Last update and review: April 27, 2020.
Debunking the CDC and Dr. Aseem Malhotra on COVID-19 and obesity.
Activist British doctor Aseem Malhotra has been repeating that obesity is a major risk factor for poor outcomes in COVID-19. In some of his comments on social media, Malhotra used references to the notoriously incompetent and corrupt CDC in the US and to some media. This is wrong. Obesity is NOT the biggest risk factor for COVID-19.
For example, Malhotra cites an article from a website europeanscientist.com which contains the following statement:
“Data from the first 2204 patients admitted to 286 NHS ICU’s with COVID- 19 reveal that 72.7% of them were overweight or obese.”
If we analyze this statement, we can see that it does not have a lot of meaning. Getting infected with the SARS-CoV-2 virus is almost inevitable for everybody since nobody on the planet had immunity to it. The fact that 72.7% of people with COVID-19 are overweight or obese reflects the demographic of the general population. Children and young adults are leaner, but they are more often asymptomatic when they get infected with SARS-CoV-2. Older adults are more often overweight and obese and they are more often symptomatic when infected with SARS-CoV-2. So, just having COVID-19 is normal. The bad thing is to have a severe course of COVID-19. And as we will show further in the text, being lean does not protect from a severe course of COVID-19.
Obesity as a predictor of a severe course or a poor outcome of COVID-19 in two studies.
Obesity is not a good thing. But, there is a growing number of studies on COVID-19 patients that show that obesity is not associated with severe COVID-19. For example, there is a study on 452 patients from Wuhan by Qin et al., (pre-print) 2020 (1), which shows that diabetes was not associated with sever COVID-19. The authors did not include obesity in the list of chronic medical conditions, but diabetes is an acceptable proxy for obesity.
Only age, hypertension, and cardiovascular disease had a statistically significant association with sever COVID-19 in the study by Qin et al., 2020 (1).
In another early pre-print by the group of authors from Marseille, France, the authors report that obesity was NOT associated with a poor outcome of COVID-19 in a study with 1061 patients (2).
Diabetes, however, was associated with a poor outcome in this study. Since it is just an early preprint, it is not clear if there was a statistical adjustment for hypertension. Since diabetes is often a cause of hypertension, there is a need to verify whether or not the diabetic subjects without hypertension tend to have a poor outcome of COVID-19. We do not know if it was done in this study from Marseille, France (2).
Aseem Malhotra: “Obesity is… associated with a 10-fold increase in mortality.” Analysis: Wrong.
Malhotra continues to repeat that obesity is associated with an increased risk of COVID-19 mortality. Here is another video with Malhotra, posted on April 27, 2020.
The in-hospital COVID-19 mortality in New York: obesity, diabetes, and CVD are not associated with higher risk.
Another study, Cummings et al., (pre-print) 2020 (3), looked at the factors associated with in-hospital mortality in New York. Approximately 26% of confirmed COVID-19 cases in New York City are hospitalized (5).
39575/150576 = 26.2%
For those who end up in a hospital, obesity, diabetes, and cardiovascular disease are NOT associated with a higher risk of death. Age and hypertension are. Cummings et al., (pre-print) 2020 (3):
We prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020.
Spruance et al., 2004 (4):
The hazard ratio describes the relative risk of the complication based on comparison of event rates.
As you can see from the table above, the hazard ratios or, in other words, the relative risk of death, in COVID-19 patients with obesity, diabetes, and cardiovascular disease are NOT higher than in patients who do not have these conditions.
The UK has a catastrophically high COVID-19 mortality rate. This mortality rate is explained by the incompetence of British medical doctors and bureaucrats.
For some reason, Aseem Malhotra’ trolling of people about their food choices is supported by the propaganda operation. The incompetence of British medical doctors and bureaucrats is not discussed. But it should be. Indeed, the same disease can not have mortality rates that differ 10-fold or 20-fold in different countries.
The fact of being in the UK increases your risk of death by 500% in comparison to Norway.
If we compare the risk of death for COVID-19 patients in different countries, for instance, in the UK and in Norway, we can see that the fact of being in the UK increases your risk of death by 500%, while obesity, diabetes and cardiovascular disease have a small or no effect on the mortality risk.
Conclusions.
So far, age and hypertension are the two strongest independent predictors of a severe course or of a poor outcome in COVID-19.
Again, obesity is not a good thing. But one should not cultivate false hopes that being lean is an insurance against a sever course and a poor outcome of COVID-19. So far, age and hypertension are the two strongest independent negative predictors in COVID-19.
Elevated blood pressure is something that can be improved in a relatively short term. Everybody is advised to check his or her blood pressure and to take necessary measures to bring it down. If you need help with this, do not hesitate to get in contact with us.
Related:
Selected references:
1. Qin (Chuan) et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China.
Pre-print. Clinical Infectious Diseases, ciaa248, https://doi.org/10.1093/cid/ciaa248
2. The study performed at IHU Méditerranée Infection, Marseille, France. on a cohort of 1061 COVID-19 patients. Excerpts and tables available as an early pre-print at https://www.mediterranee-infection.com
Accessed on April, 23, 2020.
3. Cummings et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study.
https://www.medrxiv.org/content/10.1101/2020.04.15.20067157v1
Accessed April 25, 2020.
4. Spruance SL, Reid JE, Grace M, Samore M. Hazard ratio in clinical trials.Antimicrob Agents Chemother. 2004;48(8):2787–2792. doi:10.1128/AAC.48.8.2787-2792.2004
5. Data collected by the NYC Health Department. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
Accessed on April 27, 2020.
2 Comments