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Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day fifty since

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Speaker 1: coronavirus was declared a global pandemic. Our main story. We

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Speaker 1: know that older people and those with lung disease and

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Speaker 1: serious heart conditions are at a higher risk of dying

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Speaker 1: from COVID nineteen, but researchers are learning that other factors

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Speaker 1: can also make the virus deadly. Two of them are

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Speaker 1: smoking and obesity. Understanding that also helps us understand why

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Speaker 1: the virus seems to work differently in different places. But first,

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Speaker 1: here's what happened today. If it's Thursday, that means it's

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Speaker 1: another week where we talk about a number in the

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Speaker 1: millions that we used to count in the hundreds of

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Speaker 1: thousands unemployment. Over three eight million Americans filed for unemployment

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Speaker 1: benefits last week. Since the pandemic began shutting down businesses

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Speaker 1: across the country six weeks ago, over thirty million have

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Speaker 1: now applied. Tomorrow, we'll find out what the unemployment rate

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Speaker 1: was for the month of April, but experts say it

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Speaker 1: could be as high as we haven't seen a number

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Speaker 1: like that since the Great Depression of the nineteen thirties.

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Speaker 1: The Food and Drug administration says it is moving at

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Speaker 1: lightning speed to review data on the experimental COVID nineteen

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Speaker 1: treatment rem dessevere made by Gilliad Sciences. Yesterday, an important

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Speaker 1: US trial showed promising results for the drug, but on

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Speaker 1: the very same day, the lance AT journal published a

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Speaker 1: fully vetted small Chinese study that showed different less promising results.

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Speaker 1: F d A Commissioner Stephen Hahn said the agency was

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Speaker 1: prioritizing speed while at the same time reviewing all of

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Speaker 1: the data to decide how to regulate the drug. In

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Speaker 1: other drug news, Astra Zenica agreed to make an experimental

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Speaker 1: coronavirus vaccine developed by Oxford University researchers. Astra's goal is

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Speaker 1: to have the capacity to produce one hundred million doses

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Speaker 1: by the end of the year. The company is one

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Speaker 1: of dozens around the world that have joined the race

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Speaker 1: to produce an effective vaccine. The Trump administration this week

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Speaker 1: announced an effort to make shots available to Americans by

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Speaker 1: the end of the year. The agreement between Astra and

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Speaker 1: Oxford shows that drug developers are planning to manufacture vaccines

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Speaker 1: even before they've cleared human tests. Creating an effective vaccine

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Speaker 1: is key to getting back to normal life. But Brazil

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Speaker 1: isn't waiting. In the country that's has to becoming a

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Speaker 1: global hotspot of the pandemic. Some states have dialed back

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Speaker 1: restrictions on malls, gyms, and churches. Demand is up at

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Speaker 1: gas stations across the country. Even residents of South Paulo,

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Speaker 1: where restrictions remain in place, are getting out more. According

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Speaker 1: to government tracking data, a poll shows that support for

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Speaker 1: isolation measures is fading. On Tuesday, Brazil reported its highest

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Speaker 1: number of deaths since the pandemic hit the country in

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Speaker 1: late February. It's twenty four. Our fatality rate lags only

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Speaker 1: the US and the UK, and now our main story.

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Speaker 1: As COVID nineteen spreads, doctors are learning more about why

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Speaker 1: some patients get very sick and why others only get

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Speaker 1: mildly ill. Some of the people most at risk for

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Speaker 1: severe illness have underlying conditions that affect their lungs. Older

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Speaker 1: people are also at a higher risk, but certain factors,

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Speaker 1: when combined with age, create a powder kick for the

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Speaker 1: effects of the disease. Both smoking and obesity are conditions

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Speaker 1: that can lead to fatal results in COVID nineteen patients.

