WEBVTT - The Risk to Overweight People 0:00:01.280 --> 0:00:06.160 Welcome to Prognosis. I'm Laura Carlson. It's day two hundred 0:00:06.200 --> 0:00:11.520 and twelve since coronavirus was declared a global pandemic. Today's 0:00:11.560 --> 0:00:15.440 main story. While scientists have known for a while that 0:00:15.520 --> 0:00:19.560 obesity is a risk factor for COVID nineteen, the CDC 0:00:19.760 --> 0:00:24.480 put out guidance this week suggesting even more people should worry. 0:00:25.480 --> 0:00:29.479 It turns out that just being overweight could be enough 0:00:29.560 --> 0:00:35.360 to make you vulnerable to severe COVID complications. But first, 0:00:36.360 --> 0:00:45.280 here's what happened in virus News today. Today it brought 0:00:45.360 --> 0:00:49.240 more mixed messages about the status of a coronavirus relief 0:00:49.240 --> 0:00:53.640 bill in Washington. After shutting down talks earlier this week, 0:00:53.960 --> 0:00:59.320 President Donald Trump approved a revised economic stimulus offer that's 0:00:59.320 --> 0:01:03.720 according to its top economic advisor, Larry Cudlow, but it 0:01:03.800 --> 0:01:08.720 is unlikely Congress will agree to it. Senate Majority Leader 0:01:08.760 --> 0:01:12.640 Mitch McConnell said the differences are probably too big and 0:01:12.680 --> 0:01:16.120 the time is too short for Congress to agree on 0:01:16.160 --> 0:01:22.320 a new comprehensive stimulus package before the election. Despite President 0:01:22.360 --> 0:01:28.080 Donald Trump's renewed interest in striking a deal, the rate 0:01:28.160 --> 0:01:32.399 of coronavirus infection in England almost doubled in a week. 0:01:33.480 --> 0:01:36.319 It's adding to concerns that a fresh surge of the 0:01:36.360 --> 0:01:40.920 pandemic is spreading throughout the country. One in every two 0:01:41.000 --> 0:01:45.320 hundred and forty people is infected. That's up from one 0:01:45.360 --> 0:01:49.920 in four hundred and seventy a week earlier, according to 0:01:49.960 --> 0:01:54.800 the Office for National Statistics. The figures come as the 0:01:54.920 --> 0:01:59.120 UK government prepares to announce new restrictions for the worst 0:01:59.240 --> 0:02:03.920 hit parts of the country, potentially including the closing of 0:02:04.000 --> 0:02:09.920 restaurants and bars. Finally, the Spanish government declared a state 0:02:09.919 --> 0:02:13.760 of emergency for the Madrid region, as Europe's leaders step 0:02:13.840 --> 0:02:18.080 up efforts to contain an unrelenting surge in coronavirus cases 0:02:18.120 --> 0:02:23.600 across the continent. Prime Minister Pedro Sanchez's government made the 0:02:23.639 --> 0:02:27.679 decision at a special cabinet meeting on Friday. The premier 0:02:27.760 --> 0:02:31.440 is struggling to impose his authority on regional officials who 0:02:31.440 --> 0:02:36.400 have resisted restrictions on movement. Declaring a state of emergency 0:02:36.720 --> 0:02:41.400 gives the Spanish leader extraordinary powers to order new constraints 0:02:45.000 --> 0:02:49.400 and now for today's main story. Obesity is a known 0:02:49.520 --> 0:02:54.280 risk factor for severe complications of COVID nineteen, but scientists 0:02:54.320 --> 0:02:57.600 are learning that the link between extra pounds and severe 0:02:57.680 --> 0:03:03.000 COVID nineteen is even strong younger than they thought. This week, 0:03:03.200 --> 0:03:06.440 the US Centers for Disease Control and Prevention said that 0:03:06.639 --> 0:03:11.160 people who are merely overweight, not just the OBEs, maybe 0:03:11.200 --> 0:03:16.200 at high risk of serious disease from the infection. The warning, 0:03:16.480 --> 0:03:20.480 posted on the agency's website on Tuesday means about two 