FIGHT BACK. Chauncey W. Crandall

if you qualify for “Meals on Wheels.”

       • Avoid mass transit; if you don’t drive, ask your local municipality or senior center about vans or smaller buses and make sure drivers are taking precautions.

      High Blood Pressure

      In every country hit by the virus, one thing also stands out—having high blood pressure, or hypertension, also puts you at the highest risk for being hospitalized or dying if you get COVID-19.

      But why is this so? One possible explanation is that having high blood pressure weakens the heart and makes people with it more vulnerable to pulmonary problems.

      But there is another possible reason, and this has to do with how high blood pressure is treated. There is a controversy surrounding the common high blood pressure drugs called ACE inhibitors and angiotensin receptor blockers (ARBs).

      Here’s the issue: When the coronavirus enters the body, it finds cells lined with ACE2 receptors to replicate and destroy. ACE inhibitors and ARBs, which are high blood pressure medications, can upgrade the number of ACE2 receptor sites, giving the virus more points in the body to attack and potentially making the disease outcome and course more severe and lethal.

      Several medical associations, including the American College of Cardiology and the American Heart Association, contend that these concerns are unproven and people should continue to take these drugs as prescribed. There is also a contention that these drugs may actually help treat COVID-19 by providing decoy cells for the virus to attack.

      But as there are other drugs that can lower blood pressure, most notably calcium channel blockers and beta-blockers, it seems to make sense to ask your doctor if one of these drugs would work just as well for you. Of course, never discontinue taking prescription drugs or change them without your doctor’s approval.

      Recommendations:

       • Make sure you have a thirty-day supply of your medication.

       • Keep your blood pressure under control.

       • Be careful of certain medications, like NSAIDs, and certain decongestants, which can raise blood pressure, as can some drugs that treat mental health conditions, corticosteroids, oral birth control, medications that suppress the immune system, some cancer medications, over-the-counter drugs, and supplements.

       • Limit your intake of caffeine, certain teas, and energy drinks that have stimulants that can raise blood pressure. The candy licorice can do this as well.

       • Buy a home blood pressure monitor and use it to keep an eye on your blood pressure.

       • Ask about using telemedicine for follow-up visits.

      Diabetes

      Researchers in China found that people with diabetes had three times the death rates as those without diabetes, and studies in other countries have found this as well. People with diabetes have also been found to be at greater risk if they take ACE inhibitors or ARBs, and the possible reason can be found above in this chapter, so talk to your doctor if you take these medications. Also, people with type 2 diabetes (the most common form) may have an altered immune response, and those with type 1 diabetes have a tendency to develop a condition known as diabetic ketoacidosis. Diabetic ketoacidosis can result in severe dehydration, worsening other serious complications of COVID-19.

      Recommendations:

       • Make sure you have a thirty-day supply of your medication.

       • Maintain tight blood sugar control to help reduce the risk of infections and complications.

       • Keep a ninety-day supply of diabetes supplies, medications, and insulin (if you use it) on hand.

       • Consider using telemedicine for follow-up doctor’s visits.

      Obesity

      Obesity is a major factor for serious complications of COVID-19, no matter what age the person is.

      A person whose body mass index, or BMI, is thirty or more is considered obese. BMI is based on a formula that divides a person’s weight in kilograms by their height in meters.

      According to the Centers for Disease Control and Prevention (CDC), nearly half (48.3 percent) of adults hospitalized in the United States with COVID-19 were obese and were also most likely to require intensive care or die. Although these figures were based on people age sixty-five and older, other studies have found this to be true for younger people as well.

      Exactly why obesity raises risk is unknown, but one possible explanation is that abdominal obesity, the pattern found mostly in men, may compress the diaphragm, lungs, and chest area. This makes breathing more difficult, especially when these individuals are sick.

      Recommendations:

       • Use COVID-19 as extra motivation to lose weight.

       • See the chapter on what to eat (chapter 17) as well as the chapters on sleep (chapter 16), exercise (chapter 19), and stress reduction (chapter 20), as people under stress or those who are sleep deprived tend to eat more and gain weight.

      Chronic Obstructive Pulmonary Disease

      Chronic obstructive pulmonary disease, or COPD, is the umbrella term used to encompass the serious lung conditions of emphysema and chronic bronchitis. Studies find that people with COPD are at a fivefold risk for being hospitalized with severe COVID-19 and are also at greater risk of dying.

      Recommendations:

       • Make sure you have a thirty-day supply of your medication.

       • If you use oxygen, contact your supplier to find out what to do in the event there is a COVID-19 outbreak in your area.

       • People with COPD are at increased risk for severe complications from seasonal flu and pneumonia, so contact your physician if you are having symptoms of an upper respiratory infection.

       • Ask about using telemedicine for follow-up visits.

      Asthma

      Early research on COVID-19 assumed that people with asthma would be at risk for complications because this disease constricts the airwaves, making it difficult to breathe. Later research finds that people with mild asthma are not at higher risk, but there is still a concern about those with moderate and severe asthmatic conditions.

      Recommendations

       • Follow your usual plan to keep your asthma under control.

       • Make sure you have a thirty-day supply of your medication.

       • Continue your current medications, including any with steroids. Although steroids can suppress the immune system, don’t stop taking them without your doctor’s approval.

       • Avoid your asthma triggers. Also, asthma can be triggered by anxiety, and certainly the COVID-19 pandemic has caused anxiety, as are likely any reoccurrences of virus spread. Take care of your emotional health.

       • Ask about using telemedicine for follow-up visits.

      Heart Disease

      People with heart disease are at an increased risk of serious complications from COVID-19 and also are more likely to die from it; they are at 10.5 percent increased risk of dying compared to 2.3 percent for people who do not have underlying health conditions,