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Speaker 1: Bloomberg Senior editor Jason Gale explains how these conditions have

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Speaker 1: made the coronavirus more lethal in some countries. Obesity didn't

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Speaker 1: feature much among critically ill patients when the pandemic started

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Speaker 1: in China in late two nine. That may be because

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Speaker 1: it's not as big a problem in China as it

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Speaker 1: is in some Western countries. The Chinese government says about

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Speaker 1: twelve percent of its adult population is abase. That compares

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Speaker 1: with about in the United States. Obesity is associated with

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Speaker 1: a range of health problems, from type two diabetes to

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Speaker 1: cardiovascular disease to cancer. These can all increase the severity

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Speaker 1: of COVID nineteen. But when doctors outside China looked more

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Speaker 1: closely at some of their sickest patients, they found obesity

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Speaker 1: stood out as an independent risk factor. It seems the

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Speaker 1: obesity epidemic could be exacerbating the severity of the coronavirus pandemic.

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Speaker 1: Obesity is a very important risk factor, that's Tobias Wealthy.

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Speaker 1: He's the head of medicine at Hanover University in Germany

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Speaker 1: and a member of the COVID nineteen task force in

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Speaker 1: the state of Lower Saxony. Tobias says the virus may

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Speaker 1: get past the body's immune defenses easier and obese patients

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Speaker 1: than in patients whose body mass is in the healthy range.

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Speaker 1: My explanation is that in patients who are OBEs, there

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Speaker 1: is a change in the structure of the lungs. Scientists

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Speaker 1: have found that excess fat accumulates in the airway walls,

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Speaker 1: where it takes up space and seems to increase inflammation

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Speaker 1: within the lungs. Demias thinks that in obese patients, low

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Speaker 1: grade inflammation depresses the body's initial innate immune response to

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Speaker 1: respiratory infections. That also makes it easier for pathogens like

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Speaker 1: the coronavirus to go from the nose and throat to

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Speaker 1: the lower respiratory tract, where it can damage the tiny

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Speaker 1: grape like air sax or alveola through which gas exchange

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Speaker 1: occurs for oxygen eating the blood, and then that can

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Speaker 1: lead to more inflammation and ultimately to difficulty breathing. We

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Speaker 1: don't know that the coronavirus selectively targets people with obesity

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Speaker 1: or that they're more prone to the infection, but the

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Speaker 1: emerging evidence from studies coming out of North America and

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Speaker 1: Europe over the past few weeks points to obesity being

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Speaker 1: a risk factor for getting sicker from COVID nineteen needing

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Speaker 1: intensive care and mechanical ventilation, and also for dying as

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Speaker 1: a result of the disease. Dr Margaret Pezzani Tommy she

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Speaker 1: saw the same phenomenon when she was treating H one

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Speaker 1: N one or swine flu patients during the two thousand

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Speaker 1: and nine influenza pandemic. Margaret is an associate professor of

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Speaker 1: pulmonary and Critical Care Medicine at Yale University in Connecticut.

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Speaker 1: She now treats critically ill COVID patients at Yale New

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Speaker 1: Haven Hospital. She says there are also physical challenges to

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Speaker 1: caring for obese patients. It's harder to do things like

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Speaker 1: throwing them so put them out on their valies. It's

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Speaker 1: harder to manage them on the ventilator because their airway

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Speaker 1: pressures tend to be hired just because of their body habits,

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Speaker 1: and so I think in general they're harder to care for,

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Speaker 1: and then we just have a harder time than with

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Speaker 1: ventilating them and oxygen eating them. So if a patient

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Speaker 1: is obese and becomes infected with COVID, they are more

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Speaker 1: likely to do worse than someone in a healthy weight range,

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Speaker 1: and there's another risk factor that's adding to the severity

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Speaker 1: of this pandemic, smoking newport cigarettes carefully selected blend. Previous

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Speaker 1: studies have shown that smokers are twice as likely as

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Speaker 1: non smokers to contract influenza and to have more severe symptoms.

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Speaker 1: We're now seeing a similar effect in COVID nineteen cases.

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Speaker 1: When you inhale through a cigarette, the smoke damages protective

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Speaker 1: cells that line your respiratory tract. The coronavirus also happens

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Speaker 1: to target these cells, so when a smoker develops COVID,

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Speaker 1: the cells are already vulnerable and the virus just takes

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Speaker 1: advantage of that weakness. Once the virus gets into the body,

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Speaker 1: it tries to replicate by invading cells with a specific

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Speaker 1: protein receptor. Dr Janice Leon is a respiratory physician at

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Speaker 1: Vancouver Saint Paul's Hospital and the University of British Columbia.

