertension – which seem to be the most prevalent – are more at risk of becoming severely ill if they get COVID-19. This is why the Health Department is urging all South Africans to play their part in protecting the more vulnerable members of society – people with comorbidities at any age and people aged 59 and older with or without comorbidities – from becoming infected with the virus.

2. What comorbidities put people at a higher risk of contracting severe symptoms of COVID-19?

According to the Centre for Disease Control and Prevention (CDC), the top five comorbidities are hypertension, obesity, chronic lung conditions like TB, COPD (chronic obstructive pulmonary disease), asthma and cystic fibrosis,  diabetes, and cardiovascular conditions like coronary heart disease, congenital heart disease and heart failure.

Other individuals at risk are older adults, aged 59 and over, people with autoimmune illnesses as well as compromised or suppressed immune systems due to cancer treatments or steroids. Pregnant women are also at a slightly higher risk.

COVID-19 severe symptoms mean your oxygen levels are below 93% and you require hospitalisation. If you are a person at higher risk, don’t panic because it also depends on how your comorbidities are being managed, the strength of your immune system and how much of a viral load you get exposed to, which will affect the risk factor even more. In other words, it is usually a combination of issues which lead to you getting severe symptoms.

3. If I have a comorbidity like hypertension, diabetes, asthma or heart disease but my immunity is usually very strong at fighting regular illnesses like colds and flu, does this put me at high risk of contracting COVID-19?

The presence of comorbidities does not necessarily put you at higher risk for contracting COVID-19, as everyone is equally at risk of becoming infected. Which is why we must all take precautions to prevent infection, including practicing social distancing and good hygiene (hand washing, sanitising and wearing a mask).

However, should you get infected and also have a comorbidity, you have a higher risk of getting it more severely. The severity of your symptoms will depend on how well you are taking care of yourself and managing your pre-existing condition.

4. If I have comorbidity, how can I give myself the best chance of recovery, in the event of contracting COVID-19?

The most important ways to protect yourself against the severity of the disease are :

• Boost your immune system with the supplements Vitamin C, Vitamin D and Zinc
• Maintain a healthy lifestyle and eating habits and exercise regularly
• Continue with your usual treatment – make sure you never miss out on even a day of medication
• Monitor and control your blood pressure if you suffer from hypertension
• Monitor and control your glucose levels if you have diabetes
• If you suffer from obesity, make every effort to lose weight
• Make sure you have an adequate supply of medicine
• Reduce exposure to tobacco smoke
• Get seven to eight hours of sleep
• Keep well hydrated, preferably by drinking water
• Take care of your mental health by remaining calm and positive – try not get caught up in a cycle of stress

5. If you are younger than 59 with a comorbidity are you still at a high risk?

Certain underlying medical conditions may increase risk of serious COVID-19 disease for individuals OF ANY AGE. These include, but are not limited to, cancers, chronic lung disease including asthma, chronic bronchitis or emphysema, diabetes, chronic kidney, lung or heart disease. You must take steps to lower your risk of getting infected in the first place. In addition, do your best to keep your chronic conditions well controlled

6. One of the members in my household is being treated for cancer; how do we keep her safe from getting COVID-19?

Cancer patients on treatment are immunosuppressed and at a higher risk of developing severe symptoms if they become infected. The first course of action is to minimise their risk of potential infection.

Here are some good prevention tips for cancer patients:

• Stay at home
• Follow strict social distancing rules when out in public
• Never shake hands or hug
• Practice diligent hand washing with soap and water or apply sanitiser to hands after contact with surfaces inside and outside your home
• Wear a face mask in public, crowded or small and enclosed places
• Eat well and get plenty of sleep, which helps keep your immune system healthy

7. Why are people with rheumatologic (autoimmune) disease at a high risk?

Rheumatologic or autoimmune disease is characterised by inflammation that affects the connecting or supporting structures of the body – most commonly the joints but also, tendons, ligaments, bones and muscle. Some rheumatic diseases can affect the organs of the body.

People with rheumatic diseases are at increased risk of developing severe symptoms should they become infected with COVID-19.  This is due both to the disease itself and to the immunosuppressant medication used to treat these diseases. This vulnerability can affect people living with rheumatic conditions such as lupus, myositis, rheumatoid arthritis, scleroderma and many others.

8. Why are people with diabetes at high risk?

People with diabetes are at increased risk of developing severe symptoms and related complications from COVID-19. Diabetes patients have impaired immune response to infection. Poor glycaemic control impairs several aspects of the immune response to viral infection and also to potential secondary bacterial infection in the lungs.

Many patients with type-2 diabetes are obese, and obesity is also a risk factor for severe infection. Diabetes complications such as kidney disease and cardiac disease increases the severity of COVID-19 infection.

People with type-1 diabetes who have their blood sugar well controlled are at less risk of infection and getting severe COVID-19.

9. Why are people with hypertension at a high risk?

Hypertension, or high blood pressure, is the most common comorbidity globally. For older South Africans this poses a concern because it is quite common for people over the age of 60 to develop higher than normal blood pressure (according to StatsSA).

In fact, hypertension frequently co-exists with other underlying conditions such as diabetes, obesity and cardiovascular complications.

In patients with COVID-19, untreated hypertension is associated with approximately twofold increase in mortality, compared with treated hypertension. Doctors are therefore cautioning patients with high blood pressure to keep taking their medication and individuals older than 59 should have their blood pressure checked.

10. Why are people with cardiovascular diseases at a high risk?

Cardiovascular disease, involving disorders of the heart and blood vessels, is the third-biggest killer in South Africa after TB and diabetes. It is often linked to obesity, uncontrolled high blood pressure, smoking, diabetes and high cholesterol.

