Severe coronavirus is more likely if you neglect your health. Preventive care is key.

You may think you're helping by pushing off your regular checkup. If anything, you might be making things worse.

Severe coronavirus is more likely if you neglect your health. Preventive care is key.

As the novel coronavirus pandemic first reached California, a young man with fevers and difficulty breathing came to the hospital where I practice. He had been leading a seemingly healthy life. Within 24 hours, as he went into respiratory failure, I had to place him in a medically induced coma and on a ventilator. The rapidity of his progression was shocking, but this fast, clinical decline unfortunately proved to be a more routine occurrence in hospitalized patients with COVID-19 infections. A striking commonality emerged for many of the sickest patients: They had undiagnosed, and thus untreated, chronic medical conditions.

Their severe conditions made one fact painfully clear: Preventive care in the best of times can reduce health risks in the worst of times. This might seem like the kind of lesson only a pandemic can teach, but seasonal influenza also preys annually on those with undiagnosed conditions. It is vitally important to find and establish yourself with a primary care doctor and get routine checkups to identify and treat any hidden health conditions that may be afflicting you.

Untreated conditions make you sicker

The young man that I mentioned had not seen his doctor in many years but told me he had no health conditions. Besides being a little overweight, he had never before been hospitalized. However, an initial work up revealed he had uncontrolled diabetes. While we may not know all the exact causes for why some people do so poorly with COVID-19 infection, we do know that having untreated chronic conditions such as diabetes, heart disease or asthma lead to worse outcomes, which can include respiratory failure and death. If this patient’s diabetes had been caught and treated earlier, his viral infection might have been less severe.

A recent study published in the Journal of the American Medical Association showed that, among 5,700 New Yorkers hospitalized with severe COVID-19, underlying conditions were common. Among the patients studied, 57% had high blood pressure, 42% were obese, and more than a third had diabetes.

Stethoscope

It is not uncommon for the hospital to be the first place a patient is told they have an untreated chronic condition, such as diabetes or heart disease. Sometimes, those conditions are found incidentally when treating other illness, but often, they have progressed to an extreme consequence such as a diabetic coma or heart attack. The most important thing to know about these extreme outcomes is that they are preventable. Simple testing at a primary care clinic can catch these conditions very early on, before they cause any problem of consequence.

Untreated chronic diseases or conditions have been making people very vulnerable to the coronavirus. According to the Centers for Disease Control and Prevention, data from China show a 6-to 10-fold increase in deaths for patients with underlying high blood pressure, lung disease, diabetes or cardiovascular disease. In one of the California counties I work in, Santa Clara, a striking 89% of patients that died had one or more significant chronic health conditions.

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Now is the time to be proactive and embrace the power of preventive care. Clinics are open, and many are now doing video visits for patients who do not need to be seen in person. Telemedicine is flourishing during this pandemic, but clinics are also taking necessary steps to ensure that, if you do need to be seen in person, the clinic will be a safe place to visit.

You can get care and be safe

For those that do have medical insurance or believe they cannot afford to see a doctor, there are many free and low-cost clinics that provide preventive care. The Health Resources and Services Administration website is just one of many sites that can provide a list of such nearby clinics in any community. It’s never too soon to establish a relationship with a primary care provider, and you do not want to wait until it’s too late.

In the same vein of prevention, it is also important to stay active and get regular exercise. This may seem challenging during shelter-in-place orders, when gyms and even many parks are closed, but finding an alternative — from online fitness tutorials or apps to a daily walk or jog outside as the weather warms — is essential.

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We know that the most severe cases of the novel coronavirus cause damage to the lungs, decreasing their ability to provide oxygen to the rest of the body. Under those circumstances, anything that restricts lung capacity — be it physical deconditioning, obesity or smoking — will make it that much harder to recover. Build up your lung reserve through a daily physical activity.

Ben Franklin wrote, “An ounce of prevention is worth a pound of cure.” Undiagnosed and untreated medical conditions can be dangerous during normal times, but during this pandemic, they can be the hidden risk that gives the deadliest form of the disease a foothold. See a primary care doctor regularly and make time for some movement every day. If taking charge of our own health is the silver lining of this truly awful pandemic, then it’s important to take it on without delay.

Dr. Thomas Ken Lew is an assistant clinical professor of medicine at the Stanford University School of Medicine and an attending physician of hospital medicine at Stanford Health Care–ValleyCare. Follow him on Twitter: @ThomasLewMD

Source: https://www.usatoday.com/story/opinion/2020/05/04/sickest-coronavirus-patients-untreated-chronic-conditions-column/3036840001/

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