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Asthma Is Absent Among Top Covid-19 Risk Factors, Early Data Shows – The New York Times

For people with asthma, the outbreak of a pandemic that can lead to respiratory failure has not been a welcome event. Many health organizations have cautioned that asthmatics are most likely at higher risk for severe illness if they get the coronavirus. There’s been a run on inhalers, and coronavirus patients like the actor Idris Elba have openly worried about their asthma.

But this month, when New York State, the epicenter of the outbreak in the United States, began releasing data on the top 10 chronic health problems suffered by people who died from coronavirus, asthma was notably absent from the list. State officials said only about five percent of Covid-19 deaths in New York were of people who were known to also have asthma, a relatively modest amount.

The research at this early stage is minimal and not always consistent, as one would expect. A recent commentary published in Lancet by a group of European researchers called it “striking” that asthma appeared “to be underrepresented in the comorbidities reported for patients with Covid-19” — comorbidity being the term for a secondary health problem. A small study of 24 critically ill patients in Washington State noted that three had asthma.

“We’re not seeing a lot of patients with asthma,” said Dr. Bushra Mina, a pulmonary and critical care physician at Lenox Hill Hospital in New York City, which has treated more than 800 Covid cases. The more common risk factors, he added, are “morbid obesity, diabetes and chronic heart disease.”

The top Covid-19 comorbidities listed by New York, in order, are hypertension, diabetes, high cholesterol, coronary artery disease, dementia and atrial fibrillation, a heart condition. Chronic obstructive pulmonary disease, another respiratory ailment, but one with an older demographic than asthma, ranks seventh. Renal disease, cancer and congestive heart failure round out the list.

Nearly eight percent of the U.S. population — close to 25 million people — has asthma, according to the Centers for Disease Control and Prevention. It is a lung disease that causes the airways to constrict and can make breathing hard work as the body fights for enough oxygen. Symptoms include wheezing and coughing.

One thing doctors agree on is that people with asthma should be taking long acting medications like steroids that keep their symptoms in check, because having your asthma under control is better than battling asthma and a virus simultaneously.

Health experts have generally seen little to no evidence that asthma increases the risk of developing Covid-19, but the question has been whether it causes worse outcomes for those who do have it.

“If you have mild or moderate disease, you’re probably not going to behave much differently than someone who doesn’t have asthma, particularly if you’re a younger person,” said Dr. David Hill, a board member of the American Lung Association. But he added that those with more severe cases “may get more severity of the disease.”

Dr. Linda Rogers, a specialist in pulmonary medicine at the Mt. Sinai Health system, which is on the front line of Covid treatment, said one would assume that patients with underlying lung diseases would be “at risk of worse outcomes.” But she said that “asthma is underrepresented” in patients that are sick enough to seek treatment.

Her practice focuses on people with more serious cases of asthma, but she has been able to successfully manage many of her asthma patients through telemedicine. “These are patients who, just based on their asthma alone, are on steroids all the time. I’m just surprised some of them haven’t done worse.”

Still, the data analysis on the effects of asthma is in its infancy, and health experts cited an existing body of research that shows the flu and milder coronaviruses exacerbate asthma as worrisome indicators for those with Covid-19. Dr. Rogers said that she did not want to exclude asthma “as a potential problem as it is well known that viral infections are the No. 1 cause of asthma flares in both children and adults under normal conditions.”

Dr. J. Allen Meadows, president of the American College of Allergy, Asthma and Immunology, said much the same: “Since common coronaviruses in the United States, and influenza, trigger asthma flares in well controlled patients, we might expect Covid-19 to be similar.”

One doctor who has studied viruses extensively is Young J. Juhn, a clinical epidemiologist, and professor of pediatrics and medicine at the Mayo Clinic, whose laboratory research has examined the impact of asthma on the risk of infectious and inflammatory diseases.

Dr. Juhn said the data would have to be studied and weighted in more detail, but added that, in his view, asthma put people at greater risk of poor outcomes, and potentially even more susceptible to infection, though there was limited data on the latter point. He noted that asthma disproportionately affects lower-income people who have less access to Covid testing and care.

“It may be still fair to say that the emerging data support the current guidelines considering asthma as a high-risk condition,” he cautioned, adding that “we need more definite data.”

  • Updated April 11, 2020

    • When will this end?

      This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • How does coronavirus spread?

      It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • Is there a vaccine yet?

      No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.

    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • What if somebody in my family gets sick?

      If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Should I stock up on groceries?

      Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • Should I pull my money from the markets?

      That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.


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