0:03:20.639 --> 0:03:25.120 thirds of Americans could face higher risks. I spoke with 0:03:25.160 --> 0:03:28.400 health reporter and a court about what it means that 0:03:28.440 --> 0:03:33.919 more people than previously thought could be vulnerable. So why 0:03:33.960 --> 0:03:36.480 would just having a few extra pounds make you that 0:03:36.560 --> 0:03:42.200 much more susceptible to serious complications from COVID nineteen. You know, Laura, 0:03:42.280 --> 0:03:46.240 it's a really good question. The evidence is still emerging, 0:03:46.240 --> 0:03:48.680 even on the subject of the risk of sort of 0:03:48.720 --> 0:03:52.240 having some extra pounds. You know, we already knew that 0:03:52.400 --> 0:03:56.480 people who were OBEs, you know, were at higher risk 0:03:56.560 --> 0:04:00.080 and are at higher risk for having severe cases of 0:04:00.120 --> 0:04:03.160 COVID nineteen. And this is something you know, doctors noticed 0:04:03.240 --> 0:04:06.200 pretty early in the pandemic that they were seeing obese 0:04:06.240 --> 0:04:09.720 people coming into the hospital, you know, being hospitalized at 0:04:09.800 --> 0:04:12.600 higher rates um And so this is something that's been 0:04:12.760 --> 0:04:15.960 established for a period of months. Now what's new is 0:04:16.000 --> 0:04:18.920 that the CDC is now saying we have some data 0:04:19.000 --> 0:04:22.840 to believe people who are overweight could also be at 0:04:22.920 --> 0:04:26.240 risk for serious forms of COVID nineteen. And I mean 0:04:26.480 --> 0:04:29.480 that's a pretty big deal because and we're talking about 0:04:29.839 --> 0:04:32.720 you know, nearly seventy two percent of American adults are 0:04:32.839 --> 0:04:37.920 overweight or obese. It's about forty of American adults are 0:04:37.920 --> 0:04:41.719 obese and then about or overweight. So that's a big 0:04:41.760 --> 0:04:45.760 population here, and that brings up a good point of 0:04:46.000 --> 0:04:51.039 how is the CDC assessing those who are defined as 0:04:51.200 --> 0:04:55.919 overweight or obese. Yeah, so we're going straight to b M. I. 0:04:56.240 --> 0:04:58.880 You know, body mass index, which is basically just a 0:04:58.880 --> 0:05:02.360 way of measuring your your weight and your height, you know, 0:05:02.760 --> 0:05:05.599 and coming up with an index. So it's overweight people 0:05:05.600 --> 0:05:08.000 have a body mass index of twenty five to thirty 0:05:08.040 --> 0:05:11.760 and obesity is a thirty and higher. So you know 0:05:11.800 --> 0:05:13.520 that example you could give us. You know, if you're 0:05:13.520 --> 0:05:16.160 a man, you're five ft eleven inches, you weigh two 0:05:16.240 --> 0:05:20.640 hundred pounds, you're considered overweight, you gain twenty five pounds. 0:05:20.720 --> 0:05:23.280 Let's say you're you're considered obese and you know, there 0:05:23.279 --> 0:05:25.080 are a lot of issues with b m I as 0:05:25.120 --> 0:05:27.320 a as a measure, but it is the measure that 0:05:27.360 --> 0:05:31.039 we have right now for for thinking about people's weight. Um. 0:05:31.120 --> 0:05:33.800 And that's what the studies that the CDC used to 0:05:33.880 --> 0:05:37.560 make this determination looked at. They looked at COVID nineteen 0:05:37.560 --> 0:05:40.839 outcomes and b m I and they found this connection, 0:05:41.320 --> 0:05:44.039 you know, as b m I went up between that 0:05:44.080 --> 0:05:47.680 and more severe COVID nineteen outcomes. And and how does 0:05:47.720 --> 0:05:51.640 this differ, say from some of the other comorbidity ease 0:05:51.880 --> 0:05:56.400 of COVID nineteen. What what is actually the risk? You know? 0:05:56.480 --> 0:05:59.680 We we do know just in general that having you know, 