Mike Gibson MS, MD (Cardiology, BIDMC) discusses various strategies to help reduce risks of cardiovascular events, especially during the COVID-19 pandemic.
MD Magazine – July 27, 2020
Risk Factors Causing Complications Due to COVID-19
Deepak Bhatt, MD, MPH: Welcome to this HCPLive® Peers and Perspectives presentation titled, “Reducing Cardiovascular Risks During COVID-19.” I’m Dr Deepak Bhatt from Brigham and Women’s Hospital and Harvard Medical School. I’m joined today by my good friend, Dr Mike Gibson, also from Harvard Medical School and from Beth-Israel Deaconess [Medical Center]. We are here to discuss various strategies to help reduce risks of cardiovascular events, especially during the COVID-19 [coronavirus disease 2019] pandemic. Welcome, and let’s begin.
First of all, Mike, I’ve got to say it’s great seeing you, albeit virtually. I’m looking forward to chatting with you a bit about COVID-19; hopefully there are some pearls that we can come up with for the audience. Before getting into the scientific, maybe I can start with the personal. You were someone who is not only treating COVID-19, but is a customer, so to speak. That is, you’ve gone through a lot with COVID-19 yourself and even your family. Do you care to share any of that with our audience?
C. Michael Gibson, MS, MD: Yes, Deepak. Like you, I traveled a lot. In February, in a week, I was on the road 5 different times to 5 different cities, including New York and Washington, DC. On February 25th, I got sick with cough, fever, and shortness of breath. I was barely able to walk across the room. It knocked me out for about a month. I was on the couch, listless, fatigued, and I experienced some GI [gastrointestinal] symptoms. It was very severe, and for my daughter-in-law, she had a headache and some GI symptoms, but about 5 days in, she became sick with shortness of breath. She got tested and was COVID-19 positive. My son had all the same symptoms as well. They were both ICU [intensive care unit] doctors at the Massachusetts General [Hospital], and they had to take some time off. Here in Boston, a lot of us were affected, including caregivers. It was early on for me, February 25th, and there was no testing available; it was right at the beginning.
Deepak Bhatt, MD, MPH: I’m glad you relayed what you personally experienced. People watching this segment are from all over the United States and all over the world, and they may be in a region that hasn’t yet been fully affected by COVID-19, but it will come eventually, and when it does, it’s unbelievable.
C. Michael Gibson, MS, MD: Can I give another word to the audience, Deepak? When I was 33, I had ARDS [acute respiratory distress syndrome] from varicella pneumonia: oxygen saturation in the 80s mm Hg, complete whiteout of my lungs, hepatitis, cerebritis, a platelet count of 10, everything. It’s a lot easier to breathe through a mask, and you’re a lot less short of breath breathing through a mask than if you have ARDS. I know it’s not a lot of fun to wear those masks, particularly an N95 mask, but it’s a lot better than having ARDS.
Deepak Bhatt, MD, MPH: That’s a good message for health care workers and people out there. Masking and social distancing are key, and I don’t think we can seem to say it enough.
Maybe we can get into some specifics about COVID-19, and perhaps you can describe to the audience what you think the risk factors are that make people more vulnerable to complications if they do get COVID-19, or to get COVID-19 in the first place.
C. Michael Gibson, MS, MD: Today, there was a publication that looked at a random sample of 61,000 people from Spain. For me, at least, what was striking was that the prevalence of antibody tests being positive was fairly constant. It’s about 5%, and it was similar across a lot of age groups. It didn’t vary that much. It didn’t vary by gender. In terms of being infected, it was fairly constant across a broad group of people.
For Spain, at least, there was no difference based upon socioeconomic status. That’s different than in the United States when you look at cities like Baltimore. For people who were Hispanic, in the last week, they had a 42% rate of testing positive. Here in Boston, Deepak, 36% of the Latinx community in some of our densely populated areas were positive.
The theory is that, in the Latinx community, there’s greater population density. They have work that requires that they go into the workplace. They can’t work from home as often, and they are facing a higher risk of getting the infection.
When it comes to who’s at greater or greatest risk of complications, the story is a little different. There, you see the people who are older, they are at much higher risk. Diabetics face a higher risk. Deepak, you may know that, in the past week, there were some data that showed that the virus can attack the islet cells. Some people can develop new onset of diabetes, so it’s not just old diabetes being at risk, but you’re at risk of contracting diabetes.
Other comorbidities like high blood pressure have been a risk factor. For me, it’s a little confusing. I’m not sure if it’s the high blood pressure itself, or if the high blood pressure is a marker or a surrogate of some kind of ACE [angiotensin-converting enzyme] receptor pathogenesis here or treatment with drugs. That one’s a little less clear in my mind.
The other big issue is race and mortality. People in, say, Latinx or black communities may have a higher risk of contracting the virus. That may, in turn, lead to higher mortality or greater numbers of people dying of those different ethnicities. There was a New England Journal of Medicine article that compared people of black to white ethnicities. If you do a race where both parties have equal numbers of patients, their relative risk was the same. It may be driven by a greater number of people of those ethnicities being hospitalized, rather than a greater risk once they are hospitalized, at least in TheNew England Journal of Medicine article.
It’s complicated, but older people and those with comorbidities seem to be our highest-risk patients. Who are those people? There tend to be a lot of nursing home patients who’ve been devastated by this disease.