Why do some people die with COVID-19 and some others are not affected?

It seems that the new coronavirus that causes COVID-19 affects some people more than others, as some people have only mild symptoms, others have more symptoms and are hospitalized and require respirators. Although scientists initially thought that age was the dominant factor, with young people avoiding the worst results, new research has uncovered a host of features that influence disease severity. These effects can explain why there are some perfectly healthy 20-year-olds who have the disease in difficult situations, while 70-year-olds avoid the need for critical interventions.

These risk factors include:

- Age
- Diabetes (type 1 and type 2)
- Heart disease and high blood pressure
- Smoking
- Obesity
- blood type
- Genetic factors
- Sex

First age

About 8 out of every 10 COVID-19 deaths in the U.S. have occurred in adults ages 65 and older, according to the Centers for Disease Control and Prevention (CDC). The risk of death from infection, and the possibility of hospitalization´-or-extensive medical care, increases dramatically with age. For example, adults aged 65-84 make up an estimated 4-11% of COVID-19 deaths in the United States, while adults ages 85 and older make up 10-27%.
This trend may be partly due to the fact that many elderly people suffer from chronic medical conditions, such as heart disease and diabetes, which can exacerbate symptoms of COVID-19, according to the CDC. Stat News reported that the ability of the immune system to fight pathogens decreases with age, which makes the elderly vulnerable to severe viral infection.


Secondly, diabetes, a group of diseases that lead to high blood sugar levels, also appears to be linked to the risk of more severe COVID-19 cases.
The most common form is type 2 diabetes, which occurs when body cells do not respond to the hormone insulin. As a result, the sugar that would have been transferred from the bloodstream to the cells for use as energy accumulates in the bloodstream. (When the pancreas makes little´-or-no insulin in the first place, the condition is called type 1 diabetes.
In a review of 13 related studies, scientists found that people with diabetes were approximately 3.7 times more likely to develop a critical condition of COVID-19´-or-die from disease compared to patients with COVID-19 without any underlying health conditions (including diabetes) , High blood pressure, heart disease´-or-respiratory disease), they reported this in April in the journal Infection.
However, scientists do not know whether diabetes --dir--ectly increases its severity´-or-whether other health conditions that appear to be associated with diabetes, including cardiovascular and kidney diseases, are the cause.
This is consistent with what researchers have seen with other injuries and diabetes. For example, scientists reported on April 9 in the journal Diabetes Research and Clinical Practice that influenza and pneumonia are more common and more dangerous in elderly people with type 2 diabetes. In a literature search for relevant studies looking at the relationship between COVID-19 and diabetes, the authors of this paper have found some possible mechanisms for explaining why diabetes can be worse when infected with COVID-19. These mechanisms include: "chronic inflammation, increased thrombolytic activity, poor immune response and possible --dir--ect pancreatic damage caused by SARS-CoV-2".

Research has shown that the development of type 2 diabetes is linked to changes in the body s immune system. This link could also play a role in the poorest outcomes in a person with diabetes who suffers from SARS-CoV-2, the virus that causes COVID-19.

No research on this virus and the immune response has been examined in diabetics. However, in a study published in 2018 in the Journal of Diabetes Research, scientists found through a review of previous research that patients with obesity´-or-diabetes showed that the immune system was out of weakness, with weak white blood cells called Natural Killer (NK B cells and cells, both of which help the body fight infection. The research also showed that these patients have an increase in the production of inflammatory molecules called cytokines. When the immune system produces many cytokines, the so-called "cytokine storm" can erupt and damage the body s organs. Some research has indicated that cytokine storms may be responsible for causing serious complications in people with COVID-19. In general, type 2 diabetes has been linked to a weak system itself in the body that helps fight infections such as COVID-19 and can explain why a person with diabetes is at risk of severe infection.
Not all people with type 2 diabetes have the same risk, though: A study published in May in the journal Cell Metabolism found that people with diabetes who maintain blood sugar levels in a tighter range are less likely to develop a disease cycle Severe of those who have more fluctuations in blood sugar levels.

Scientists are not sure whether this high risk of severe COVID-19 infection also applies to people with type 1 diabetes (T1D). A coordinated study by T1D Exchange - a non-profit research organization focused on treatments for type 1 diabetes - began in April to study the results of T1D patients with COVID-19. When a person with T1D becomes infected, blood sugar levels tend to rise to dangerous levels and acid can accumulate in the blood, which is called diabetic ketoacidosis. As such, any serious injury to a person with type 1 diabetes can be severe.


Third, heart disease and high blood pressure

People with conditions that affect the cardiovascular system, such as heart disease and high blood pressure, generally have worse complications than COVID-19 than those without pre-existing conditions, according to the American Heart Association. However, historically healthy people can also experience heart damage from viral infection.

