Being high-risk for COVID complications looks different than most people think

There's been a lot of talk about how patients with certain underlying conditions are at greater risk of dying from COVID-19, but it isn't just the severely ill who are vulnerable to this virus.

Take me, for instance. I don't meet most people's expectations of a high-risk patient. I'm relatively young. I don't have a visible disability. I'm physically active in fact, I'm a professional dancer.

Since I was five years old, though, I've had asthma.

Under normal circumstances, my asthma has very little impact on my life. I inhale a puff of medication every morning, avoid households with cats, and wear a scarf over my mouth in the cold. Otherwise, my lung condition rarely crosses my mind.

At least, it didn't before the onset of the pandemic. Respiratory diseases like COVID-19 often affect asthmatics more seriously than the average person our airways, already prone to swelling, can become doubly inflamed when a virus takes hold.

Health Canada and the CDC have warned people with asthma to take extra precautions to avoid COVID infection. For me, this has included working at home, avoiding indoor public spaces, and opting for takeout instead of dining in. As a colleague put it, I'm essentially still living at Alert Level 3, even though the rest of the province has shifted to Level 2.

I sometimes feel barmy from the lack of social interaction, but, on the plus side, my house has never been tidier.

Given the situation, I'm comfortable taking a few extraordinary measures to protect my own health. Still, I've been surprised to see comments on social media advocating for the complete reopening of the province on the basis that people like me, who have pre-existing medical conditions, are the only ones who need to worry about COVID.

Isolate the vulnerable, these posts suggest, and everyone else's lives could go back to normal.

The trouble is this proposal is rooted in basic misconceptions about COVID and its victims.

People aren't as safe as they think

A widely shared statistic from the CDC has convinced many people without chronic medical conditions that they don't need to worry about the virus. The stat shows that 94 per centof Americans who've died of COVID had at least one other factor that contributed to their deaths.

What you don't see when that number is bandied about, though, is that many of the "contributing conditions" in COVID deaths are problems that were caused by the virus, not problems the patient had before they were infected.

When a physician or coroner fills out a death certificate, they indicate the major medical events that led to a person's death. Respiratory failure, cardiac arrest, renal failureand sepsis might be listed alongside COVID to give a full picture of the patient's condition, even though they were consequences of the viral infection.

The unpleasant truth is that many of the dead had years ahead of them.

Dr. Marc Larsen, incident command operations chair for COVID-19 at St. Luke's Hospital in Kansas City, Mo., compares it to a patient who dies of a gunshot wound. Their death certificate might list hemorrhagic shock and liver laceration as causes of death in addition to the gunshot. That doesn't mean the hemorrhagic shock and liver laceration existed prior to the injury.

In fact, about one-third of adults who've died of COVID had no previous medical problems that might have contributed to their deaths.

Large numbers in N.L.qualify as 'high risk'

Let's say the public was still willing to take their chances with COVID, despite those less appealing odds. What would isolating "the vulnerable" actually look like?

The percentage of our population who are susceptible to complications from the virus is surprisingly high. More than a quarter of Canadians are estimated to have conditions that put them at risk of severe illness.

In Newfoundland and Labrador, the number could be even higher. Our province has some of the highest rates in the country of the conditions that make people vulnerable to COVID: we've recently had more cancer diagnoses per capita than anywhere else,and a full 33 per centof us are diabetic or pre-diabetic.

There are also some other commonfactors that qualify people for the high-risk category, like smoking and obesity. Newfoundland and Labradorstill has the largest proportion of smokers in Canada at 19..5 per cent, and 40.2 per centof us are considered obese.

After all that, it seems almost unnecessary to point out our aging population: 19.4 per centof Newfoundlanders and Labradorians are over the age of 65.

Even if we assume there's tremendous overlap between these groups people who are over 65 with cancer and diabetes surely more than half our population falls squarely into COVID's crosshairs. A reopening for people without risk factors would benefit only a minority of us.

High risk doesn't mean low quality of life

If it's startling that so many people are high-risk for COVID, it's because there's an assumption that those who've died with underlying conditions already had one foot in the grave.

The unpleasant truth is that many of the dead had years ahead of them.

They were obese and healthy, disabled and physically active, chronically ill and living full lives.

Having a characteristic that makes you especially vulnerable to COVID doesn't mean you're in poor health or at imminent risk of death.

I, for one, intend to live decades yet. If everyone in this province continues to take the precautions that have kept our COVID rate low so far, hopefully we can all do the same.

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