0:05:59.680 --> 0:06:02.440 a little extra weight or or you know, a good 0:06:02.480 --> 0:06:05.080 amount of extra weight can be tied to these negative 0:06:05.120 --> 0:06:08.760 health outcomes. And that's what's made actually untangling this question 0:06:08.800 --> 0:06:13.200 about obesity so complicated because people who are are obese 0:06:13.320 --> 0:06:16.920 often have other medical conditions right that we know put 0:06:16.960 --> 0:06:20.880 you at risk for COVID nineteen. UM. You know, things 0:06:20.920 --> 0:06:24.880 like maybe uh, you know, diabetes, for instance, But we 0:06:24.880 --> 0:06:27.080 we know that obesity seems to put you at even 0:06:27.160 --> 0:06:29.760 higher risk than even just looking at those medical conditions 0:06:29.760 --> 0:06:33.320 a person may have. In general, we know that these 0:06:33.400 --> 0:06:37.320 metabolic changes tie to access weight can reduce the immune 0:06:37.360 --> 0:06:41.200 systems ability to fight disease. Um. That's what I spoke 0:06:41.279 --> 0:06:43.880 to nutrition professor about. And you know that there are 0:06:43.920 --> 0:06:46.279 other reasons that people who who are obese could have 0:06:46.400 --> 0:06:49.760 worse health outcomes with COVID nineteen, things like reduced lung 0:06:49.760 --> 0:06:52.760 capacity and sleep apnea. You know, I think the scientists 0:06:52.920 --> 0:06:56.080 is still emerging on this one, but there has been 0:06:56.160 --> 0:07:00.719 this concerning trend identified by researchers, which is at people 0:07:00.800 --> 0:07:02.680 with higher b m I s do seem to have 0:07:03.080 --> 0:07:07.640 these more difficult experiences with COVID nineteen. And I think 0:07:07.680 --> 0:07:10.320 what we should really take away from from this, even 0:07:10.320 --> 0:07:13.280 though the science is still emerging, as I've said, is 0:07:13.320 --> 0:07:15.600 that you know, this idea of who is at risk, 0:07:15.680 --> 0:07:18.200 I think people like to downplay it and like to 0:07:18.360 --> 0:07:20.840 silo it and say, oh, it's just people with other 0:07:20.920 --> 0:07:25.480 medical conditions. I'm healthy, it's all good. And I think 0:07:25.800 --> 0:07:28.640 you know, first of all, people who have medical conditions, 0:07:28.760 --> 0:07:32.280 you know, like diabetes, are people, and it's concerning that 0:07:32.320 --> 0:07:34.880 they would be more at risk for this number one. 0:07:34.920 --> 0:07:38.000 But number two, you know, we're now talking about potentially 0:07:38.040 --> 0:07:42.120 the near vast majority of Americans who could be at 0:07:42.160 --> 0:07:45.360 greater risk from COVID nineteen. So you know, to say, oh, 0:07:45.400 --> 0:07:47.880 it's just you know this person or that person, like 0:07:48.080 --> 0:07:50.280 this is a lot of people we're talking about now here. 0:07:52.080 --> 0:07:56.280 And what about the inverse argument that now everyone, it seems, 0:07:56.440 --> 0:08:00.160 is at high risk for serious complications from COVID nineteen. 0:08:00.840 --> 0:08:03.520 If you look at how the CDC has presented this information, 0:08:03.600 --> 0:08:07.560 they're saying, we know that obese people are at increased 0:08:07.640 --> 0:08:10.680 risk of having serious COVID nineteen. You know, along in 0:08:10.720 --> 0:08:13.880 that category as people with cancer, people with cp D, 0:08:14.400 --> 0:08:18.440 you know, heart conditions, people who are immun compromise, smokers, 0:08:19.000 --> 0:08:22.200 people with type two diabetes. Right. Uh. And then if 0:08:22.240 --> 0:08:25.320 you look at being overweight, which they say there's a 0:08:25.360 --> 0:08:27.960 little bit less data for, and so they're you know, 0:08:27.960 --> 0:08:30.960 people who