With the US president, Donald Trump, testing constructive for coronavirus, hypothesis has begun concerning doable outcomes. The truth is, it’s not possible to say for sure what is going to occur to a person as soon as they’ve contracted COVID. Some individuals might don’t have any signs in any respect, whereas others might have far worse outcomes. It’s one of many many mysteries of the virus that scientists worldwide are working across the clock to untangle.

With regards to threat, there are some issues we do know, however many who stay unsure. There are additionally some issues we are able to change and a few that we’re caught with. It’s now frequent information that age is a very powerful issue driving the danger of worse outcomes from COVID. Being male, residing with weight problems, being from a non-white ethnic group and having long-term circumstances – akin to diabetes and coronary heart illness – additionally improve threat.

The elevated threat with age is placing – individuals 80 and older are estimated to be 70 instances extra more likely to die than these underneath 40. Within the UK, being aged 70 or older lessons individuals as clinically susceptible, or reasonably in danger. Within the USA, eight out of each ten deaths attributed to COVID have been of individuals 65 and older.

In contrast, weight problems is estimated to extend threat of demise from COVID by nearly 50%, and kind 2 diabetes is estimated to double the danger.

These are solely the headline components – totally different drugs might have an effect on threat, as might a bunch of different components which is able to range from individual to individual and embrace issues akin to viral load, which means how a lot of the virus an individual is uncovered to within the first place.

Age, physique weight and being a person are all threat components for extreme COVID and improve the chance of needing intensive care.

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Linked to many of those threat components can also be the important thing, however advanced, difficulty of socioeconomic standing – with individuals from much less advantaged teams struggling a disproportionate burden of COVID illness and demise.

A number of the above threat components are non-modifiable, which suggests, primarily, we’re caught with them. You possibly can’t change how previous you might be. The excellent news, nevertheless, is that motion might be taken to handle among the others. Raised physique weight, for instance, is pushed by a posh system of socioeconomic, industrial, environmental and genetic components, however governments can roll out insurance policies to assist handle a few of these. There are additionally evidence-based strategies out there to help wholesome weight reduction.

Being rich is wholesome

When masking Trump’s threat components, one is much less spoken of however weighs closely in his favour – his socioeconomic standing. Folks from less-advantaged teams are at higher threat from COVID.

If one teases this out, the well being advantages of upper socioeconomic standing grow to be all the way down to quite a lot of components, together with a decrease threat of contracting the illness within the first place (typically linked to socioeconomic components akin to occupation or the place you reside). Different components at play embrace the presence and remedy of underlying well being circumstances, the relative threat of publicity to air air pollution and different environmental threats to well being – and, crucially, entry to healthcare.

For individuals with essentially the most extreme types of COVID, remedy with the drug dexamethasone can cut back threat of demise by as much as one-third. Socioeconomic standing is without doubt one of the components figuring out who will get one of the best remedy for COVID, notably in nations the place there is no such thing as a common healthcare – together with the US.

When the UK’s prime minister, Boris Johnson, contracted COVID this 12 months, it was described as a wake-up name, notably with regard to weight problems. The prime minister himself has raised physique weight as a difficulty, and attributes his extreme an infection to that threat issue.

It stays to be seen how Trump reacts, each bodily and politically, to his personal an infection. There is no such thing as a doubt that, as a result of his place, he might be receiving each facet of healthcare he may want for. In contrast, hundreds of thousands of People can not entry fundamental care, together with entry to important drugs akin to insulin for kind 1 diabetes (Trump just lately asserted insulin is priced as cheaply as water, which sadly is way from true), not to mention intensive care in the course of the acute section of a pandemic.

Whereas the press focuses on the danger components that will put Trump at higher threat of extreme an infection, we must always not overlook these modifiable and strikingly inequitably distributed components which work in his favour. Focus must be not solely on treating the virus, however on mending the damaged system that has allowed it to assert the lives of 207,000 People and counting.

Jamie Hartmann-Boyce receives funding from the Nationwide Institute for Well being Analysis, the British Coronary heart Basis and Most cancers Analysis UK.