We are living in strange times.
A novel virus has swept the world, initially unknown in its virulence and pathogenicity. It is now endemic, exhibiting seasonality, and recognized to have an infection fatality rate of approximately 0.15%1.
What is abundantly clear is that this virus does not affect everyone equally. People with specific preexisting health conditions are disproportionately affected. There is an enormous risk gradient in severity of COVID-19 infection between the most vulnerable and the least vulnerable.
The Unspoken Metabolic Susceptibility Factors
SARS-COV-2 overwhelmingly and disproportionately affects the obese2, Vitamin D deficient34 and those with metabolic dysfunction56 i.e. insulin resistance, Type II diabetes, cardiovascular disease, chronic kidney disease, fatty liver and the constellation of lifestyle diseases attendant of the metabolic syndrome.
A number of physiological reasons underlie this susceptibility, most notably impaired immune system function and a smouldering fire of metabolic inflammation. Such a state of chronic, low level immune activation appears to predispose to an inflammatory cascade known as a cytokine storm7, which results in severe lung damage often necessitating hospitalization, supplemental oxygen and eventually ventilatory support.
Don’t believe me? Just ask any critical care nurse or doctor about the body mass index, metabolic health status and body fat distribution of their patients who are intubated, on non-invasive ventilation or on high-flow oxygen.
For the elderly, COVID-19 poses a particular risk. Older people have had more time to accumulate metabolic dysfunction and micronutrient deficiency. They also have less physiological reserve to deal with the stress of infection.