are overweight maybe at increased risk, it's not 0:08:31.280 --> 0:08:34.160 a certainty at this point. You know, they also included 0:08:34.200 --> 0:08:39.200 that category people with asthma, cystic fibrosis, liver disease, people 0:08:39.200 --> 0:08:42.400 who are pregnant, people with type one diabetes. So you 0:08:42.440 --> 0:08:45.320 know the reality is, yeah, a lot of people are 0:08:45.360 --> 0:08:48.079 at risk for this thing, and and we may only 0:08:48.120 --> 0:08:53.240 know later you know, exactly who and you know exactly 0:08:53.280 --> 0:08:56.800 what the consequences are for people who survive COVID nineteen 0:08:56.840 --> 0:09:00.520 as well. So the jury is still out now. As 0:09:00.559 --> 0:09:06.040 you mentioned, population numbers of those who classify as overweight 0:09:06.240 --> 0:09:09.480 or obese are actually quite high in the United States, 0:09:09.520 --> 0:09:13.360 including the President of the United States himself, President Trump. 0:09:14.040 --> 0:09:19.520 How has President Trump's weight potentially affected his experience of 0:09:19.679 --> 0:09:24.360 or recovery from COVID nineteen. It's that's a good point. 0:09:24.400 --> 0:09:27.520 This is a high profile example of exactly what we're 0:09:27.520 --> 0:09:30.880 talking about, right, and um, you know, Trump's position has 0:09:30.920 --> 0:09:32.840 said that he is you know, on the up and 0:09:32.960 --> 0:09:35.560 up here, but it is worth noting that when his 0:09:35.640 --> 0:09:38.280 diagnosis was announced, there was a lot of concern. He's 0:09:38.360 --> 0:09:41.400 pretty squarely in terms of the high risk groups. He's 0:09:41.440 --> 0:09:43.960 pretty squarely there. Right. It's not just b M I, 0:09:44.000 --> 0:09:47.839 although he's you know, clinically considered obese, but it's also 0:09:48.200 --> 0:09:50.440 his age, it's the fact that he's a male. You know. 0:09:50.559 --> 0:09:52.280 I'm not sure we know that much more about the 0:09:52.280 --> 0:09:56.240 President's health, but I think it's important to note, you know, 0:09:56.320 --> 0:10:00.000 he had a pretty aggressive treatment regiment, and it's sparked 0:10:00.040 --> 0:10:03.120 concerns that maybe he was sicker than we were being told. 0:10:03.160 --> 0:10:05.120 You know, he was taken to the hospital. You know, 0:10:05.200 --> 0:10:07.920 we know he was treated with pretty much almost all 0:10:07.960 --> 0:10:11.080 the drugs you can treat a COVID nineteen patient with 0:10:11.320 --> 0:10:15.600 its DECKS and Methodzone, which is a steroid uh from Dezevie, 0:10:15.760 --> 0:10:18.880 which is a drug that's it's shown to help people 0:10:18.920 --> 0:10:22.760 who are who are hospitalized. Um, and an experimental drug 0:10:22.800 --> 0:10:26.400 from Regeneron that's an antibody cocktail. How might this new 0:10:26.520 --> 0:10:31.600 risk of being overweight factor into the development and even say, 0:10:31.640 --> 0:10:36.600 the efficacy of a COVID nineteen vaccine. Yeah, it's an 0:10:36.679 --> 0:10:40.240 important subject, right. We've been talking about vaccine development for 0:10:40.280 --> 0:10:44.160 so many months now, and what we know is that 0:10:44.240 --> 0:10:48.920 vaccines can be less effective for obese people. So we 0:10:48.960 --> 0:10:51.920 know that specifically with the flu vaccine for instance, And 0:10:51.960 --> 0:10:54.920 this does raise questions about, you know, how should development 0:10:54.960 --> 0:11:00.839 be handled of these vaccines for certain subgroups like these people? Right? 