WEBVTT - What Puts Patients at Risk

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

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<v Speaker 1>coronavirus was declared a global pandemic. Our main story. We

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<v Speaker 1>know that older people and those with lung disease and

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<v Speaker 1>serious heart conditions are at a higher risk of dying

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<v Speaker 1>from COVID nineteen, but researchers are learning that other factors

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<v Speaker 1>can also make the virus deadly. Two of them are

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<v Speaker 1>smoking and obesity. Understanding that also helps us understand why

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<v Speaker 1>the virus seems to work differently in different places. But first,

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<v Speaker 1>here's what happened today. If it's Thursday, that means it's

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<v Speaker 1>another week where we talk about a number in the

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<v Speaker 1>millions that we used to count in the hundreds of

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<v Speaker 1>thousands unemployment. Over three eight million Americans filed for unemployment

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<v Speaker 1>benefits last week. Since the pandemic began shutting down businesses

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<v Speaker 1>across the country six weeks ago, over thirty million have

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

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<v Speaker 1>was for the month of April, but experts say it

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<v Speaker 1>could be as high as we haven't seen a number

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<v Speaker 1>like that since the Great Depression of the nineteen thirties.

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<v Speaker 1>The Food and Drug administration says it is moving at

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<v Speaker 1>lightning speed to review data on the experimental COVID nineteen

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<v Speaker 1>treatment rem dessevere made by Gilliad Sciences. Yesterday, an important

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<v Speaker 1>US trial showed promising results for the drug, but on

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<v Speaker 1>the very same day, the lance AT journal published a

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<v Speaker 1>fully vetted small Chinese study that showed different less promising results.

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<v Speaker 1>F d A Commissioner Stephen Hahn said the agency was

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<v Speaker 1>prioritizing speed while at the same time reviewing all of

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<v Speaker 1>the data to decide how to regulate the drug. In

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<v Speaker 1>other drug news, Astra Zenica agreed to make an experimental

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<v Speaker 1>coronavirus vaccine developed by Oxford University researchers. Astra's goal is

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<v Speaker 1>to have the capacity to produce one hundred million doses

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<v Speaker 1>by the end of the year. The company is one

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<v Speaker 1>of dozens around the world that have joined the race

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<v Speaker 1>to produce an effective vaccine. The Trump administration this week

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<v Speaker 1>announced an effort to make shots available to Americans by

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<v Speaker 1>the end of the year. The agreement between Astra and

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<v Speaker 1>Oxford shows that drug developers are planning to manufacture vaccines

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<v Speaker 1>even before they've cleared human tests. Creating an effective vaccine

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<v Speaker 1>is key to getting back to normal life. But Brazil

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

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<v Speaker 1>global hotspot of the pandemic. Some states have dialed back

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<v Speaker 1>restrictions on malls, gyms, and churches. Demand is up at

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<v Speaker 1>gas stations across the country. Even residents of South Paulo,

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<v Speaker 1>where restrictions remain in place, are getting out more. According

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<v Speaker 1>to government tracking data, a poll shows that support for

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<v Speaker 1>isolation measures is fading. On Tuesday, Brazil reported its highest

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<v Speaker 1>number of deaths since the pandemic hit the country in

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<v Speaker 1>late February. It's twenty four. Our fatality rate lags only

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<v Speaker 1>the US and the UK, and now our main story.

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<v Speaker 1>As COVID nineteen spreads, doctors are learning more about why

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<v Speaker 1>some patients get very sick and why others only get

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<v Speaker 1>mildly ill. Some of the people most at risk for

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<v Speaker 1>severe illness have underlying conditions that affect their lungs. Older

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<v Speaker 1>people are also at a higher risk, but certain factors,

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<v Speaker 1>when combined with age, create a powder kick for the

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<v Speaker 1>effects of the disease. Both smoking and obesity are conditions

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<v Speaker 1>that can lead to fatal results in COVID nineteen patients.

