Young adults with the coronavirus disease (Covid-19) usually get mild symptoms, but risks of complications and death rise significantly for people under 35 with obesity, hypertension and diabetes, according to a new research.

An analysis of clinical profiles of 3,222 young adults (aged 18-34 years; mean age of 28.3 years) hospitalised for Covid-19 between April 1 and June 30 in 419 hospitals in the US revealed that 21% of them needed intensive care, 10% required mechanical ventilation, and 2.7% died.

Morbid obesity, diabetes and hypertension were the most common risk factors in young adults, with those having more than one of these conditions facing risks comparable to older adults having no pre-existing illnesses, reported a study published in JAMA Internal Medicine, which is the journal of the American Medical Association.

The study found that 36.8% of hospitalised young adults were obese, 24.5% were morbidly obese, 18.2% had diabetes, and 16.1% had hypertension (morbid obesity, hypertension and being male are associated with greater risk of mechanical ventilation and death).

In India too, men with Covid-19 are twice more likely to die than women, with men accounting for 69% of all deaths, reveals health ministry data. People under 40 with Covid-19 account for fewer than 10% of total Covid-19 deaths in India, with deaths being the highest in the 61-70 years age group in both genders.

“People under 40 usually have mild disease and most cases can be managed at home or in Covid Care Homes. Those who are hospitalised almost always have co-morbidities like obesity, diabetes and hypertension, and less than 5% need ICU admission. But if they do and are put on ventilator, their vascular risk increases and their chances of getting a heart attack or stroke becomes the same as older adults,” said Dr Yatin Mehta, chairman Institute of Critical Care and Anaesthesiology, Medanta The Medicity, Gurugram.

Covid-19 has also been called a vascular disease as it leads to the formation of blood clots in arteries and veins, which can block blood supply to the heart, brain and lungs and lead to stroke, heart attack and respiratory failure.

“If you are obese, you are likely to be diabetic or have hypertension, and vice versa, so the risk is compounded,” said Dr Mehta.

The progression of Covid-19-induced thrombosis is very rapid in young adults, with deaths often occurring within 24 hours of hospitalisation. “Older adults die of pneumonia and other Covid-19-related complications, but sudden, unexpected death is more common in young adults in their 20s and 30s, whose condition dips very rapidly. In such cases, the cause of death is usually cardiovascular, with abnormal clotting in brain, lungs and heart leading to cardiac arrest,” said Dr Shiv K Sarin, director, Institute of Liver and Biliary Sciences, New Delhi.

At Max SuperSpecialty in New Delhi’s Saket, people under 40 account for less than 4.5% deaths, with 29% deaths occurring in those between 40 and 59 years old, and 47% deaths in the 60-74 age group.

Those over 75 years account for 18% deaths at the hospital. “Young people have mild disease and rarely need hospitalsiation, but they need to be isolated to break the chain of infection, which makes testing, tracking and treating important, as does social distancing and wearing masks,” said Dr Sandeep Budhiraja, clinical director, Max Healthcare.

“We should not look at the absolute number of cases and deaths; those will always be high, given India’s large population. What we must look at is deaths per million, and India has 56 deaths per million compared to 596 for the US and 61 for Brazil, which remain far lower than other countries even if you factor in some amount of under-reporting…,” said Dr Budhiraja.

Four young adults, the takeaway is that those with obesity, diabetes, and hypertension share the same risks as older adults. So they must seek Covid-19 treatment under supervision from the moment they get their test results.

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