0:11:00.920 --> 0:11:03.240 You know, is there a need for vaccine developers to 0:11:03.320 --> 0:11:06.320 look more specifically at how obese people do in these 0:11:06.360 --> 0:11:09.840 trials and see if these vaccines actually work as well 0:11:09.880 --> 0:11:13.000 for them? Um? You know, we are still far from 0:11:13.040 --> 0:11:16.280 having a clear answer that any vaccine really works at all. Um. 0:11:16.320 --> 0:11:18.640 But that's going to be an important part in rolling 0:11:18.640 --> 0:11:22.000 out this whole thing, because this is a large segment 0:11:22.040 --> 0:11:25.040 of the American population. Again, as as I've said a 0:11:25.040 --> 0:11:29.079 couple of times now, now many pharmaceutical companies have announced 0:11:29.120 --> 0:11:32.320 that they are in trials and late stage trials of 0:11:32.400 --> 0:11:36.720 a potential vaccine, and they have been testing this vaccine 0:11:36.840 --> 0:11:42.160 on numerous groups. Do we know if they are specifically 0:11:42.200 --> 0:11:46.880 testing their proposed vaccine on groups that are overweight or 0:11:46.920 --> 0:11:51.280 even obese. It's a good question. We know that they're 0:11:51.360 --> 0:11:54.160 at least thinking about it. Um. You know, along with 0:11:54.200 --> 0:11:58.640 this question of diversity of clinical trial population and an 0:11:58.679 --> 0:12:02.160 age of clinical trial population, it's not totally clear that 0:12:02.200 --> 0:12:04.680 companies are going to say we need to have you know, 0:12:04.800 --> 0:12:09.520 sevent of clinical trial participants be obese for instance. Um, 0:12:09.559 --> 0:12:13.040 But you know, I spoke with someone involved in the 0:12:13.080 --> 0:12:15.960 work to recruit for these clinical trials and and you know, 0:12:16.000 --> 0:12:19.480 he said, it is likely that because so much of 0:12:19.520 --> 0:12:23.400 the population is obese, that that's going to be represented 0:12:23.400 --> 0:12:27.559 in the trials. In other words, like hopefully, because you 0:12:27.600 --> 0:12:31.000 know so many Americans are obese, this will also translate 0:12:31.080 --> 0:12:33.160 over into into the trials. But you know, we we 0:12:33.240 --> 0:12:35.520 do have reason to worry about this because we know 0:12:35.800 --> 0:12:39.440 pharmaceutical companies try to make their products look as good 0:12:39.440 --> 0:12:43.240 as possible, right, and they want someone who's healthy as 0:12:43.240 --> 0:12:46.160 healthy as possible to be in this trial in order 0:12:46.200 --> 0:12:49.040 to show their their products work. So there is a 0:12:49.080 --> 0:12:53.240 concern that they may be screening for for you know, 0:12:53.280 --> 0:12:56.200 to keep fewer obese people in the in these trials. 0:12:56.200 --> 0:12:58.800 We we don't really have date on that, unfortunately, but 0:12:59.000 --> 0:13:01.280 you know, there's reason to be hopeful and the reason 0:13:01.320 --> 0:13:09.880 to be concerned. I would say that was Emma Cord, 0:13:10.360 --> 0:13:12.959 and that's it for our show today. For coverage of 0:13:13.000 --> 0:13:15.600 the outbreak from one D and twenty bureaus around the world, 0:13:16.000 --> 0:13:20.440 visit Bloomberg dot com slash coronavirus and if you like 0:13:20.520 --> 0:13:22.840 the show, please leave us a review and a rating 0:13:23.080 --> 0:13:26.560 on Apple Podcasts or Spotify. It's the best way to 0:13:26.600 --> 0:13:31.880 help more listeners find our global reporting. The Prognosis Daily 0:13:32.000 --> 0:13:36.600 edition is produced by Tover foreheads Jordan Gaspore, Magnus Hendrickson 0:13:36.800 --> 0:13:41.120 and me Laura Carlson. Today's main story was reported by 0:13:41.120 --> 0:13:45.920 Emma Cord. Original music by Leo Sidrin. Our editors are 0:13:46.040 --> 0:13:50.800 Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head 0:13:50.800 --> 0:13:53.079 of podcasts. Thanks for listening.