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Understanding YOUR Risk Factors around COVID-19

How Risky?

There is a high level of community concern about getting sick with COVID-19. This is totally reasonable considering the saturation coverage on all news outlets.  

It is clear from the actions of many that they are very concerned about their health safety and that of their family. So I thought that I would offer some balance to the discussion.  

Know Your Risks

There are physiology facts that are often overlooked. People who are truly healthy who follow good habits are rarely sick. That means that they don’t take a drug from their doctor and they are happy and active. All the common health markers are optimal.

The Official Message

The “messaging” is very much directed to ensure that we don’t become lax. The management of the health consequences of a high proportion of the population becoming sick at once - a steep curve - causing a complete collapse of the hospital system. It’s the sick people already in hospital as well as the new admissions that the officials are concerned about. And so they should be. No one wants someone recovering from a hip replacement or a cancer operation to have their recovery compromised by contracting the new Coronavirus, (COVID-19).

In a previous blog I talked about the maths concept of an exponential curve. The exponential growth curve is the magic of compounding interest and bacterial or Viral infection. When we expand our view of the virus from the individual to the community we then count people infected rather than bugs growing. Think rabbits and mice - they can become a plague quite quickly in ideal circumstances.  

Mice from two to many

RNaught (R0)

So another maths concept is the RNaught value of a bug. This will describe the potential steepness of the curve. The number of people who could be infected by someone who has COVID-19, or any communicable bug. 

You’re in a room with 5 people for a 1 hour meeting. You have the bug. At the end of the meeting are you still the only person with the infection (R0) or have you given it to just 1 other (R1) or to all 5 (R5)?

You can see that R0 doesn’t grow in size and R1 grows slowly: That newly infected person will infect only 1 more person and they will infect only 1 more person and so on. A mostly additive growth. An R4 means that the 4 newly infected people who leave the meeting will each infect 4 more people in their daily dealings. That growth in numbers is going to give you a steep growth curve.  

You would be very happy with a 15% compounding interest rate calculated daily and paid daily. You would never need to go to work again!  

There is a lot of discussion about the R0 value of COVID-19. The opinion by scientists from a number of countries is that the R0 is between 1.4 and 3.9. This means that it will spread very quickly and suddenly become unmanageable. 

Too few hospital beds

When all the infected people begin to fall sick at once then it very quickly becomes an overwhelming load for the health system.  

Now the next topic is especially important. Although a lot of us could become infected it is likely a very small and quite defined group that are at real risk. Most of us don’t need to do anything different to what we normally do if we get sick, except now we stay home and get better. None of that “soldier on” nonsense, giving your cold or flu to the whole office!  

Targeting the Risk Groups 

So, back to the beginning: What is Your risk?  

As has been noted elsewhere, the Italian population is the 2nd oldest in the world and the oldest in Europe. We know from the data in Singapore, Korea and Italy that men over 70 are most at risk. But not all men over 70 - you need to have other pre-existing health issues.  99% of all the Italian fatalities had a pre-exisitng medical condition, with High Blood Pressure being the most common. Many do, but not all.  

The common family of blood pressure drugs are the ACE inhibitor class. The ACE inhibitor family of drugs work with the same receptor site that the COVID-19 virus attaches it self to. The ARB drugs (Angiotensen Receptor Blockers) increase the expression of the protein 3-5 times. These proteins are found in the lungs predominantly. This greatly increases the receptor proteins that the virus can gain entry to the body. Here is a link to an article that will explain the current understanding: https://www1.racgp.org.au/newsgp/clinical/ace-inhibitors-arbs-and-covid-19-what-gps-need-to

Lung anatomy

ACE proteins live here

Sensible Response and Actions 

It is recommended that no abrupt action be taken. The basics of hand washing and personal distancing (Social Distancing) will be your best protection along with established non-pharmaceutical support such as Vitamin C. You should contact your GP for individual clinical advice. 

I guess that this latest info does alter the likely numbers of at risk people. A large proportion of the population takes a blood pressure medication and commonly a combination ACE inhibitor and Beta Blocker. That does tend to increase the “at risk” group size. I am assuming that the Italian data is provided via the medical and medication history of those who died or became acute cases. It is not clear if untreated high blood pressure poses the same risk factors.  

Where do you stand?

If you’re not an old man with several “co-morbidities” (things going wrong at once) you are very likely to be just fine. You will most likely be exposed and not feel sick at all. You are healthy! You might also have a cold/flu for a few days. It will likely be mild so you should spend at least a day in bed and then wait till you’re feeling good before going back to work.  

Smoke and Dust - and Additional Risk 

I have been concerned about the lung health of Sydney residents post the fires and dust of the last 4 months. This is known to reduce lung tissue health. We are more likely to get a cough that is hard to shake. The COVID-19 bug enters the body via the lungs.

We are putting together a program to help to boost lung health in the coming weeks so that you increase your chances of having a smooth ride through the winter when COVID-19 and all the other winter bugs will be doing the rounds. 

Recap/repeat

To Recap 

An old man with poor health is most at risk especially if he has high blood pressure that is medicated.  

Be aware that the current government push is to reduce the infection rate - which all agree is important. 

Feel confident that for the vast majority of the Australian population this virus is a very mild infection causing mild symptoms.  

We will get through this...

We will all get through this. It might well change a number of things in terms of the economy. That is most likely to cause all of us much more pain than a few weeks in lock down or a cold.  

Helpful Resources 

If you have time there are some great interviews here on this YouTube channel: https://www.youtube.com/watch?v=i-1RVB_H1Mw

He is a data geek and talks very fast - big brain moving fast. He takes a very broad view and talks to a very wide range of people:  

https://www1.racgp.org.au/newsgp/clinical/ace-inhibitors-arbs-and-covid-19-what-gps-need-to