New Delhi: In the absence of a cure or a vaccine, the only ammunition human beings have to fight the Covid-19 pandemic is to build immunity and stay fit. But what puts India at a higher risk is not only its dense population and weak health infrastructure, but also the higher prevalence of a cluster of lifestyle diseases, together called ‘metabolic syndrome’.
This cluster includes high blood pressure (BP), diabetes, obesity, and clogged arteries, which make people more prone to cardiovascular diseases. They are the most common cause of non-communicable diseases like kidney damage and chronic lung disease, and treating Covid-19 in such patients is a tougher task.
But what compounds the problem in India is that a lot of younger people also have metabolic disorders, which brings the high-risk age for Covid-19 down to 40 years or even lower.
Metabolic disorders in India
Experts blame industrialisation, mechanisation, and westernisation for the increasing prevalence of metabolic disorder in India, while environmental pollution is also considered an important risk factor.
A 2018 study titled ‘Cardio-metabolic disease in India — the up-coming tsunami’ had blamed smoking, alcohol, high intake of sodium, laziness and inactivity and absence of exercise in the daily schedule for the growing malaise. It added that the influence of “the Western world on the dietary pattern, replacing high-fibre diet with refined carbohydrates and saturated fats, has added more to the challenge”.
“The prevalence of metabolic disorders has been documented in around 25 per cent of adult males and 40 per cent of adult females in India. Those who are in the age-bracket of 40 years to 60 years are more prone to such disorders,” said Dr Avnish Seth, director, gastroenterology and hepatobiliary diseases, Fortis Memorial Research Institute, Gurugram.
Metabolic risk factors are a common cause of non-communicable diseases such as heart disease, stroke, cancer, diabetes and chronic lung disease. These diseases, according to the World Health Organization (WHO), collectively are responsible for almost 70% of all deaths worldwide.
It adds that almost three quarters of all non-communicable disease deaths, and 82 per cent of the 16 million premature deaths (before reaching 70 years of age), occur in low- and middle-income countries.
In India, these diseases are estimated to account for 63 per cent of all deaths. In 2016, around 60 lakh Indians died due to these diseases, of which more than 33 lakh were males, according to WHO data.
Dr Arutselvi Devarajan, senior research associate at the Department of Epidemiology at Chennai’s Professor M. Viswanathan Diabetes Research Centre said: “India’s burden of non-communicable diseases is presently more than half of the total deaths. With Covid-19, we have not just been fighting a communicable disease alone, but also a growing backdrop of non-communicable diseases that could needlessly raise the death toll.”
Devarajan added: “A report on global burden of disease highlighted that out of total disease burden, 61 per cent was due to infectious and associated diseases in 1990, which dropped to 33 per cent in 2016. On other hand, NCDs increased from 30 per cent in 1990 to 55 per cent in 2016.”
The Government of India also acknowledges the challenge. “People with non-communicable diseases are at increased risk of developing complications due to Covid-19,” says a pop-up message on the website of the National Centre for Disease Informatics and Research (NCDIR), an institute oversees non-communicable diseases in India under the Indian Council of Medical Research.
The NCDIR adds that people suffering from such diseases are at increased risk of “developing complications from existing diseases due to disruption of routine care”.
Covid-related implications for India
Dr Veera Baladandayuthapani, professor at the Department of Biostatistics at the University of Michigan in the US, analysed data from over 2.6 lakh Covid-19 patients worldwide, and concluded that diabetes, hypertension, cardiovascular and respiratory diseases have high rates of occurrence.
“This has major implications for India,” Baladandayuthapani wrote in a blog at Medium. He explained that India one of the highest rates of diabetic patients, close to 12 per cent, which amounts to close to 15.6 crore people who are at risk. Hypertension rates, he wrote, are close to 30 per cent, amounting to 39 crore, and the number of people with cardiovascular issues is estimated to be 5.4 crore.
IIM Indore assistant professor and biostatistics expert Sayantan Banerjee is undertaking a detailed study on a national level to understand the relationship between Covid-19 and metabolic syndrome.
In the initial phase of the study, Banerjee’s team analysed data of the fourth round of the National Family Health Survey (NFHS-4) and the list of red, orange and green districts in India. “We started with Madhya Pradesh and have found that the prevalence of metabolic disorders such as hypertension along diabetes is much more in red zones than green zones. In some areas, the disorder is more in red and orange in both zones,” he told ThePrint.
He added that these diseases can bring down the age of India’s at-risk population.
“This brings down the high-risk age group for Covid-19 category as well in India. It is not just the people above 65 years of age who are vulnerable in India, but the younger age-group with metabolic syndrome or non-communicable diseases are equally vulnerable,” he said.
Poor outcomes of treatment
Dr Rashid Gouri, a senior resident at AIIMS, New Delhi, who is treating Covid-19 patients, told ThePrint that metabolic disorders produce “poor outcomes” in treatment, even for younger patients.
“Metabolic disorders cause poor outcomes in the young population along with delayed recovery,” Gouri said.
“Consequences of metabolic disorders such as diabetes cause renal failure, which exacerbates the clinical situation,” he added.
According to a study published in medical journal The Lancet, obesity can restrict ventilation, impair immune responses to viral infection, and induce diabetes and oxidant stress to adversely affect cardiovascular function.
“We conclude that in populations with a high prevalence of obesity, Covid-19 will affect younger populations more than previously reported. Public messaging to younger adults, reducing the threshold for virus testing in obese individuals, and maintaining greater vigilance for this at-risk population should reduce the prevalence of severe Covid-19 disease,” the study, published on 4 May, said.
S.V. Subramanian, professor of population health and geography at Harvard University, told ThePrint that India also suffers from under-nutrition, which warrants another probe.
“The emerging evidence from the clinical characteristics of Covid-19 deaths in the high income countries suggests hypertension and diabetes as a susceptibility. However, we need to learn more by examining the data on Covid-19 patients in India that how the virus interacts with people with undernutrition as well, which we know is a huge issue among adults and children in India,” he said.