Why does having another disease increase your risk of dying of COVID-19?

Updated: May 21, 2020

Some people who have COVID-19 already have a medical condition that causes complications when fighting off the virus. This is important to know because most people that are dying from COVID-19 have at least one comorbidity and, specifically, most have one (or more) of three conditions: high blood pressure, obesity, or diabetes. Below is a description of how each of them can increase the chance of death while infected with corona virus.


Having high blood pressure can both increase susceptibility to the corona virus and increase the body's vulnerability to COVID-19.

Susceptibility has to do with ACE receptors and viral load. ACE receptors are the exact spot on a cell where the virus attaches itself to gain entry and infect a cell. We have ACE receptors all over our bodies, but a person with high blood pressure produces a higher number of ACE receptors all around the body. More ACE receptors means more cells can be infected when exposed to the virus which increases the viral load, making a person more susceptible to the virus.


The factors that increase vulnerability for people with high blood pressure include: already narrowed blood vessels in the heart, kidneys, lungs, or brain that could be blocked (severe COVID-19 infection causes a clotting effect), an already weakened heart muscle that cannot cope with the added demand of low oxygen levels, or already low levels of anti-oxidants such as nitric oxide which help fight off the virus. Patients who stay on their blood pressure lowering medication do better than people who stop them.

Obesity does not increase the susceptibility to the virus, but it leads to poorer outcomes. The most likely culprit is the increased inflammatory state that extra fat cells produce. Fat cells release pro-inflammatory cytokines including one, named IL-6, which has been shown to directly be involved with respiratory failure in COVID-19.

Another possible mechanism is the presence of microvascular disease -narrowing of the tiny blood vessels - leading to organ failure with COVID-19, similar to the high blood pressure patients.

A third reason is that the extra weight makes it more difficult for the patient to fill the lungs completely which decreases the amount of oxygen entering the body.

A fourth difficulty for obese patients is that the excess fat cells require excess oxygen which can add stress on the essential organs.

The last potential problem could be similar to that of diabetics in that the obese person may not know they have poor blood sugar control.


obesity risk image


Diabetes increases both susceptibility and vulnerability to COVID-19 disease. Like the high blood pressure patients, diabetic patients produce more ACE receptors, the binding sites of the virus which can increase viral load.


Diabetes has to do with the control of blood sugar and the action of the hormone insulin on the body.  Poor control of blood sugars is responsible for two things that can make patients vulnerable to COVID-19: One, it can cause an impaired immune response to viral infections which leaves the person able to catch a second infection making recovery more difficult. Two, the high blood sugars from diabetes may have already damaged the lining of the blood vessels (called the endothelium) which leaves the patient with a decreased amount of virus-fighting antioxidants (like nitric oxide) available.


Fortunately, some of the risk can be reduced. You can improve your metabolic health by normalising your glucose, decreasing your blood pressure, and decreasing your level of inflammation. This can help reduce your risk of serious complications or death in a short amount of time…. hopefully, by the time the lockdown lifts and exposure rates go up again! There are 4 ways to do this quickly; doing any one of them will make a difference:

  1. Cut out sugars from your diet – all of them – including carbohydrates (bread, pasta, rice, white potatoes, etc…) and fruit.

  2. Implement time restricted eating – where you only eat food during a specific period of time like: 1 hour every 24 hours.

  3. Fast - for 24-48 hours drinking water only (longer under a doctor’s supervision), weekly or biweekly.

  4. Go on a low carbohydrate diet or a ketogenic diet

There are doctors who have shown marked improvement in levels in 3-14 days.  Below are some links to their information:

FASTING: Dr Jason Fung, Nephrologist – Articles, podcasts, books on Google – this is a good video to start with.

LOW CARB: Dr. David Unwin, General Practitioner – This article introduces his amazing success for hundreds of type 2 diabetics.

HARD SCIENCE/EXPLANATION: Dr. Richard Johnson, Nephrologist  Journal Article and this interview.


If you are worried that you may be in this category, you can assess your risk by measuring your 'waist to height ratio', testing your fasting blood glucose, testing your fasting insulin level, and checking your blood pressure.  Some of these you can do at home. 



Further Reading

cytokines and adipose tissue

Il-6 and COVID-19 outcome

Thrombosis and COVID-19

Microvascular disease and obesity

Microvascular Disease Obese

Diabetes and endothelial damage

Diabetes and IL6

Clotting, Endothelium

Diabetes and COVID-19

Obesity prevalence in COVID-19

Obesity severity in COVID-19

Comorbidity 5700 patients

Diabetics and COVID-19

Ethnicity and Covid 19

Anyone with diabetes should read this report

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