Is Cardiovascular Disease, Diabetes, HIV/AIDS And Tuberculosis Pre-Disposing Risk Factors For Increased Infection By SARS-Cov-2 And/or Death From COVID-19? Preliminary Results and Implications for South-East Asia

Abstract

Aims: Early clinical data indicate that both the susceptibility to infection and the outcomes (e.g., death) of COVID-19 are strongly associated with pre-existing clinical conditions and diseases, especially cardiovascular disease (CVD). A preliminary epidemiological study, based on five months of diagnosed cases for COVID-19, for the beginning of the pandemic, January to 06 June 2020, was undertaken for the six major global regions: Europe, The Americas, Western Pacific, Eastern Mediterranean, South-East Asia and Africa, covering 173 infected countries. Methods: Pre-existing medical conditions that were considered to affect the number of infections by SARS-CoV-2 virus, and death by COVID-19 were the prevalence of CVD, diabetes mellitus (DM), Human Immunodeficiency Virus (HIV) and Tuberculosis (TB). A comparison was done to establish correlation, if any, between the prevalence of these four comorbid diseases and the observed number of COVID-19 cases (infections) and deaths, by Pearson correlation analysis Findings: The global prevalence of the four pre-existing diseases is: CVD (1 332,1 million, 17,2%) > DM (686,4 million, 8,9%) > HIV (37,9 million, 0,8%) > TB (6,2 million, 0,08%), and is ranked as follows per region (% of global): CVD: Western Pacific 29,05% > South-East Asia 26,26% > America 16,65% > Europe 14,32% > Eastern Mediterranean 8,32% > Africa 6,31%; DM: South East Asia : 27,32% > Western Pacific: 24,42% > Eastern Mediterranean: 15,51 > The Americas (14,94) > Europe: 9,08 > Africa: 8,73%; HIV : Africa (74,9) > The Americas (10,3) > Europe (6,6) > Western Pacific (5,4) > Eastern Mediterranean (1,5) > South-East Asia (1,30); TB : Africa (39,5%) > Western Pacific (31,0) > Eastern Mediterranean(13,1%) > South-East Asia (7,6%) > The Americas (4,7%) > Europe (4,1%). The most common comorbid conditions for COVID-19 patients are, in decreasing prevalence: CVD > DM > HPT > Chronic Obstructive Pulmonary Disease > HIV > cerebrovascular disease/obesity > cancer/smoking/chronic kidney disease > TB. Within regions: for The Americas, there was a significant correlation between deaths due to underlying DM. Four regions had a significant correlation for underlying CVD: Europe: Infection due to CVD; Eastern Mediterranean: Infection due to CVD; South-East Asia: Deaths due to CVD and TB; Western Pacific: Deaths due to CVD; Africa: Infection due to HIV. Across regions: South-East Asia: ranked first as having a significant correlation for deaths due to CVD and TB, followed by Western Pacific: deaths due to CVD, Americas: deaths due to DM, Europe: infection due to CVD, Africa: infection due to HIV, and the Eastern Mediterranean: infection due to CVD. The global COVID-19 CFR, based on total deaths and cases, at 16 August 2020, is 3,58%. The approximate CFR for COVID-19 patients with comorbidity is: 10,6% ± 1,1 for CVD, 9,4% ± 5,6 for DM and 6,0% ± 0 for HPT. The South-East Asia region appeared to have a significant correlation, for all 4 co-morbid conditions, and risk of infection by SARS-CoV-2, and deaths by COVID-19, in decreasing rank: deaths vs TB/CVD > deaths/cases vs DM > deaths vs HIV. Conclusions: The common global diseases (CVD, DM, HIV, TB) are also risk factors for SARS-CoV-2 infection and deaths by COVID-19, in decreasing rank: CVD > DM > HIV > TB. Continents, and countries, with currently high proportional mortality due to non-communicable diseases, (CVD and DM), like South-East Asia, appear to be at higher risk for infection and death by COVID-19, compared to those with higher proportionality due to communicable diseases (HIV, TB), like Africa. The high number of case infections and death due to COVID-19 in the Western Cape appears to be similar to that for The Americas, where DM appears to be a significant comorbid condition.