Author : Shoba Suri

Expert Speak Health Express
Published on Mar 27, 2020
Food for thought in the wake of COVID-19 pandemic

Coronaviruses are a large family of viruses and COVID-19 is a new strain discovered in 2019. As of 26 March 2020, World Health Organization (WHO) reports over 4, 00,000 confirmed cases and more than 20,000 deaths due to COVID-19, with the numbers rapidly increasing with new cases being reported from different territories. From what experts know so far, certain co-morbidities place those who have contracted covid-19 at higher risk. According to the World Heart Federation, “non-communicable diseases (NCD), specifically chronic obstructive pulmonary disease, heart disease, hypertension and diabetes are major risk factors for developing severe symptoms of COVID-19.” This is corroborated by a recent study from China, which reports higher prevalence in patients with hypertension (30 percent), diabetes (19 percent), and coronary heart disease (8 percent). To begin with, NCDs are today the world’s biggest killers, leading to 71 percent of all deaths in 2018. Sixty-three percent of all deaths in India are attributed to NCDs, with 23 percent at risk of premature deaths.

COVID-19 is highly infectious, unlike the seasonal flu (which some are prone to compare it to). The virus affects persons with a compromised/weakened immune system. An unhealthy lifestyle has been a risk factor to the development of NCDs and associated comorbidities, and calorie deficits are known to weaken the immune system. A viral disease like COVID- 19 can spread fast, undetected and kill already immunocompromised populations – like the elderly, and those with chronic non-communicable disease.

Lancet has estimated an overall case fatality rate (CFR) for COVID-19 of three percent. WHO’s own estimate of the global death rate is 3.4 percent. For India, it is estimated at two percent. The CFR tends to vary depending on the number of deaths being recorded real-time. Indeed, according to Figure 1, Italy has a high CFR of 7.94 percent. 

Figure 1: COVID-19 death rate in countries as of 17 March (accessed at 11:30 am on 23rd March)

Source: Johns Hopkins 2020. WHO COVID-2019 Situation Reports ECDC 2020

Another important factor to note is that coronavirus does not affect all ages equally. A study by the Chinese Center for Disease Control and Prevention concludes that older people with pre-existing health conditions are more prone to getting affected by coronavirus. Figures 2a & 2b indicate the extent to which the virus can affect the elderly and the high death rate of almost 15 percent by COVID-19 as compared to less than one percent for the seasonal flu.

Figure 2 a: COVID-19 death rate by age (accessed at 11:30 am on 23rd March)

Source: Chinese Center for Disease Control and Prevention, February 2020

Figure 2 b: Flu vs COVID-19 death rate by age (accessed at 11:30 am on 23rd March)

Source: Chinese Center for Disease Control and Prevention, February 2020

More than two-thirds of deaths are of individuals with co-morbidities of non-communicable diseases (See Table 1). The death rate tends to vary by age, health conditions, and sex (See Figure 3).

Table 1: COVID-19 cases and deaths in China with co-morbidities

Co-morbid Condition Cases (%) Deaths (%)
Hypertension 12.8 39.7
Diabetes 5.3 19.7
Cardio Vascular Diseases 4.2 22.7
Chronic Respiratory Disease 2.4 7.9
Others 0.5 1.5

Figure 3: Proportion of COVID-19 deaths in China by age, health and sex

Source: Chinese Center for Disease Control and Prevention, February 2020

Italy, where the highest number of cases have been reported after China, is also the second largest in the world in terms of the ageing population. Nearly one-fourth (23 percent) of Italians are over the age of 65 years, with many having pre-existing conditions like hypertension and respiratory ailments; these predispose them to contracting COVID-19. (See Figure 1 for comparative death rates across countries).

An analysis of COVID-19 cases from the United States indicates the highest CFR in persons aged 65 years and above, indicating risk of disease and death. According to the report of the WHO-China Joint Mission on Coronavirus Disease 2019, at highest risk are people above 60 years of age with co-morbidities such as hypertension, diabetes, cardiovascular diseases and chronic respiratory diseases.

A study on COVID-19 hospitalized patients from Wuhan found almost half of the cases (48 percent) suffering from underlying chronic diseases. Of the total cases, 30 percent had hypertension, followed by diabetes (19 percent) and coronary heart disease (eight percent).

The South Asian region, meanwhile, has reported 1945 cases as of 26th  March, with twenty-seven deaths. Segregating the cases by country, Pakistan has the highest number of cases at 1057, followed by India at 649, Sri Lanka (102), Afghanistan (80), Bangladesh (39), Maldives (13), Nepal (3), and Bhutan (2). There have been a total of twenty seven deaths: India (13), Pakistan (8), Bangladesh (4), and Afghanistan (2).  A closer look at some of the death cases from India reveals some similarity. The case of 76-year-old man from Karnataka who had severe co-morbidities like hypertension, diabetes, and asthma.  The case of death reported from Delhi, of a 68-year-old woman with diabetes and hypertension. Maharashtra saw the death of a 63-year-old man having co-morbidities including hypertension, pneumonia, and increased heart rate. In Punjab, a 70-year-old man who also suffered from diabetes and cardiac ailments is the reported death so far. The two deaths in Gujarat, 70 and 85 years old with comorbid conditions succumbed to the virus. In Tamilnadu, a 55 year old with history of uncontrolled diabetes with hypertension has been reported. The cases from Pakistan and Bangladesh tell the same story. The deaths were of elderly individuals (≥ 70 year) suffering from co-morbidities of diabetes, cardiac conditions, and hypertension.

Researchers are exploring the utility of old drugs for treating COVID-19, until antivirals are developed. Meantime, the pillars of prevention are being highlighted across the world, including measures like handwashing, maintaining hygiene, and social distancing. At the same time, an important aspect is addressing the prevalence of the underlying health conditions that increase the risk of contracting coronavirus in certain individuals. The prevention of these NCDs to reduce the burden on health and development is indeed one of the targets for meeting the 2030 SDG agenda.

The risk to COVID-19 is higher in people with weak immune defences and can further be compromised in chronic conditions like heart disease, lung disease and diabetes. Adding to the burden can be emotional stress, lack of sleep and physical exhaustion, which can further make one prone to diseases by weakening immunity. The presence of risk factors for NCDs like tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol in childhood and adolescence has significant association with development of disease in adulthood. It is known that the shift in dietary patterns and physical activity reflect in the increasing prevalence of non-communicable diseases. Increased consumption of foods with high salt, high sugar, saturated fats and processed foods relate directly to a rise in NCDs.

Maintaining a healthy diet with food that boost immunity can help fight infections. Physical activity and nutrition have known to boost the immune system. Foods rich in Vitamin C, D, and E improve the immune system by increasing the infection-fighting cells. The antioxidant in Vitamin C & E plays an important role in controlling infections and functioning of the immune system. Diets poor in micronutrients (Iron, Zinc, Selenium, Vitamin A) cause negative effects on the immune system and have a synergistic role in reducing infection risk. Increasing the consumption of citrus fruits, bell peppers, garlic, ginger, spinach, yogurt, almond, turmeric, papaya in one’s daily diet can help strengthen immunity to fight infections. Also keeping the body hydrated and adequate sleep to increase protein associated with infection and inflammation can help in curtailing the disease.

It is important to keep in mind, however, that what works in combating COVID-19 itself is yet unknown. “Your immune system is (the) best weapon against coronavirus,” as said by a Turkish scholar. Strengthening the immune system with healthy nutrition may help equip people with a defence mechanism against viruses.

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Shoba Suri

Shoba Suri

Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...

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