Who Is Most Vulnerable To COVID-19? And Other Questions Answered

Obesity, hypertension and diabetes are linked to more serious cases of COVID-19. Discriminatory policies have meant that African-Americans and Latinos suffer from those conditions at higher rates.

RACHEL MARTIN, HOST:

As we fight COVID-19, we are learning more about it, including who are the people most vulnerable to this disease and which prevention tactics are working. NPR's Allison Aubrey has been digging into both and joins me now. Good morning, Allison.

ALLISON AUBREY, BYLINE: Good morning, Rachel.

MARTIN: So there is new data out showing that the overwhelming majority of people who are sick enough to be hospitalized in the U.S. have at least one underlying condition or disease. The top chronic conditions - high blood pressure, obesity, diabetes. How come?

AUBREY: Well, obesity is often a marker for a number of other problems. And, of course, it's pretty common in the U.S., as is diabetes. Now, there's still a lot to learn here, but one reason that people with these conditions may have a tougher time fending off the virus has to do with the functioning of immune cells. Research has shown that people with obesity are not as well protected by the flu vaccine. They tend to get sicker. I spoke to a researcher at the University of North Carolina, Melinda Beck. She studies this. She explains that as people become overweight, their metabolism changes, and this shift can affect many cells, including immune system cells.

MELINDA BECK: What we see with obesity is that these cells don't function as well. So they're not doing the job that they're supposed to be doing because of the condition of obesity. So you're impairing that critical immune response to deal with either the virus infection or to make a robust response to a vaccine.

AUBREY: So this, Rachel, may be part of the explanation as to why COVID seems to hit people with obesity and diabetes harder.

MARTIN: We've also seen the virus hit black Americans especially hard. According to the Centers for Disease Control and Prevention, about a third of people hospitalized have been African American, yet only 13% of the U.S. population is black. Do we know why?

AUBREY: You know, there are a bunch of factors here. For starters, there is a higher prevalence of diabetes and obesity among African Americans and Hispanics in the U.S. These are two of the conditions linked to more serious illness. In addition, Marc Morial of the National Urban League told me, you know, black workers are more likely to hold the kinds of jobs that you can't do from home. So African Americans and Hispanics may be more likely to be exposed to this virus due to more close contact with others. And as Anthony Fauci, the top adviser, has pointed out, there are longstanding health disparities in the country and inequities in access to health care that need to be addressed going forward.

MARTIN: Yeah. When you talk about disparities and inequalities, I mean, that can all lead to stress, right?

AUBREY: Sure, yes.

MARTIN: I mean, is that a known factor in who is vulnerable to this?

AUBREY: You know, it is possible that stress is a factor here. I spoke to Rena Robinson. She's a researcher and a chemistry professor at Vanderbilt University. And she points to research that documents the link between discrimination and stress.

RENA ROBINSON: I think it could play a role. I mean, black and African American in this country that face discrimination over the course of one's life, especially early on, can have underlying high levels of chronic stress. And chronic stress can make one more vulnerable to infection because it can lower your body's ability to fight off an infection. And it can lower one's ability to even be susceptible to getting the infection in the first place.

AUBREY: You know, Robinson told me it's a combination of factors that explain the racial divide, probably all of these things we've mentioned. And she says genetic risk could also play a role, maybe. There's still a lot to learn here. But there are studies, for instance, that have shown that African Americans may have genetic risk factors that make them more vulnerable to high blood pressure.

MARTIN: All right. So let's look ahead now, if we could. I think everybody is anxious to know when life can start to get back to whatever normal is going to be now.

AUBREY: Right.

MARTIN: What are officials looking at? What are the factors going into that decision?

AUBREY: Sure. Well, public health officials are looking at a whole bunch of factors. I spoke to Scott Gottlieb. He's the former FDA commissioner. And he says one key indication to look for is a sustained decline in new cases - so a number of days where there are no new cases or a decline in cases rather. Now, that's going to vary depending on where you are, right? So reopening the country won't be like flipping a switch. It is not going to happen everywhere all at once. It will be gradual, staggered in different regions. And the new normal is likely to feel very different.

MARTIN: Right. Still not normal, frankly (laughter).

AUBREY: Right.

MARTIN: Well, we'll wait and see. So tomorrow, the president is expected to announce yet another group. He's referring to it as the opening our country council. What do we know about it?

AUBREY: Well, he says it's going to be a bipartisan group that will include scientists and business leaders. And, look, there's going to be some tension here because there is, of course, an urgency to get the economy moving again, to get people back to work. But it's also important to continue to protect people's health, right? So Scott Gottlieb says states may take the lead here. We're going to see governors, mayors, state and local health departments at work here. And as restrictions are lifted, there are going to need to be systems in place to prevent another outbreak. We're going to hear more in the coming weeks about surveillance systems to track for illness, about contact tracing - we'll hear more about that later in the show - to identify people who've come in contact in close contact with someone infected. And in the coming months, we're going to get more data on drugs that may be helpful to treat people with COVID.

SCOTT GOTTLIEB: If you have those two tools in your toolbox - a drug that can help prevent disease and rescue people coupled with a surveillance system that's very aggressive at identifying spread within a local community within a city - I think that's a robust enough set of tools that this could become a livable threat, that we can get back to a fairly normal way of life and be able to mitigate the risk from coronavirus even before we have a vaccine in place. Now, life will never be perfectly the same until we have a vaccine that can fully vanquish it.

AUBREY: And that's at least a year off. So even when social distancing is relaxed, we'll probably continue to see things like big limits on big public gatherings.

MARTIN: All right. NPR's Allison Aubrey. We appreciate it, Allison.

AUBREY: Thank you very much, Rachel.

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