What Puts Patients at Risk

here's what happened today. If it's Thursday, that means it's another week where we talk about a number in the millions that we used to count in the hundreds of thousands unemployment. Over three eight million Americans filed for unemployment benefits last week. Since the pandemic began shutting down businesses across the country six weeks ago, over thirty million have

now applied. Tomorrow, we'll find out what the unemployment rate was for the month of April, but experts say it could be as high as we haven't seen a number like that since the Great Depression of the nineteen thirties. The Food and Drug administration says it is moving at lightning speed to review data on the experimental COVID nineteen

treatment rem dessevere made by Gilliad Sciences. Yesterday, an important US trial showed promising results for the drug, but on the very same day, the lance AT journal published a fully vetted small Chinese study that showed different less promising results. F d A Commissioner Stephen Hahn said the agency was prioritizing speed while at the same time reviewing all of the data to decide how to regulate the drug. In other drug news, Astra Zenica agreed to make an experimental

coronavirus vaccine developed by Oxford University researchers. Astra's goal is to have the capacity to produce one hundred million doses by the end of the year. The company is one of dozens around the world that have joined the race to produce an effective vaccine. The Trump administration this week announced an effort to make shots available to Americans by the end of the year. The agreement between Astra and Oxford shows that drug developers are planning to manufacture vaccines

even before they've cleared human tests. Creating an effective vaccine is key to getting back to normal life. But Brazil isn't waiting. In the country that's has to becoming a global hotspot of the pandemic. Some states have dialed back restrictions on malls, gyms, and churches. Demand is up at gas stations across the country. Even residents of South Paulo, where restrictions remain in place, are getting out more. According to government tracking data, a poll shows that support for

isolation measures is fading. On Tuesday, Brazil reported its highest number of deaths since the pandemic hit the country in late February. It's twenty four. Our fatality rate lags only the US and the UK, and now our main story. As COVID nineteen spreads, doctors are learning more about why some patients get very sick and why others only get mildly ill. Some of the people most at risk for

severe illness have underlying conditions that affect their lungs. Older people are also at a higher risk, but certain factors, when combined with age, create a powder kick for the effects of the disease. Both smoking and obesity are conditions that can lead to fatal results in COVID nineteen patients. Bloomberg Senior editor Jason Gale explains how these conditions have

made the coronavirus more lethal in some countries. Obesity didn't feature much among critically ill patients when the pandemic started in China in late two nine. That may be because it's not as big a problem in China as it is in some Western countries. The Chinese government says about twelve percent of its adult population is abase. That compares with about in the United States. Obesity is associated with a range of health problems, from type two diabetes to

cardiovascular disease to cancer. These can all increase the severity of COVID nineteen. But when doctors outside China looked more closely at some of their sickest patients, they found obesity stood out as an independent risk factor. It seems the obesity epidemic could be exacerbating the severity of the coronavirus pandemic. Obesity is a very important risk factor, that's Tobias Wealthy. He's the head of medicine at Hanover University in Germany and a member of the COVID nineteen task force in

the state of Lower Saxony. Tobias says the virus may get past the body's immune defenses easier and obese patients than in patients whose body mass is in the healthy range. My explanation is that in patients who are OBEs, there is a change in the structure of the lungs. Scientists have found that excess fat accumulates in the airway walls, where it takes up space and seems to increase inflammation

within the lungs. Demias thinks that in obese patients, low grade inflammation depresses the body's initial innate immune response to respiratory infections. That also makes it easier for pathogens like the coronavirus to go from the nose and throat to the lower respiratory tract, where it can damage the tiny grape like air sax or alveola through which gas exchange occurs for oxygen eating the blood, and then that can

lead to more inflammation and ultimately to difficulty breathing. We don't know that the coronavirus selectively targets people with obesity or that they're more prone to the infection, but the emerging evidence from studies coming out of North America and Europe over the past few weeks points to obesity being a risk factor for getting sicker from COVID nineteen needing intensive care and mechanical ventilation, and also for dying as