Life Science reported that the first death from a coronavirus in the United States, for example, occurred when the virus somehow damaged a woman s heart muscle, causing it to eventually explode. The 57-year-old maintained good health and exercised regularly before infection, and she reportedly had a healthy heart of "normal size and weight". A study of COVID-19 patients in Wuhan, China, found that more than 1 in 5 patients had heart damage - some of the patients who had samples had severe heart conditions, and some had not.

By seeing these patterns emerge, scientists have developed many theories about why COVID-19 has affected both damaged and healthy hearts, according to the Live Science report.

In one scenario, by attacking the lungs --dir--ectly, the virus may deplete the body s supply of oxygen to such an extent that the heart must work harder to pump oxygenated blood through the body. The virus may attack the heart --dir--ectly, because the cardiac tissues contain the angiotensin---convert--ing enzyme (ACE2), a molecule that is attached to the virus to infect cells. In some individuals, COVID-19 can also trigger an excessive immune response known as cytokine, as the body becomes severely inflamed and the heart can suffer damage as a result.

Fourthly smoking

People who smoke cigarettes may be vulnerable to severe COVID-19 infection, which means that they face an increased risk of pneumonia, suffer from organ damage and need breathing support. A study of more than 1,000 patients in China, published in the New England Journal of Medicine, illustrates this trend: 12.3% of current smokers included in the study were admitted to the intensive care unit, ventilated´-or-died, compared to 4.7 % Of non-smokers.
Cigarette smoke can make the body vulnerable to coronavirus infection in several ways, according to a recent Live Science report. Basically, smokers may be susceptible to viral infection because exposure to smoke suppresses the immune system over time, damages the tissues of the respiratory system and causes chronic inflammation. Smoking is also associated with many medical conditions, such as emphysema and atherosclerosis, which may worsen the symptoms of COVID-19.

A recent study, published on March 31 on the bioRxiv prepress database, suggested a more speculative explanation for why COVID-19 infected smokers more strongly. Initial research has not yet been reviewed by peer, but early interpretations of the data indicate that smoke exposure increases the number of ACE2 receptors in the lungs - a receptor that is connected to SARS-CoV-2 for cell injury.

Many receptors appear on so-called cup and club cells, which secrete mucus-like fluid to protect respiratory tissues from pathogens, debris and toxins. These cells certainly grow in number the longer a person smokes, but scientists do not know whether the subsequent increase in ACE2 receptors translates --dir--ectly into symptoms of COVID-19 worse. Moreover, it is not known whether high ACE2 levels are relatively unique to smokers,´-or-common among people with chronic lung disease.

Fifth, obesity

Numerous early studies have suggested a link between obesity and the most serious COVID-19 disease in people. One study, which analyzed a group of COVID-19 patients under the age of 60 in New York City, found that those who were obese were twice as likely to be hospitalized as twice as non-obese and were 1.8 times admitted to critical care.
"This has important and practical implications" in a country like the United States where about 40% of adults suffer from obesity, the authors write in the study, which was accepted in Clinical Infectious Diseases but not yet reviewed´-or-published. Likewise, another preliminary peer-reviewed study found that the two largest risk factors for hospitalization from coronavirus are age and obesity. This study, published in medRxiv, looked at data from thousands of patients with COVID-19 in New York City, but studies from other cities around the world found similar results, according to the New York Times.

A preliminary study from Shenzhen, China, which was also not subject to peer review, found that COVID-19 patients with obesity more than doubled their risk of developing acute pneumonia compared to patients of normal weight, according to the report published in a previous online edition in The Lancet Infectious magazine. Diseases. The researchers stated that those who are overweight but not obese, have an 86% higher risk of developing acute pneumonia than people with "normal" weight. Another study, accepted in the Journal of Obesity and Peer Review, found that approximately 124 COVID-19 patients admitted to the intensive care unit in Lille, France, were obese.

The researchers wrote in the study that it is not clear why obesity is associated with more hospitalization and more severe COVID-19 disease, but there are many possibilities. Obesity is generally seen as a risk factor for severe injury. The researchers wrote, for example, that those who were obese had a longer and more severe disease during the swine flu epidemic. Obesity patients may also experience decreased lung capacity´-or-increased inflammation in the body. More inflammatory particles scattered in the body may cause harmful immune responses and lead to severe disease.


Sixth blood type

The blood group appears to predict a person s susceptibility to CoV-2, although scientists have not found a link between the blood group itself and the severity of the disease.

