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Global Japan
JUN 19, 2020

Looking Back on the Coronavirus Risk Factors We Didn’t Expect

By Yukikazu Natori
Photo by Thryn

According to World Meter, as of June 12, for every million people in Belgium, there have been 832 deaths by coronavirus. The numbers for Spain, Italy, the UK, and France are similar. Relative to a million people, these numbers make the impact seem small.

But compare these European numbers to the ones in Asia, and a different picture emerges.

Taiwan, for example, had only 0.3 deaths per million people. Hong Kong had 0.5.

Singapore? Four deaths. Japan? Seven.

Why is there such a vast difference between East and West?

Obvious Risk Factors

The chance of getting COVID-19 (morbidity) and the chance of dying of COVID-19 (mortality) are functions of two things: societal resilience and personal health.

Diagram illustrating the morbidity and mortality of COVID-19 as two circles. One circle is societal resilience, and the other is personal health.
Developed by Yukikazu Natori

Personal health is a function of genome, aging, chronic inflammation, lifestyle, and diet.   There are aspects of this that are quite obvious: if you regularly do anything that damages your lungs, like smoking, COVID-19 will affect you more severely.

Societal resilience is composed of three factors: 1) health-related social infrastructure, 2) governmental policy and its implementation, and 3) culture and customs. As we know, testing plays an important role in preventing the spread of the virus. Additionally, cultures that traditionally limit shaking hands or hugging seem to have fewer cases.

There’s a lot of coverage out there about the societal resilience side of things—people are eager to compare government policies, point fingers, or boast about cultural oddities—but outside of wearing a mask and washing your hands, there are other coronavirus risk factors in play.

Obesity

Disturbing data indicates obesity increases the risk of COVID-19 for young people. This is significant given that 40% of Americans are considered obese, compared to 20% in Italy and 6.2% in China. True to form, America has seen more young people admitted to intensive care units for COVID-19, bucking the typical coronavirus age distribution in other countries.

Inflammation

There are a huge number of diseases that are sources of chronic inflammation. Some are lifestyle-related, such diabetes (diet), chronic bronchitis (smoking), and gum disease (poor brushing habits). Others have little to do with lifestyle, such as allergies.

While inflammation is a natural immune response, continued inflammation damages the body.

Age in and of itself is associated with higher inflammation. One reason for this is the decrease in sex hormones such as estrogen and testosterone, as both are protective against inflammation.

Cats

Cats are asymptomatic carriers of COVID-19, and researchers recently confirmed cat-to-cat transmission. While cat-to-human transmission hasn’t been confirmed, the hardest hit countries also have some of the highest rates of cats as pets.

Graph illustrating the coronavirus cases per million people, in order of highest to lowest by cat population.
Numbers from petokoto and the UN. Current as of June 12.

While this is bad news for cat owners, it’s a good clue for researchers. The COVID-19 receptors in cats and humans are more straightforward and structurally consistent than those in dogs and rats, which might indicate a good drug target.

BCG Vaccine

The BCG vaccine, first used in 1921, protects against tuberculosis. Though rates of tuberculosis have decreased since then, BCG is still recommended as a childhood vaccine in many countries.

In addition to protection from tuberculosis, BCG gives a general boost to the immune system—perhaps even against COVID-19. However, some strains of the BCG vaccine are clearly more effective than others.

Iraq, for example, uses the Japanese BCG strain. It has had 89 cases and 3 deaths per million people. In comparison, Iran uses a locally produced strain and has had 1,461 cases and 84 deaths per million people. Other countries that use the Japanese strain are similarly low impact, such Taiwan and Japan.

Health Impacts Moving Forward

Most people will never know if they had coronavirus. Survivors with mild damage will be fine, as long as they keep a healthy lifestyle. Survivors with serious damage, however, will likely be facing health-related repercussions for the rest of their lives.

And society will have to adjust to their needs.

First, we can expect new types of medical services, medical care, and indoor lifestyles for the elderly. Second, big data related to health conditions like body weight, blood pressure, exercise, and sleep quality will become increasingly important for society to better coexist with COVID-19 and other new viruses.

Regardless of how individuals are affected this time, we will all need to work together to limit our coronavirus risk factors moving forward.