Patients with pre-existing heart conditions were found to have a 13 per cent risk of death, while for those with pre-existing lung conditions, just slightly lower at eight per cent.

These were figures found in the Report of the World Health Organisation (WHO)-China Joint Mission on Coronavirus Disease 2019 (COVID-19) released in February this year. The report also accounted for patients without any preexisting health conditions – a mere one per cent risk of dying from coronavirus disease – and the stark difference in mortality rates is a cause for alarm.

Demographics and risk factor

“Generally, the mortality risk of a patient with COVID-19 increases with age,” said Asst Prof Ong Boon Hean, Consultant, Department of Cardiothoracic Surgery, National Heart Centre Singapore (NHCS). Individuals in their fifties have a one to two per cent risk of death; those in their sixties have a four to five percent risk; patients in the seventies have an eight to 10 per cent risk; and the risk level shoots up to between 15 and 20 per cent if they are in their eighties.

The reason for the higher mortality risk primarily stems from the fact that as we age, our physiological reserves become lower, shared Asst Prof Ong who is also the Director of the Lung Transplant Programme at NHCS. The ability of an older person to overcome a serious infection is reduced as compared to someone who is younger. Older patients also tend to have more pre-existing medical conditions, which could further increase their risk of succumbing to the infection.

For instance, compare a patient in his thirties with a heart or lung condition with another healthy individual in his sixties. The younger patient, because of his medical condition, would face an increased risk compared to a healthy peer while the older patient, by virtue of his age, would have lower physiological reserves to fight the virus – so both are at an increased risk of death.

Lung damage a high probability

In patients with COVID-19, about 15 to 20 per cent develop significant pneumonia, an infection of the lungs which causes air sacs in the lungs to fill with fluid and inflammatory cells as a response to the infection. When this happens, patients have difficulty breathing and would typically require hospitalisation and oxygen support.

According to the WHO-China report and a study which looked into more than 72,000 cases from the Chinese Center for Disease Control and Prevention1, Asst Prof Ong observed that of this group, a quarter progressed to a more severe form of illness requiring intensive care support such as artificial ventilation or drugs to support their blood pressure. These patients have an overall mortality risk of 50 per cent.

As COVID-19 is still a relatively new disease, the long-term prognosis after infection remains unclear. However, Asst Prof Ong cautioned that any patient with a severe lung infection, be it caused by COVID-19 or other illnesses, could be at risk of developing permanent damage to their lungs.

He shared that, for instance, some survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were found to have impaired lung function even after recovery from the acute illnesses. The degree of impairment was described to be worse in those with more severe pneumonia2,3.

In light of the current pandemic, it is critical that we take all the necessary precautions to protect ourselves against COVID-19.

Healthy body and mind to fight the battle

Staying in the pink of health – in both body and mind – during this challenging period is crucial in fighting the long-drawn battle against COVID-19. Asst Prof Ong has these tips to share:

  • Eat a well-balanced and healthy diet
  • Have sufficient sleep
  • Drink adequate amount of water (Follow fluid restrictions from your doctor, if any)
  • Quit smoking as it worsens pre-existing heart and lung conditions

Continue with medications

In most cases, a person’s immune system is usually not directly affected by their pre-existing heart or lung conditions.

However, some patients need to take medications for their pre-existing conditions that may affect their immune system, such as steroids. It is important for these patients to adhere to the medication regime unless advised by the doctor to do otherwise. Compliance to medications help to keep pre-existing conditions
under control, which will in turn lower a patient’s risk of developing complications from COVID-194.

The current pandemic has inevitably caused disruptions and heightened anxiety and stress. Hence, there is critical need to take care of one’s mental health. The Singapore government has set up a 24-hour National Care Hotline at 1800-202-6868 – to offer support for those who feel weighed down and need a listening ear.

covid-19 tips

1 Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242.
2 Kang Il Jun et al. Long-term Respiratory Complication in Patients with Middle East Respiratory Syndrome: 1-year Follow-up After the 2015 Outbreak in South Korea, Open Forum Infectious Diseases, Volume 4, Issue suppl_1, Fall 2017, Page S577
3 Hui DS, Joynt GM, Wong KT, et al. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax 2005;60:401-409.
4 Sources: COVID-19 and Heart Patients (Q&A). European Society Cardiology. 2020. and Covid-19 and Lung Disease Q&A. European Lung Foundation. 2020.

This article is from Murmurs Issue 36 (January – April 2020). Click here to read the full issue.