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Why Underlying Conditions Pose More Risk with COVID-19

 Authored by Bob Wright, M.A.T. – Director of Education at Hilton Head Health

“COVID-19 doesn’t distinguish who it infects. But it does distinguish who it kills.”

That’s according to Dr. Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University. We are all vulnerable to catching the virus but the elderly and those with underlying health issues are far more vulnerable to having serious complications.  

It is not surprising that age is a risk factor. As we age our immune system weakens, making it harder to fight off infections. In fact, according to The Centers for Disease Control, 8 out of 10 deaths due to the Coronavirus in the US have been in people 65 and older, with those over 85 at the greatest risk. To make matters worse, older adults are more likely to have the very underlying health issues that also increase the risk. Aging is a double edge sword when it comes to risk for COVID-19 

What are those underlying health issues and why do they place us at greater risk? By in large, they are chronic diseases such as obesity, heart disease, diabetes, and chronic lung disease. While they are more common in the elderly, with 84% of those over 65 having at least one and 70% having 2 or more, age is not is a prerequisite, We are developing these chronic diseases at younger ages than ever before, and having one or more of the places even younger people at risk.  

90% of those hospitalized due to the coronavirus had one or more of these or other underlying health issues, regardless of their age. Here is a brief overview of the most significant ones and why they increase the risk of complications. 


Chronic inflammation is usually present in overweight people and it can weaken the immune system, impairing the healing process and prolonging recovery. Also, obesity increases the risk of other chronic diseases that increase susceptibility to complications. 48% of those being hospitalized are obese. 


Those with diabetes whose blood sugar levels are higher are more likely to have diabetes-related health problems. Those health problems can make it harder to overcome COVID-19. Like obesity, increases chronic inflammation, weakening the immune system.  

Chronic lung conditions 

Examples such as chronic obstructive pulmonary disease and asthma can damage the lungs making them more vulnerable to complications.  

Heart Disease

Heart conditions such as heart failure and coronary artery disease are likely at greater risk as well. COVID-19 can damage the respiratory system and make it harder for your heart and lungs to work. Almost half of those being admitted to hospitals with the Coronavirus have hypertension, a major risk factor for heart and other vascular diseases.  

If you are over 65, or you have underlying health conditions, you must be very vigilant in following the social distancing and personal hygiene guidelines. You obviously want to minimize your exposure to the virus as much as possible.  It is also imperative to follow your health care professional recommendations to manage those conditions. Make sure that you take all medications as prescribed and be sure not to run off your prescriptions.  

Because many of the underlying conditions mentioned earlier can be influenced by our lifestyle, this might the perfect time to look for things that you can do to lower your risk. While this is probably not the best time to make major lifestyle changes, it is a great time to look for small changes that can make a big difference. 

Small Ways to Improve Your Health

Interrupt sitting

If you are like me, you are probably finding yourself in front of the TV more than you are used to. Make sure you get up and move around regularly. One study found that gentle walking, 2 minutes every hour, lowered the risk of premature death by 33% compared to those sat almost nonstop. 

Look for ways to sure up your diet.

During stressful times it’s tempting to focus on comfort foods and snack foods. It’s challenging now in part because it is difficult to get to the store or find the foods you might be looking for. Try to keep healthy staples like whole-wheat pasta, low sodium pasta sauces, brown rice, low sodium canned beans, frozen veggies, and fruit available. Keep the chips to a minimum and focus on nuts, whole wheat crackers, and lightly salted hot aired popcorn as better snacks. If you have a category of foods like frozen dinners, salad dressings, pasta sauces, breads or cereals that you are having trouble figuring out what the healthiest choices are, there is a great resource available on the app store called Fooducate. You scan the bar code of the product you are considering. Fooducate then rates it. If your choice is rated poorly, you can find healthier choices to be touching the alternative tab.   

Increase your berry consumption

In the Nurses’ Health Study, Women who consumed about the most (3 ½ cup serving) of blueberries and strawberries per week, were 34% less likely to suffer a heart attack during the 18 year study period than those who consumed the least. It might be difficult to find fresh berries consistently now, but frozen is just as nutritious.   

Use the healthy plate model for portion control and improved diet quality.

Make sure that half of your plate is made up of a variety of colorful vegetables, (frozen are fine) one quarter made up of whole grains such as brown rice, quinoa, whole-wheat pasta, etc. and the other quarter, healthy protein like beans or lentils, fish, poultry or lean meat.  Feel free to load up on fruit as well.  

As Dr. Mozaffarian puts it, “In this time of crisis, healthy eating is more important than ever. Healthy foods can boost the immunes system and help people of all ages fight off respiratory infections.  

Find time to relax or meditate

This might be one of the most challenging, but most important things to focus on. The good news is that as little as 5 – 10 minutes of meditation per day can reduce stress hormones and elevate your mood. If you have trouble doing it on your own app like Headspace, Calm and Insight Timer are available at the app store. 

Pay attention to your weight

Once again this is probably not the best time to take on a major weight loss program. Small changes, however, can really help. For every pound lost, there are 4 lbs. less stress on weight-bearing joints.  As little as a 3 % weight loss translated into clinically meaningful reductions in risk factors for heart disease and diabetes, and as mentioned earlier, both increase the risk of complications associated with the coronavirus. If weight loss is unrealistic during this challenging time, not gaining weight would be a major success as well.  

Up to this point, the public health focus to managing COVID-19 has been to “flatten to curve” through social distancing and good personal hygiene. But flattening the curve does not make the virus go away. This virus is here to stay and even when and if there is an effective vaccine, like the flu it will still be around. Being healthy will be the best insurance you have to reduce the chances of contracting it and minimizing the complications if you do. One of the challenges with getting motivated to manage chronic health issues is that their consequences seem so far away. But as Dr. David Katz puts it, the COVID-19 pandemic has turned chronic health liabilities like heart disease and diabetes into acute threats. He went on to say that “There’s never been a better time for America to get healthy.”  

Bob Wright
Director of Education at Hilton Head Health

Click here for more information about the wellness and weight loss programs at Hilton Head Health, recently named the #1 Wellness Resort the Country by USA Today