Chronic health conditions are rampant in Arkansas, putting more of the state's population at risk of getting seriously ill or dying from the new coronavirus, experts say.
Like in much of the South, heart disease, high blood pressure, asthma, lung disease and diabetes are commonplace in the Natural State. Early research from Italy suggests such conditions are linked to complications and deaths from covid-19, the illness caused by the coronavirus.
That's led the federal Centers for Disease Control and Prevention to warn people with chronic illnesses, as well as older adults -- two groups that often overlap -- to take extra care during the global outbreak that has sickened hundreds of thousands and put doctors on alert.
"We have an idea what's coming," said Dr. Nikhil Meena, a University of Arkansas for Medical Sciences pulmonologist. "We just have to be prepared for it, and mitigate it as much as possible."
[CORONAVIRUS: Click here for our complete coverage » arkansasonline.com/coronavirus]
Roughly 29 million Americans younger than 59 and close to 40 million age 60 and older have a chronic health disorder that makes them more likely to get very sick from covid-19, a recent analysis from health-policy nonprofit Kaiser Family Foundation said.
But even in that landscape, Arkansas is a chronic-illness hot spot. In 2017, the state was first in the nation for its death rates from chronic lower respiratory diseases, such as emphysema, bronchitis and asthma, and third for deaths from heart disease, kidney disease and diabetes, CDC data says.
The latter condition is a perpetual bane of Arkansas public-health officials, with about 14% of the state's adult population reporting that they are diabetic, the nation's fourth-highest incidence, according to a Robert Wood Johnson Foundation report.
Paired with an aging population and more than 1 in 5 adults who say they smoke, a pretty big group of Arkansans has at least one health factor that could cause trouble for them, should they get sick.
As the numbers of people in the state diagnosed with the new viral illness have reached 100, those with health concerns of any kind should "be vigilant" about their conditions and monitoring covid-19's spread, said state chronic-disease director Dr. Appathurai Balamurugan.
Covid-19 and chronic conditions could exacerbate one another in a dangerous chicken-and-egg process, he explained.
"When people with diabetes have their diabetes poorly controlled, it leads to more infection[s]," Balamurugan said. "Of course the body's response to fight infection is putting out more corticosteroids -- adrenaline or epinephrine -- and that increases the blood sugar."
Chronic health conditions are often correlated with what researchers call "social determinants of health," such as poverty. In Arkansas, they're intertwined with poverty, poor nutrition and lifestyle factors like low activity levels, said Dr. Barry Tedder, a cardiologist with St. Bernards Healthcare.
As well as being systemic, and, therefore, hard to fight, having one chronic condition makes it more likely that people will get another, such as a diabetic person developing heart disease.
People with these kinds of conditions already should be cautious during the usual viral-infection season, like when flu and pneumonia are going around, Balamurugan said. Such an infection adds extra strain on the heart as it pumps, which can aggravate existing cardiac disease.
But the poorly understood nature of covid-19 means people with health problems should sit up and pay attention, experts said. So far, there is no specified treatment for the disease and a vaccine likely is more than a year away, experts said.
"It seems to be that CVD, cardiovascular disease, is a better predictor of complications than underlying lung disease" for covid-19 patients, which is somewhat unique among respiratory infections, Tedder said.
It's not known why that is, but Tedder said it might have something to do with the persistent inflammatory state created by heart disease, or the way the coronavirus binds with some receptors in the body.
Even past health factors can have lingering effects that people should be conscious of as risk factors, experts agreed. For former smokers with lung damage, that injury can make it hard for cells and structures in the lungs to recognize infections and effectively fight them off, Meena said.
That makes such a patient "high risk" even when fighting the flu and common cold, he said.
For those managing chronic health conditions, experts said the best thing to do is take steps to avoid contracting covid-19 in the first place.
That means avoiding public areas and travel whenever possible, thoroughly and frequently washing hands, not touching one's face, and rescheduling non-urgent checkups or other medical appointments.
Tedder suggested taking advantage of telemedicine to minimize exposure from crowded doctors offices, when possible. Refilling prescriptions by mail is another tool.
Doctors also emphasized keeping up with any typical medications, such as insulin, and monitoring metrics such as blood pressure or blood sugar, which Balamurugan said could be "as important" as looking out for covid-19 symptoms.
"This could be the straw that broke the camel's back," he said.
Meena reiterated the benefits of quitting smoking, even if one has been smoking for many years. Stopping smoking right away can cut down on lung inflammation and reduce constriction on blood vessels.
"Quitting smoking is the best thing you can do for yourself at any point," Meena said. "There's always a benefit, even if you quit for the last couple of years of your life."
Common symptoms of covid-19 include fever, cough and shortness of breath. If someone from an at-risk group starts having symptoms, they should call to a primary-care doctor to talk about what to do.
Covid-19 has caused severe illness in some people, and officials and physicians have stressed the need to slow the outbreak so as not to overtax Arkansas emergency rooms and hospitals as the outbreak continues.
"The question is how fast do we get there," Meena said.
"Do we get there in two weeks, or do we get there in two months? If we get there in two weeks, we will not be able to take care of the majority of these people in the hospital, because we just don't have the capability."
A Section on 03/22/2020