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<v Speaker 1>Bloomberg Senior editor Jason Gale explains how these conditions have

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<v Speaker 1>made the coronavirus more lethal in some countries. Obesity didn't

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<v Speaker 1>feature much among critically ill patients when the pandemic started

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<v Speaker 1>in China in late two nine. That may be because

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<v Speaker 1>it's not as big a problem in China as it

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<v Speaker 1>is in some Western countries. The Chinese government says about

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<v Speaker 1>twelve percent of its adult population is abase. That compares

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<v Speaker 1>with about in the United States. Obesity is associated with

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<v Speaker 1>a range of health problems, from type two diabetes to

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<v Speaker 1>cardiovascular disease to cancer. These can all increase the severity

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<v Speaker 1>of COVID nineteen. But when doctors outside China looked more

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<v Speaker 1>closely at some of their sickest patients, they found obesity

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<v Speaker 1>stood out as an independent risk factor. It seems the

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<v Speaker 1>obesity epidemic could be exacerbating the severity of the coronavirus pandemic.

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

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<v Speaker 1>He's the head of medicine at Hanover University in Germany

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<v Speaker 1>and a member of the COVID nineteen task force in

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<v Speaker 1>the state of Lower Saxony. Tobias says the virus may

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<v Speaker 1>get past the body's immune defenses easier and obese patients

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<v Speaker 1>than in patients whose body mass is in the healthy range.

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<v Speaker 1>My explanation is that in patients who are OBEs, there

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<v Speaker 1>is a change in the structure of the lungs. Scientists

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<v Speaker 1>have found that excess fat accumulates in the airway walls,

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<v Speaker 1>where it takes up space and seems to increase inflammation

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<v Speaker 1>within the lungs. Demias thinks that in obese patients, low

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<v Speaker 1>grade inflammation depresses the body's initial innate immune response to

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<v Speaker 1>respiratory infections. That also makes it easier for pathogens like

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<v Speaker 1>the coronavirus to go from the nose and throat to

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<v Speaker 1>the lower respiratory tract, where it can damage the tiny

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<v Speaker 1>grape like air sax or alveola through which gas exchange

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<v Speaker 1>occurs for oxygen eating the blood, and then that can

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<v Speaker 1>lead to more inflammation and ultimately to difficulty breathing. We

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<v Speaker 1>don't know that the coronavirus selectively targets people with obesity

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<v Speaker 1>or that they're more prone to the infection, but the

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<v Speaker 1>emerging evidence from studies coming out of North America and

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<v Speaker 1>Europe over the past few weeks points to obesity being

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<v Speaker 1>a risk factor for getting sicker from COVID nineteen needing

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<v Speaker 1>intensive care and mechanical ventilation, and also for dying as

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<v Speaker 1>a result of the disease. Dr Margaret Pezzani Tommy she

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<v Speaker 1>saw the same phenomenon when she was treating H one

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<v Speaker 1>N one or swine flu patients during the two thousand

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<v Speaker 1>and nine influenza pandemic. Margaret is an associate professor of

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<v Speaker 1>pulmonary and Critical Care Medicine at Yale University in Connecticut.

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<v Speaker 1>She now treats critically ill COVID patients at Yale New

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<v Speaker 1>Haven Hospital. She says there are also physical challenges to

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<v Speaker 1>caring for obese patients. It's harder to do things like

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<v Speaker 1>throwing them so put them out on their valies. It's

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<v Speaker 1>harder to manage them on the ventilator because their airway

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<v Speaker 1>pressures tend to be hired just because of their body habits,

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

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<v Speaker 1>and then we just have a harder time than with

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<v Speaker 1>ventilating them and oxygen eating them. So if a patient

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<v Speaker 1>is obese and becomes infected with COVID, they are more

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<v Speaker 1>likely to do worse than someone in a healthy weight range,

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<v Speaker 1>and there's another risk factor that's adding to the severity

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<v Speaker 1>of this pandemic, smoking newport cigarettes carefully selected blend. Previous

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<v Speaker 1>studies have shown that smokers are twice as likely as

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<v Speaker 1>non smokers to contract influenza and to have more severe symptoms.

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<v Speaker 1>We're now seeing a similar effect in COVID nineteen cases.