When blockages stop the blood flow from the arteries to the heart or brain, you can have a heart attack or stroke. Severe COVID-19 can damage your lungs which then causes your blood oxygen level to drop. It can also bring about inflammation which is more likely to make blood clots as well as cause your blood pressure to drop. When this happens, your heart has to pump faster and harder to circulate oxygen, and can strain a weak heart.

11. Why are people with obesity at high risk?

Did you know that at least 70% of South African women and something like a third of the country’s men are unhealthily overweight or obese? This means that more than eight million people live with obesity. This figure is higher than the number of South Africans living with HIV. One of the biggest reasons so many people suffer from obesity is a poor diet high in sugar.

People living with obesity are at higher risk of experiencing severe symptoms if they contract COVID-19. Obesity can also cause a chronic inflammatory state which affects immunity, which means that people who are overweight are more likely to get infections.

Multiple comorbidities are also common with obesity, such as type 2 diabetes and asthma, which affect the severity of the disease.

12. If my young child has asthma or diabetes, does this put him or her in the high-risk category?

Most children experience mild symptoms of COVID-19 if they become infected. They may even remain asymptomatic, but they can still be carriers and spread the virus.

However, children with certain underlying medical disorders may experience severe symptoms if they become infected. The types of disorders are asthma, diabetes and chronic kidney, lung, liver or heart disease.

Your child should continue to take his or her chronic medication to lower the risk of getting severely ill with COVID-19. Oral steroids and aerosol measures to control asthma should be continued to reduce the risk of complications.

13. Are there any medications for comorbidities that may put you at higher risk of experiencing severe COVID-19 symptoms?

Medications that suppress your immune system, like chemotherapy, may increase your chances of becoming severely ill if you are infected by COVID-19. However, it has not been proven that certain chronic medications, such as those used for hypertension and anti-inflammatories for pain and arthritis, might put you at greater risk.

How you respond to infection depends on many factors, medication being only one of them. It would be best to consult with your doctor first before changing your medication or stopping it altogether because this could make your underlying condition worse.

Medication compliance is essential in all chronic conditions and should only change if your doctor says so. Except for oral steroids (such as Prednisolone, Dexamethasone or Hydrocortisone) using prescribed medication should continue as normal during the COVID-19 pandemic. Do not take experimental and hypothetical drugs which you hear about without consulting with a specialist first.

14. I am taking my treatment for TB; what do you suggest I do if I become infected with COVID 19?

If you are experiencing mild symptoms, which may or may not be COVID-19 related, it is important to carry on taking your TB treatment to completely cure your TB. Also, inform your TB treatment provider and find out how to access COVID-19 diagnostic services it if you need to. There is no evidence currently that TB medications increase your risk of developing severe COVID-19 symptoms.

If you are diagnosed with COVID-19, let the healthcare provider know that you are on TB treatment. If you have been started on any treatment for COVID-19, your care provider can make sure there are no drug-to-drug interactions with other medications. This is particularly important if you are on treatment for drug-resistant TB as you are on more medications and you may be at more risk of drug-to-drug interactions.

As the impact of COVID-19 on people with TB and on treatment is unknown, you should, if possible, practice strict social distancing, wear a mask at all times around people and control infections to minimise your risk of getting infected.

15. Since the symptoms for TB are quite similar to COVID-19, what should a person look out for to know whether they have one or the other illness?

The symptoms of COVID-19 can be similar to those of TB, such as fever, cough and shortness of breath, but there is usually a difference in the speed that the symptoms start. COVID-19 symptoms are likely to come on much more quickly.

If you come into contact with someone known to have either TB or COVID-19, that increases your chance of contracting these diseases. If you are unwell and are showing the above symptoms and have been in contact with someone with either TB or COVID-19, it is important that you are tested for both. When you visit the healthcare facility, let them know your symptoms and any risk factors you may have for either TB or COVID-19 so they can ensure the appropriate infection prevention and control measures can be implemented while you wait for your diagnosis.

16. I have recovered from TB, does this still make me vulnerable to getting severe COVID-19 disease or becoming infected at all?

As COVID-19 is so new, there are no data currently on whether those who have TB or who have a previous history of TB are more at risk of worse outcomes. However, COVID-19 affects the lungs and, as we know, there is usually some left-over damage in the lungs following TB disease, which may put you at increased risk of developing more severe COVID-19 symptoms.

People who have had TB, particularly those who have had lung surgery or were diagnosed with post-TB lung disease, should consider avoiding exposure to high risk situations.

In addition to the advice regarding regular handwashing, regular cleaning of surfaces, wearing of masks in public and practicing social distancing measures, some of the ways to protect yourself include keeping in good general health and not smoking.

Thank you to these Lenmed doctors below who kindly assisted us with answers to these frequently asked questions.

The lenmed Group is a world-class chain of Private Hospitals that brings quality healthcare to communities across Southern Africa.

For more information please contact:

Dr H Bacus
Endocrinologist
MBChB (Natal), FCP (SA), Certificate Endocrinology & Metabolism (SA)
Shifa Private Hospital
Tel: +27 (0) 31 208 5092

Dr F Amod
Infectious Disease Specialist
MBChB, FCPath (micro), FCP (medicine)
Shifa Private Hospital
Tel: +27 (0) 31 240 5260

Dr RS Mistry
Physician
FCP SA (1996), MBBCh (WITWATERSRAND) (1989)
Ahmed Kathrada Private Hospital
Tel: +27 (0) 11 854 1489
Email: [email protected]

The lenmed Group is a world-class chain of Private Hospitals that brings quality healthcare to communities across Southern Africa.

Disclaimer: Any information contained here is merely a guideline. Always visit your healthcare practitioner for any health-related advice or diagnosis.