Size of the population susceptible to coronavirus infection is significant
Between 25th and 30th of March, 2020, the total number of confirmed COVID-19 cases in India has more than doubled i.e. from 519 to 1,251, according to the data released by the Ministry of Health and Family Welfare (MoHFW). In a span of 6 days, the total number of deaths from COVID-19 has more than trebled i.e. from 9 to 32. In a health situation like this, when the coronavirus infection is spreading fast like wildfire across the country, it becomes necessary to map people or groups who are at greater risk to get infected as compared to the rest of us.
The World Health Organisation (WHO) has confirmed that older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more prone to develop serious illness. The WHO has stated that persons who eat a well-balanced diet are likely to be healthy with stronger immune systems and lower risk of chronic illnesses and infectious diseases.
According to research done by the Centers for Disease Control and Prevention (CDC), the leading national public health organisation under United States’ Department of Health and Human Services, those who are at high-risk for severe illness from COVID-19 include:
* People aged 65 years and older
* People who live in a nursing home or long-term care facility
* Other high-risk conditions could include:
- People with chronic lung disease or moderate to severe asthma
* People who are pregnant should be monitored since they are known to be at risk with severe viral illness, although to date data with CDC on COVID-19 has not shown increased risk
The CDC has also noted that there are several health conditions, which can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.
Size of vulnerable groups in India
Based on the above-mentioned studies, it is time to look at the size of vulnerable populations/ groups who have a higher chance to get infected by COVID-19 vis-à-vis the rest of the population. Let us first see the nutritional status of adult women and men in our society. Data from the fourth round of the National Family Health Survey (viz. NFHS-4) shows that almost a quarter of adult women (i.e. 22.9 percent) have a body mass index (BMI) below 18.5 kilogram/ meter square, which clearly indicates underweightedness (i.e. thinness) amongst them. Roughly one-fifth of men (i.e. 20.2 percent) in the age cohort 15-49 years have a BMI below 18.5 kg/ meter square.
According to the National Health Service (NHS), the publicly funded healthcare system of the United Kingdom, if someone is underweight, it's likely that s/he is not consuming a healthy, balanced diet, which can lead to that person lacking nutrients that the body requires to perform properly. When someone is underweight, then the immune system is not 100 percent strong. So, s/he is more likely to catch a cold, flu or any other infection. Underweight women have irregular menstrual cycles, which is a fertility disorder.
Data from the NFHS-4 tells us that nearly one-fifth of adult men (i.e. 18.6 percent) as well as adult women (i.e. 20.7 percent) have a BMI, which is greater than or equal to 25.0 kg/ meter square, which signals overweightedness (i.e. obesity) amongst them.
According to the NHS, obesity can cause a number of serious and potentially life-threatening conditions, including type-2 diabetes, coronary heart disease, stroke, high blood pressure (viz. hypertension), asthma, some types of cancer (such as breast cancer, womb cancer and bowel cancer), liver disease and kidney (renal) disease.
Irrespective of gender, the prevalence of thinness among persons in the 15-49 years age bracket is higher in rural areas vis-à-vis urban India. So, it is not surprising to notice that the prevalence of obesity among adults is higher in urban areas vis-à-vis rural areas.
The NFHS-4 data shows that the proportion of Indian women in the age cohort 15-49 years who are anaemic is 53.0 percent. Approximately 50.3 percent of pregnant women in the same age-group are anaemic (i.e. <11.0 g/dl). On the contrary, around one-fourth of adult men (viz. 22.7 percent) are anaemic (i.e. <13.0 g/dl).
Among other things, iron deficiency affects the immune system, finds the NHS. It has also been observed by the NHS that the potential complications of Vitamin B12 or folate deficiency anaemia can include problems with the nervous system, temporary infertility, heart conditions, pregnancy complications and birth defects. Persons with severe anaemia are also at risk of developing heart failure.
Data from the NFHS-4 indicates that roughly 5.8 percent of women in the age cohort 15-49 years are diabetic (i.e. >140 mg/dl) and 2.8 percent of them have a very high blood sugar level (i.e. >160 mg/dl). Similarly, 7.9 percent of adult men in the country are diabetic (i.e. >140 mg/dl) and 3.8 percent of them suffer from a very high blood sugar level (i.e. >160 mg/dl).
According to the CDC, diabetes can cause many complications in a human being, including heart disease and stroke, blindness and other eye problems, kidney disease, nerve damage, amputations, gum disease and depression.
The overall proportion of adult women in the country who suffer from hypertension viz. high blood pressure (viz. slightly above normal, moderately high and very high) is 8.8 percent, according to the NFHS-4. As opposed to that, the overall proportion of men in the age group 15-49 years who have hypertension is 13.4 percent.
Termed as a "silent killer", hypertension can cause serious damage to the heart. According to the WHO, high blood pressure is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases.
Kindly note that persons with poorly controlled diabetes and hypertension are more likely to get infected by COVID-19 than others.
Apart from the NFHS-4, one can also consult the National Health Profile-2019 (NHP-2019) for data on non-communicable diseases (NCDs). That report was released by the MoHFW last year. Based on available evidence from the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), out of 6.52 crore patients who attended NCD clinics (between 1st January, 2018 and 31st December, 2018), 4.76 percent people were diagnosed with diabetes, 6.19 percent were diagnosed with hypertension, 1.70 percent were diagnosed with both diabetes mellitus and hypertension, 0.30 percent were diagnosed with cardiovascular diseases, 0.11 percent were diagnosed with stroke and 0.26 percent were diagnosed with common cancers (including oral, cervical and breast cancers).
As stated earlier, patients with poorly controlled HIV or AIDS are immunocompromised, among other things. A technical report entitled India HIV Estimations 2017 by the MoHFW shows that by the end of 2017, there were an estimated 21.40 [range 15.90-28.39 lakh] lakh people living with HIV (PLHIV) in the country. The HIV prevalence rate among adults (15-49 years) was 0.22 percent in 2017. A little more than two-fifths (42 percent) of the total estimated PLHIV were found to be females.
The NHP-2019 report shows that nearly 5.2 percent (estimated) of the country's population belonged to the age group 65 years and above in 2017. It should be noted that persons aged 65 years and above are considered to be at higher risk of getting infected by the coronavirus disease.
Smokers and alcoholics too face the risk of getting infected by COVID-19 because they might suffer from immune deficiency. A report entitled Magnitude of Substance Use in India 2019 indicates that although 27.3 percent of men consume alcohol, the corresponding figure for women is merely 1.6 percent. About one-fifth of alcohol consuming men are alcohol dependent, whereas only one-in-sixteen alcohol-consuming women have dependence on it.
The NFHS-4 report for the entire nation shows that the proportion of men in the age group 15-49 years who smoke (such as cigarettes, bidis, cigars, pipe and hookah) is 28.0 percent and for adult women the corresponding figure is 0.9 percent. The proportion of men in the age group 15-54 years who smoke is 29.3 percent. It means that a little less than one-third of Indian men in this age cohort are at greater risk of getting infected by COVID-19.
Readers may note that there will be inter-district, inter-state and inter-regional differences in the prevalence of many of the ailments that have been discussed in this news alert.
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Image Courtesy: Inclusive Media for Change/ Himanshu Joshi
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