At 162 kg (357 pounds), Mumbai resident Trishala Jain always knew that her weight was a problem. She had tried many exercise regimens and joined gyms to work out but could not stick to a routine. This month, when the novel coronavirus struck 29-year-old Jain, her obesity became the greatest risk factor that could hinder her recovery. Doctors said that her young age was probably the only saviour.
As Covid-19 rages throughout India, doctors are increasingly noticing how obesity plays a dangerous role along with the novel coronavirus infection. From worryingly low levels of oxygen in the blood, prolonged dependency on oxygen support to higher chances of being put on a ventilator, excess weight puts Covid-19 patients in the high-risk category.
“In people with obesity, the excess body fat, mainly the abdominal fat, hinders the process of lung expansion during breathing,” said consulting physician Gautam Bhansali from Bombay Hospital, who treated Jain. “As the coronavirus attacks the lungs, patients struggle to breathe, and in obese patients, the deterioration can be rapid as their lungs already don’t have enough space to expand.”
Jain spent five out of nine days in the hospital in the Intensive Care Unit, struggling to breathe on her own. As her blood oxygen levels dropped drastically, she had to be put on 15 liters (4 gallons) of oxygen per minute.
“The normal oxygen levels are between 99 and 100, but Jain’s oxygen saturation had dropped to 81,” said Bhansali. “Because of obesity, such patients also retain more carbon dioxide in their body, which again is a serious challenge. We detect the CO2 level in the patients through a blood test called Arterial Blood Gas (ABG). Less oxygen and high CO2 is a clear indicator that the lungs are not doing good.”
Bhansali said that Jain recovered quickly because she is young and did not have any other comorbid conditions. However, another Covid-19 patient with obesity, 62-year-old Mehnaz Lokhandwala, who was treated by Bhansali, required 34 days of hospitalization. Lokhandwala weighed 172 kg (379 pounds).
“Besides obesity, I am also borderline diabetic and hypertensive,” Lokhandwala told Zenger News. She was diagnosed with breast cancer and her surgeon had advised a Covid-19 test before her operation.
“The first test I did was negative, but the second one returned positive,” said Lokhandwala, who was discharged from the hospital on Oct. 2. But she continues to require small amounts of oxygen while sleeping and during her physiotherapy sessions.
According to Bhansali, the biggest fear while treating such patients is invasive ventilation.
“These patients don’t do great after they land on ventilator support,” said Bhansali. “Fortunately, in the case of Lokhandwala, we were able to manage her on high flow oxygen at first and on a Bilevel Positive Airway Pressure (BiPAP) machine later on.”
Lokhandwala lost 20 kg (44 pounds) while battling Covid-19. “I hope to keep up with the weight loss now by consulting an endocrinologist and following a diet,” she said.
Obesity and overweight pose a major risk for chronic diseases, including Type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer, according to the World Health Organization.
“The rising epidemic reflects the profound changes in society and in behavioral patterns of communities over recent decades,” the WHO states. “While genes are important in determining a person’s susceptibility to weight gain, energy balance is determined by calorie intake and physical activity.”
A revised guidance issued by the U.S. Centers for Disease Control and Prevention (CDC) on Oct. 6 points to the “increased risk of severe illness from the virus that causes Covid-19 among adults with Covid-19 who have obesity, who are overweight, or who smoke or have a history of smoking.”
“The recovery rates of Covid-19 patients who are morbidly obese are very low,” said Dr. Hemant Deshmukh, dean of the civic-run King Edward Memorial Hospital in Mumbai, one of the main centers handling high-risk Covid-19 patients. “Their treatment outcome is not good. We have lost many patients with obesity and diabetes.”
According to Deshmukh, their observations have shown that patients with central obesity (excess fat in the abdominal area) have developed high blood sugar levels due to the infection. “Such patients had to be put on medication for diabetes, and we don’t know how long they will go on with high sugar levels,” he said.
A July 2020 paper also stated that outcomes with Covid-19 are worse in those who are obese, and that a significant proportion of those needing intensive care are overweight or obese.
“Patients with obesity are at high risk of mortality from COVID-19 infection,” the paper concluded. It said that age, critical illness, need for advanced respiratory support and severe comorbidities are also risk factors for mortality.
Medical experts also saw the link between obesity and high mortality during the outbreak of respiratory virus H1N1, the swine flu, in 2015.
(Edited by Uttaran Das Gupta and Judy Isacoff.)
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