While the World Health Organization has put the death rate from novel coronavirus, COVID-19, at 3.4%,¹ a study in Nature Medicine put it much lower, at 1.4%.² The fact is, with many cases going unreported and untested, mild and asymptomatic cases may not be included in official COVID-19 death rate figures, which could skew the death rate significantly, making it appear higher than it actually is.

In Italy, however — the “new” epicenter for COVID-19 — the number of deaths reportedly overtook those in China by mid- to late March 2020.³

As the home to the world’s second-oldest population after Japan, Italy’s elderly population is at increased risk of death from COVID-19, but there’s another factor that also makes you more susceptible to death or serious illness if you contract COVID-19: an underlying health condition, particularly diabetes or high blood pressure.

This is why, if you want to stay healthy in this pandemic, one of the best strategies is to get your underlying chronic conditions under control; even diabetes and high blood pressure can often be reversed via healthy diet and lifestyle.

99% of COVID-19 Deaths in Italy Had Underlying Conditions

According to a study by The Istituto Superiore di Sanità, Italy’s national health authority,⁴ more than 99% of fatalities from COVID-19 occurred among people who had underlying medical conditions.

The finding came from an examination of 18% of Italy’s COVID-19 deaths, which revealed that only three people who died — or 0.8% — had no underlying conditions. On the contrary, nearly half the victims had three underlying conditions while one-fourth had one or two.⁵

Further, among the fatalities, 76.1% had high blood pressure, 35.5% had diabetes and 33% had heart disease.⁶ While the median age of those infected was 63, most deaths occurred in older people, with 79.5 being the average age of those who’ve died. Among those who were under 40 when they died, all had serious underlying health conditions.⁷

A report of the WHO-China Joint Mission on COVID-19, released in February 2020, similarly found a higher crude fatality ratio (CFR) among people with additional health conditions. While those who were otherwise healthy had a CFR of 1.4%, those with comorbid conditions had much higher rates, as follows:⁸

• Cardiovascular disease — 13.2%

• Diabetes — 9.2%

• High blood pressure — 8.4%

• Chronic respiratory disease — 8%

• Cancer — 7.6%

Underlying Conditions, Obesity Increase Risk of Poor Outcomes

Another study looking into the impact of co-existing health conditions like high blood pressure, heart disease and diabetes on COVID-19 outcomes found they’re linked to “poorer clinical outcomes,” such as admission to an intensive care unit, a need for invasive ventilation or death.⁹

The study involved 1,590 laboratory-confirmed hospitalized patients, revealing that people with a chronic condition were 1.8 times more likely to have a poor outcome compared to those with none. This jumped to 2.6 times more likely for those with two chronic conditions.¹⁰

The first review of fatal COVID-19 cases in China also found diabetes may be associated with mortality,¹¹ as did a report of 72,314 cases by the Chinese Center for Disease Control and Prevention.¹²

While the researchers found a mortality rate of 2.3% in the overall population, this rose to 10.5% among people with cardiovascular disease and 7.3% among those with diabetes.¹³ Likewise, in a Lancet study of 191 patients in China, 48% of those who died from COVID-19 had high blood pressure.^14,15

Likewise, the Intensive Care National Audit and Research Centre released a report on 196 patients critically ill with COVID-19.¹⁶ Among them, 56 patients had a body mass index (BMI) of 25 to 30, which is classified as overweight, 58 had a BMI of 30 to 40, which indicates obesity, and 13 had a BMI of 40 or higher which is classified as severely obese. Overall, 71.7% of the critical patients were overweight, obese or severely obese.¹⁷

This could have serious implications for the U.S., where approximately 45%, or 133 million, people suffer from at least one chronic disease.¹⁸ Among them, more than 1 in 10 have diabetes (and another 1 in 3 has prediabetes),¹⁹ while 108 million adults have high blood pressure.²⁰ Further, 71.6% of U.S. adults aged 20 and over are overweight or obese.²¹