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<v Speaker 1>When you inhale through a cigarette, the smoke damages protective

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<v Speaker 1>cells that line your respiratory tract. The coronavirus also happens

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<v Speaker 1>to target these cells, so when a smoker develops COVID,

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<v Speaker 1>the cells are already vulnerable and the virus just takes

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<v Speaker 1>advantage of that weakness. Once the virus gets into the body,

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<v Speaker 1>it tries to replicate by invading cells with a specific

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<v Speaker 1>protein receptor. Dr Janice Leon is a respiratory physician at

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<v Speaker 1>Vancouver Saint Paul's Hospital and the University of British Columbia.

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<v Speaker 1>Janice found there were more of these receptors in the

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<v Speaker 1>airways of patients with a common smoking related condition called

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<v Speaker 1>chronic obstructive pulmonary disease or COPD, So it may be

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<v Speaker 1>that the virus has an easier time undering the lungs

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<v Speaker 1>of people who have CELPD. That's one possibility as to

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<v Speaker 1>why they may actually do worse. Right now, Janice is

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<v Speaker 1>studying whether these receptors can be manipulated with certain drugs

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<v Speaker 1>to ward off COVID nineteen to bias wealthy yet Hanover

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<v Speaker 1>University says data coming from Southern European countries like Spain

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<v Speaker 1>and Italy show that smokers have a higher risk of

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<v Speaker 1>worst disease compared with non smokers. But there's one country

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<v Speaker 1>that at least initially didn't match that pattern despite having

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

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<v Speaker 1>pandemic started in the Chinese city of Wuhan, smokers weren't

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<v Speaker 1>predominant among the sickest patients, and this didn't square with

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<v Speaker 1>what researchers have since found in other parts of the world,

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<v Speaker 1>and especially stump scientists because smoking is so prevalent in China.

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<v Speaker 1>For example, in Hubei Province, in which Wuhan is the capital,

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<v Speaker 1>close to six of mid smoke, but study showed only

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<v Speaker 1>a fraction of severely ill COVID nineteen patients were smokers,

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<v Speaker 1>and that was puzzling. Tobia says. One explanation might be

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<v Speaker 1>that the data weren't reliably collected and recorded in the

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<v Speaker 1>early days of the pandemic, but even past that, there

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<v Speaker 1>was another factor, one that might have predisposed the wider

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<v Speaker 1>population to more severe illness once they're called COVID nineteen,

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<v Speaker 1>and that's air pollution. What is cigarette smoke. Cigarette smoke

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<v Speaker 1>is a kind of very intensive pollution, but if there

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<v Speaker 1>is a high pollution, it could overcome the effects of

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

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<v Speaker 1>with about eleven million people, is known for its still smelting.

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<v Speaker 1>Tobias says that the connection to poor air quality in

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<v Speaker 1>China and severely ill COVID patients lines up with trends

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<v Speaker 1>and parts of the world. When the pandemic started in

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<v Speaker 1>China and also when it started in nos and Italy,

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<v Speaker 1>very surprisingly, our pollution had been very high at this

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<v Speaker 1>time point, so there may be a synergistic effect of

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

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<v Speaker 1>seeing it play out slightly differently in communities around the world,

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<v Speaker 1>exposing different vulnerabilities and sometimes exacerbating longstanding health problems. In

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<v Speaker 1>the case of air pollution, it isn't something that can

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<v Speaker 1>be easily tackled, at least on an individual level to

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<v Speaker 1>reduce the risk from COVID nineteen. But smoking is of

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<v Speaker 1>all the good reasons to quit smoking, The current pandemic

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<v Speaker 1>amounts to one more. That was just in Gale in Melbourne,

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<v Speaker 1>And that's our show today. For coverage of the outbreak

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<v Speaker 1>from one and twenty bureaus around the world, visit Bloomberg

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<v Speaker 1>dot com slash coronavirus and if you like the show,

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<v Speaker 1>please leave us a review and a rating on Apple

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<v Speaker 1>Podcasts or Spotify. It's the best way to help more

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<v Speaker 1>listeners find our global reporting. The Prognosis Daily edition is

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<v Speaker 1>hosted by Me Laura Carlson. The show is produced by Me,

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

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<v Speaker 1>was reported by Jason Gale. Original music by Leo Sidran.

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<v Speaker 1>Our editors are Francesco Levi and Rick Shine. Francesco Levi

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<v Speaker 1>is Bloomberg's head of Podcasts. Thanks for listening. Two