a result of the disease. Dr Margaret Pezzani Tommy she saw the same phenomenon when she was treating H one N one or swine flu patients during the two thousand and nine influenza pandemic. Margaret is an associate professor of pulmonary and Critical Care Medicine at Yale University in Connecticut. She now treats critically ill COVID patients at Yale New Haven Hospital. She says there are also physical challenges to caring for obese patients. It's harder to do things like

throwing them so put them out on their valies. It's harder to manage them on the ventilator because their airway pressures tend to be hired just because of their body habits, and so I think in general they're harder to care for, and then we just have a harder time than with

ventilating them and oxygen eating them. So if a patient is obese and becomes infected with COVID, they are more likely to do worse than someone in a healthy weight range, and there's another risk factor that's adding to the severity of this pandemic, smoking newport cigarettes carefully selected blend. Previous studies have shown that smokers are twice as likely as non smokers to contract influenza and to have more severe symptoms. We're now seeing a similar effect in COVID nineteen cases.

When you inhale through a cigarette, the smoke damages protective cells that line your respiratory tract. The coronavirus also happens to target these cells, so when a smoker develops COVID, the cells are already vulnerable and the virus just takes advantage of that weakness. Once the virus gets into the body, it tries to replicate by invading cells with a specific

protein receptor. Dr Janice Leon is a respiratory physician at Vancouver Saint Paul's Hospital and the University of British Columbia. Janice found there were more of these receptors in the airways of patients with a common smoking related condition called chronic obstructive pulmonary disease or COPD, So it may be that the virus has an easier time undering the lungs of people who have CELPD. That's one possibility as to

why they may actually do worse. Right now, Janice is studying whether these receptors can be manipulated with certain drugs to ward off COVID nineteen to bias wealthy yet Hanover University says data coming from Southern European countries like Spain and Italy show that smokers have a higher risk of worst disease compared with non smokers. But there's one country that at least initially didn't match that pattern despite having

a high rate of smokers, and that's China. When the pandemic started in the Chinese city of Wuhan, smokers weren't predominant among the sickest patients, and this didn't square with what researchers have since found in other parts of the world, and especially stump scientists because smoking is so prevalent in China. For example, in Hubei Province, in which Wuhan is the capital, close to six of mid smoke, but study showed only a fraction of severely ill COVID nineteen patients were smokers,

and that was puzzling. Tobia says. One explanation might be that the data weren't reliably collected and recorded in the early days of the pandemic, but even past that, there was another factor, one that might have predisposed the wider population to more severe illness once they're called COVID nineteen, and that's air pollution. What is cigarette smoke. Cigarette smoke is a kind of very intensive pollution, but if there is a high pollution, it could overcome the effects of

cigarette smoking alone. Tobiasis theory hasn't been confirmed yet. Wohound, with about eleven million people, is known for its still smelting. Tobias says that the connection to poor air quality in China and severely ill COVID patients lines up with trends and parts of the world. When the pandemic started in China and also when it started in nos and Italy, very surprisingly, our pollution had been very high at this time point, so there may be a synergistic effect of

different types of air pollution. As COVID nineteen spreads, we're seeing it play out slightly differently in communities around the world, exposing different vulnerabilities and sometimes exacerbating longstanding health problems. In the case of air pollution, it isn't something that can be easily tackled, at least on an individual level to reduce the risk from COVID nineteen. But smoking is of all the good reasons to quit smoking, The current pandemic

amounts to one more. That was just in Gale in Melbourne, And that's our show today. For coverage of the outbreak from one and twenty bureaus around the world, visit Bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is hosted by Me Laura Carlson. The show is produced by Me,

top Foreheads, Jordan Gaspoure and Magnus Hendrickson. Today's main story was reported by Jason Gale. Original music by Leo Sidran. Our editors are Francesco Levi and Rick Shine. Francesco Levi is Bloomberg's head of Podcasts. Thanks for listening. Two