The Transylvania Times -

Impact On At-Risk Groups Unclear


Last updated 8/10/2020 at 3:15pm

From the obese to the elderly to smokers, some of the most at-risk groups for negative outcomes related to COVID-19 are highly concentrated in Transylvania County.

But the why and how for each group, in terms of their particular susceptibility to COVID-19, isn’t always clear, as scientists and health experts continue to learn more as the virus continues to spread throughout the nation.

“With every passing few weeks, scientists and physicians learn more,” said Elaine Russell, Transylvania County health director. “With every passing period of time we are able to understand better how this virus impacts and attacks the body.”

Perhaps the most notable at-risk population is the elderly. According to the CDC, those 65-74 years old are hospitalized at a rate of 198.7 per 100,000 of the total population.

That number jumps to 329.3 per 100,000 for those between 75-84 years old and rockets to 513.2 per 100,000 for those older than 85.

According to Census data, 31.4 percent of Transylvania County residents are 65 or older, with 12 percent of the population being between 70-79 and approximately 8 percent being 80 or older.

Tara Rybka, public information officer for the health department, said the main reasons the elderly are so vulnerable to COVID is two-pronged – as people get older, their immune system naturally weakens, and, with age often comes other underlying health conditions.

“From what I’ve seen, it’s really about those biological changes from aging in general, the decrease in immune function and the fact that as we age, we’re more likely to have more co-morbidities,” she said.

While the elderly are more susceptible to contracting COVID, and more likely to suffer negative outcomes, the risk for the population at large increases with age. A person in their 30s is more at risk than a teenager, but not as vulnerable as a person in their 40s or 50s.

One of the hotbeds for outbreaks of COVID has been nursing homes and care facilities.

Russell said there are two main reasons as to why those in nursing home facilities are particularly at risk.

One is the fact that they are often suffering from underlying health conditions. The other is the close quarters in which the residents live and the ability for the virus to spread rapidly.

“Individuals who are in nursing homes are there because they are having health complications and health challenges. So, that, in and of itself, places them at greater risk for complications. Couple that with the inherent risk of living in a congregate living setting, it just sets the stage for that dynamic,” she said.

Rybka said that if there were two people of the same age and the same health – one living in a nursing home and one living in their own home – that the person in the nursing home would be at more risk, simply from their congregate setting, but wouldn’t necessarily be at any higher risk for negative outcomes should they contract the virus.

Obesity and diabetes are two more risk factors. According to a 2018 Community Health Assessment put out by the health department in coordination with Transylvania Regional Hospital and other key health partners in the community, 57.9 percent of the county was categorized as overweight or obese, with 28.4 percent being labeled obese.

That same study identified 10 percent of the county as diabetic, with an additional 9 percent being deemed pre-diabetic.

Rybka said there are several theories as to why COVID negatively affects the obese more than other segments of the population.

“The speculation is that it could be due to the fact that many people who are obese already experience some sort of breathing difficulty and may put them experiencing that cytokine storm due to inflammation,” she said.

Cytokines are cell-signaling molecules that aid cell-to-cell communication in immune responses.

A cytokine storm is a severe immune reaction in which the body releases too many cytokines into the blood stream too quickly.

This can bring about severe health complications, including organ failure and death.

Rybka added there is also speculation that fat cells can serve as a reservoir for the virus.

In terms of diabetes, Rybka said while there is a connection between diabetes and COVID, the exact nature of that relationship is unknown. She said that people with diabetes are at a higher general risk for infections, and more likely to suffer severe symptoms from illnesses like pneumonia.

Russell added that, based on national data, people with diabetes who contract COVID have longer recovery periods.

When it comes to smoking, the 2018 community health report estimated 15 percent of the county are smokers, with roughly 4 percent using smokeless tobacco.

The adverse effects of smoking have been well-documented, particularly the effect on the lungs.

As a virus that aggressively attacks the lungs, Rybka said smokers are susceptible because their lungs are already weakened.

“Smoking impairs your lung function,” she said. “So, you’ve got that reduced lung capacity in the first place. And since one of the primary symptoms of COVID is difficulty breathing, those who smoke are already starting off at a place of reduced lung function compared to the rest of the population.”

Rybka added that smokers are also at increased risk of respiratory infections, and when those infections develop, they tend to be more severe.

The method of smoking, and the act itself, also creates risk.

Rybka said using a hookah or vaping, which are more communal ways of smoking traditional cigarettes, create situations where the virus could easily spread from person to person.

But even smoking a cigarette, she said, brings risks. Part of the guidelines to prevent contracting COVID include not touching your face or putting your hands close to your mouth.

To a degree, both of those actions are unavoidable when you smoke a cigarette.

Another group Rybka said is particularly at risk are those with cardiovascular disease.

Statewide, 50 percent of those who have died from COVID suffered from a cardiovascular disease; and, along with cancer, cardiovascular disease has been a leading cause of death in Transylvania County the past several years.


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