Jiao Zhao, from Southern University of Science and Technology, Shenzhen, and colleagues examined the blood types of 2,173 patients using COVID-19 in three hospitals in Wuhan, China, as well as the blood types of more than 23,000 non-COVID-19 people in Wuhan and Shenzhen. The researchers found that individuals with group A blood types (A-positive, A-negative and AB-positive, AB-negative) were more likely to develop the disease compared to non-A-group types. Scientists wrote in the medRxiv prepress database on March 27 that people with blood type O (negative O and positive O) had a lower risk of infection compared to non-O blood types. The study was not reviewed by their peers in this field.
In a recent study on blood type and COVID-19, published online on April 11, by medRxiv, scientists looked at 1,559 people who had been tested for SARS CoV-2 at Presbyterian Hospital in New York. Of these, 682 were tested positive. Individuals with blood types A (positive and negative A) were 33% more likely to test positive compared to other blood types and both positive and negative blood types were less likely to have a positive test than other blood groups. (There is a 95% chance that the increase in risk will rise from 7% to 67% more.) Although only 68 individuals from the AB blood group were included, the results showed that this group was also less likely than others to test COVID -19.

Coronavirus causes damage to various parts of the body.

The researchers studied the association between blood type and risk factors for COVID-19, including age, gender, and whether a person is overweight, and other basic health conditions such as diabetes, high blood pressure, lung disease, and cardiovascular disease. They found that some of these factors were related to the blood group, with a link between diabetes and negative blood types B and B A, and between weight gain and positive blood groups O, for example, among others. When they consider these connections, researchers still find an association between blood type and COVID-19 sensitivity. When researchers pooled their data with research done by Zhao and colleagues outside China, they found similar results as well as a significant decrease in positive COVID-19 cases among members of blood group B.
Why the blood type does not increase´-or-decrease the person s risk of developing CoV-2 is unknown. A person s blood type refers to the type of specific antigen that covers the surface of blood cells. These antigens produce specific antibodies to help fight pathogens. Previous research has suggested that at least in the SARS-CoV coronavirus, antibodies to A have helped inhibit the virus--;-- This same mechanism could be with SARS-CoV-2, blood type O helps individuals prevent virus, according to Zhao s team.


Seven genetic factors

Many medical conditions can worsen symptoms of COVID-19, but why do healthy people sometimes have a history of serious illness´-or-die from the virus? Scientists suspect that certain genetic factors may make some people particularly vulnerable to the disease, and many research groups aim to locate where these vulnerabilities exist in our genetic code.

Science has reported that genes that --dir--ect cells to build ACE2 receptors may differ in one scenario between people who have a severe infection and who have no symptoms at all. Instead, the differences may lie in genes that help rally the immune system against invasive pathogens, according to a recent Live Science report.

For example, a study published on April 17 in the Journal of Virology indicates that certain combinations of human leukocyte antigen (HLA) genes, which train immune cells to recognize germs, may be protective against SARS-CoV-2, while combinations leave The other body is open to attack. HLAs represent only one gear in our immune system, so its relative impact on COVID-19 infection remains unclear. Additionally, the Journal of Virology study used computer models only to simulate HLA activity against coronavirus. Clinical and genetic data from COVID-19 patients will be required to clarify the role of HLAs in real-world immune responses.

Eighth sex

COVID-19 hits men more than women. Experts say biology and behavior may be one of the reasons why more men than women develop COVID-19 and die from illness. Numerous studies have shown that more men than COVID-19 die than women.
Part of the reason, experts say, is that women have stronger immune systems than men. They add that men also tend to engage in more risky behavior such as ignoring physical exclusion and not taking symptoms seriously.

More men than COVID-19 die worldwide more than women, and the possible causes extend from biology to bad habits.

Men and women are more likely to be infected with the new coronavirus, a study published last month in Frontiers in Public Health said. However, the researchers also reported that men are more likely to suffer from the severe effects of the disease.
Chinese researchers said that in a large subgroup of COVID-19 patients, more than 70 percent of the dead were men. They said they found similar results when they examined research for an outbreak of severe acute respiratory syndrome (SARS) in 2003.

The World Health Organization (WHO) reported that 63 percent of COVID-19 deaths in Europe were among men. A study conducted by the Institute of Higher Health in Rome in March found that among Italians who were hospitalized with the new Corona virus, 8 percent of men died compared to 5 percent of women.
In New York City, men die about the coronavirus almost twice as often as women. The city s Ministry of Health reported in early April that 43 COVID-19 deaths per 100,000 men, compared to 23 deaths per 100,000 women.

Some of the reasons why COVID-19 may be more deadly to men than women may include the fact that heart disease is more common in elderly men than in older women. ”Dr. Stephen Berger, an infectious disease expert and co-founder of the World Health Network for Infectious Diseases and Epidemiology (GIDEON) ), Studies also found that high blood pressure and liver disease are more prevalent in men and these all contribute to more negative outcomes using COVID-19.

Women have higher concentrations of ACE2 in their blood than men, a study published on May 10 reported. The researchers reported that ACE2 enables coronavirus to infect healthy cells, and this may help explain why men are more likely to develop COVID-19 than women. The immune system may also be a factor.

Genetics may also play a big role. Because of their increased X chromosome, women have a stronger immune system and response to infection than men.

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