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Speaker 1: Janice found there were more of these receptors in the

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Speaker 1: airways of patients with a common smoking related condition called

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Speaker 1: chronic obstructive pulmonary disease or COPD, So it may be

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Speaker 1: that the virus has an easier time undering the lungs

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Speaker 1: of people who have CELPD. That's one possibility as to

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Speaker 1: why they may actually do worse. Right now, Janice is

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Speaker 1: studying whether these receptors can be manipulated with certain drugs

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Speaker 1: to ward off COVID nineteen to bias wealthy yet Hanover

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Speaker 1: University says data coming from Southern European countries like Spain

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Speaker 1: and Italy show that smokers have a higher risk of

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Speaker 1: worst disease compared with non smokers. But there's one country

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Speaker 1: that at least initially didn't match that pattern despite having

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Speaker 1: a high rate of smokers, and that's China. When the

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Speaker 1: pandemic started in the Chinese city of Wuhan, smokers weren't

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Speaker 1: predominant among the sickest patients, and this didn't square with

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Speaker 1: what researchers have since found in other parts of the world,

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Speaker 1: and especially stump scientists because smoking is so prevalent in China.

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Speaker 1: For example, in Hubei Province, in which Wuhan is the capital,

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Speaker 1: close to six of mid smoke, but study showed only

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Speaker 1: a fraction of severely ill COVID nineteen patients were smokers,

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Speaker 1: and that was puzzling. Tobia says. One explanation might be

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Speaker 1: that the data weren't reliably collected and recorded in the

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Speaker 1: early days of the pandemic, but even past that, there

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Speaker 1: was another factor, one that might have predisposed the wider

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Speaker 1: population to more severe illness once they're called COVID nineteen,

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Speaker 1: and that's air pollution. What is cigarette smoke. Cigarette smoke

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Speaker 1: is a kind of very intensive pollution, but if there

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Speaker 1: is a high pollution, it could overcome the effects of

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Speaker 1: cigarette smoking alone. Tobiasis theory hasn't been confirmed yet. Wohound,

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Speaker 1: with about eleven million people, is known for its still smelting.

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Speaker 1: Tobias says that the connection to poor air quality in

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Speaker 1: China and severely ill COVID patients lines up with trends

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Speaker 1: and parts of the world. When the pandemic started in

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Speaker 1: China and also when it started in nos and Italy,

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Speaker 1: very surprisingly, our pollution had been very high at this

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Speaker 1: time point, so there may be a synergistic effect of

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Speaker 1: different types of air pollution. As COVID nineteen spreads, we're

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Speaker 1: seeing it play out slightly differently in communities around the world,

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Speaker 1: exposing different vulnerabilities and sometimes exacerbating longstanding health problems. In

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Speaker 1: the case of air pollution, it isn't something that can

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Speaker 1: be easily tackled, at least on an individual level to

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Speaker 1: reduce the risk from COVID nineteen. But smoking is of

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Speaker 1: all the good reasons to quit smoking, The current pandemic

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Speaker 1: amounts to one more. That was just in Gale in Melbourne,

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Speaker 1: And that's our show today. For coverage of the outbreak

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Speaker 1: from one and twenty bureaus around the world, visit Bloomberg

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Speaker 1: dot com slash coronavirus and if you like the show,

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Speaker 1: please leave us a review and a rating on Apple

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Speaker 1: Podcasts or Spotify. It's the best way to help more

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Speaker 1: listeners find our global reporting. The Prognosis Daily edition is

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Speaker 1: hosted by Me Laura Carlson. The show is produced by Me,

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Speaker 1: top Foreheads, Jordan Gaspoure and Magnus Hendrickson. Today's main story

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Speaker 1: was reported by Jason Gale. Original music by Leo Sidran.

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Speaker 1: Our editors are Francesco Levi and Rick Shine. Francesco Levi

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Speaker 1: is Bloomberg's head of Podcasts. Thanks for listening. Two