Death Rate of Covid-19 by Age / Prior Illness / Ethnic Group

Dr. Michael Roizen of the Cleveland Clinic is helping prepare a paper for Ohio and other states about how to think about reopening their states. You can see some of his data here.

He includes this chart about death rates in Ohio, which look much like data from New York, China, and Italy. Clearly the risk of death rises dramatically with age.

But that changes if you factor in other health issues. High blood pressure, smoking, being overweight, lack of exercise, all contribute to increased morbidity. So you can be younger and still be in a high risk category because of your health.

Mystery of the Disease’s Dramatically Varying Symptoms

Some people experience Covid-19 as nothing more than a mild cold, and others exhibit no symptoms at all. Then there are the thousands who sicken and, often, die. Scientists are working hard to understand the underlying reasons for such huge discrepancies in symptoms and outcomes. 

Scientists have speculated other factors influence susceptibility, including pre-existing levels of inflammation and immunity, the amount of virus that starts an infection, and patients’ genetic makeup.  Some theories that scientists are honing in on include:

• Immune system
• As the body mounts an intense effort to fight off the previously unknown pathogen, the immune system can kick into overdrive — what’s known as a cytokine storm — causing collateral damage that may do more harm than the virus itself.
• Twin landmark studies published Thursday in the journal Science showed that insufficient interferon may lurk at a dangerous turning point in SARS-CoV-2 infections.^[10]
• Based on statistics, scientists have also found that:
• Children with less-developed immune systems could be less vulnerable.^[2]
• Women may experience severe symptoms less frequently.^[4]
• Genetic makeups
• The receptor the virus uses to penetrate host cells, called ACE2, can be present in varying numbers in different people based on their genetics and on environmental factors, such as what medicines they take.
• Prior illness
• Those in harm’s way are older adults and people with conditions that are tied to inflammation. Many of these conditions also have a genetic component.
• Three of the most-powerful risk factors for severe disease are:
• High blood pressure
• Obesity 
• Obesity is a pro-inflammatory state: People who carry extra weight have higher levels of immune response and inflammation
• Diabetes

Ethnic Group

Based on a Lancet paper, it states that:^[8]

Of 209 preprints, 34 reported ethnicity – 13 found Black, Asian and Minority Ethnic (BAME) individuals had an increased risk of infection with SARS-CoV-2 and 12 reported worse clinical outcomes, including ITU admission and mortality, in BAME patients compared to White patients. Of 12 grey literature reports, seven with original data reported poorer clinical outcomes in BAME groups compared to White groups.

References

1. Repricing the World
2. What we know and don't know about the impact of COVID-19 in children
3. Your Risk of Getting Sick From Covid-19 May Lie in Your Genes
4. The New Coronavirus Appears To Take A Greater Toll On Men Than On Women
5. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
6. Skin Rashes: An Emerging Symptom of COVID-19
7. Male coronavirus patients with low testosterone levels are MORE likely to die from COVID-19, German hospital finds
• German hospital assessed the hormone levels of 45 COVID-19 patients in ICU
• Found that the vast majority of men admitted had low testosterone levels
• Testosterone may be able to stop the body's immune system from going haywire
• Low levels of the sex hormone are unable to regulate the body's immune response, leading to a 'cytokine storm' which can be fatal
8. The impact of ethnicity on clinical outcomes in COVID-19: A systematic review
9. SARS-CoV-2 has a sweet tooth
• Glucose enhanced SARS-CoV-2 viral load and mRNA expression of pro-inflammatory cytokines and type I/III interferons in these cells in a dose-dependent manner.
10. Covid Doctors Find a Turning Point in Life-Threatening Cases
11. Coronavirus Deranges the Immune System in Complex and Deadly Ways