Risk Factors - A Wide Umbrella Under Which Many Stand

Nurses COVID

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Risk factors for severe swine flu a wide umbrella under which many stand

http://www.google.com/hostednews/canadianpress/article/ALeqM5i7tXz_Z0bUPQEDkFZBk3vhcK4Tew

Don't think that you are at risk? Most of us would not have said so a few months ago, but there have been some surprises ...

Whether speaking of a 58-year-old man or a 38-year-old woman or a little boy of nine, officials announcing swine flu deaths are almost always quick to note "underlying health conditions" may have contributed to the fatal outcome. It could create the impression that only the sickly are dying from the new H1N1 flu virus - a claim no one is making. To the contrary, many, including the World Health Organization, say between one-third and one-half of swine flu deaths have occurred in people who were previously healthy.

But how healthy is previously healthy? The answer depends on who you ask.

Dr. Anand Kumar is a critical care specialist who has been treating swine flu cases in embattled intensive care units in several Winnipeg hospitals.He says a small portion of the ICU patients look like flu's typical victims, people with health conditions known to be badly exacerbated by a bout of influenza. But more are younger and - until they got sick - healthier than flu patients hospitals typically seen during a regular influenza season."They're normal people.... If you asked them 'Are you healthy?' they'd say 'Yeah, pretty healthy."'

Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency, believes the constant refrain of "underlying conditions" bespeaks a sort of wishful thinking, an attempt to explain away the unusual age range of the people the new virus is sending to hospital or to the morgue.

"That's the story that I think people haven't really registered," says Gardam. "We're clinging to these 'Oh, they had underlying illness, therefore it's OK."'

"This is not a disease of older adults. There's no question," says Dr. Allison McGeer, an influenza expert with Toronto's Mount Sinai Hospital."For people under 50, this is a significantly more severe disease than seasonal flu. For people over 50, it's much better," she notes. But are the people under 50 who are being badly hit by the virus specimens of perfect health or are many of them already shaded by the broad umbrella known as "pre-existing health conditions?" How you view a condition like asthma - seen in 41 per cent of the hospitalized cases in New York City - may influence how you answer that question.

New York City has had one of the biggest swine flu outbreaks to date. As of Tuesday, more than 700 New Yorkers have been hospitalized with swine flu and 23 people in the city have died from infections.

...we may also find new risk factors, but they have not yet been adequately described analytically to be able to say it's a legitimate risk factor." One such potential new risk factor is obesity....knowing who is truly at the most risk from this virus will dictate who stands where in the queue for swine flu vaccine once it becomes available and who should get priority access to antiviral drugs.

A number of health conditions and lifestyle behaviours are known to increase a person's risk of becoming severely ill and even dying from influenza. They include:

Lung conditions: Flu is tough on people with chronic obstructive pulmonary disorder or COPD. Likewise asthma - 41 per cent of hundreds of hospitalized swine flu patients in New York City were asthma sufferers.

Heart disease, diabetes and diseases that compromise the immune system: People with these conditions have a harder time fighting off flu.

Pregnancy: Not an illness, but a time when a woman's immune system must strike a fine balance between protecting her and not rejecting the foreign tissue she's carrying. Past pandemics have been hard on pregnant women and a number have already died from swine flu.

Smoking: Anything that weakens the lungs makes flu a more dangerous foe.

Obesity: Not traditionally recognized as raising one's risk from flu, obesity is on the table as a potential complicating factor with swine flu. Anecdotally doctors treating patients say they are seeing more obese people among the severe cases. Some say it's just the morbidly obese, others say even people 20 or 30 pounds overweight seem harder hit. Experts are watching, but a link hasn't been confirmed.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I wonder what role sleep deprivation plays in vulnerability? Many younger people, and people in general, do not get enough sleep. The hours the average person sleeps has gone down over the years.

indigo girl

5,173 Posts

Specializes in Too many to list.
I wonder what role sleep deprivation plays in vulnerability? Many younger people, and people in general, do not get enough sleep. The hours the average person sleeps has gone down over the years.

Oh, thanks a bunch, FireStarterRN! I am a night worker with a chronic sleep deprivation problem. I guess, I better start taking that melatonin a good friend gave me yesterday...

Sure, sleep deprivation does affect the immune system, good point.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Your post mentions people 20-30 lbs overweight being at higher risk. I've read that sleep deprivation contributes to weight gain. I wonder if the real problem for those folks is sleep deprivation, not a few extra pounds...

indigo girl

5,173 Posts

Specializes in Too many to list.
Your post mentions people 20-30 lbs overweight being at higher risk. I've read that sleep deprivation contributes to weight gain. I wonder if the real problem for those folks is sleep deprivation, not a few extra pounds...

Could be.

Or is it that being overweight is related to decreased lung function and metabolic syndrome?

Belly fat affects lung performance

http://www.hc2d.co.uk/content.php?contentId=10504

As part of a group of problematic symptoms dubbed metabolic syndrome, a large waist measurement is already linked with high blood pressure, diabetes, and heart disease.

But excess belly fat is now firmly linked to decreased lung function, regardless of other factors.

Writing in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, study lead author Natalie Leone said that the researchers found a positive independent relationship between lung function impairment and metabolic syndrome due mainly to abdominal obesity.

Excess belly fat might affect breathing by causing the body to become inflamed, or it may be due to a restriction of the diaphragm.

People classified as having metabolic syndrome have three of the following symptoms: an elevated level of triglicerides (blood fats), elevated blood pressure, elevated blood sugar, and a low level of HDL cholesterol.

Poor lung function has also been linked with higher death and hospitalisation rates due to heart disease.

Leone said the association might result from the mechanical effects of truncal obesity on the muscles and skeleton in the chest, and/or the metabolic effects of fat tissue.

Leone's team also found a significant interaction between metabolic syndrome and smoking status, with estimated lung function impairment risk in current and former smokers being higher than in those who never smoked.

(hat tip PFI/belarusa)

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

22 Articles; 9,986 Posts

Specializes in LTC, assisted living, med-surg, psych.

Sure glad I'm over 50............:uhoh21: Age, in this case, is about the only risk factor I DON'T have. Sure hope they've got a vaccine up and running soon!

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