Pharmacists and COVID-19 Disease Risks: A Call to Action

Since April and August of 2020, 1.9 million years of life have been lost around the world form COVID-19.¹ The virus has contributed to premature deaths across the wide-spectrum of demographic subsets.  Early deaths were associated with seniors accounting for 80% of years lost in April 2020.¹ However, more recently, working-age adults have died prematurely. For example, data from August, 2020 show working-age adults have accounted for 48% of years of life lost including 25% from 20-44 years old (more males than females), and 23% from 45-64 years old (more females than males).¹  These statistics are both sobering and devastating.   Why is this virus so purulent to the human host? 

The answer may not be associated principally with the virus, but rather with risk factors that substantially increase the chance of the human host to die.  The first is obesity.^2-3 The World Health Organization estimates that over 1.9 billion adult persons are overweight or obese.⁴ There is not a single country in the world that has obesity under control.  All world countries have an obesity rate of >20% and many are approaching 30-50%.² In the U.S. the estimates are 43% of our citizens are obese.² Obesity-related chronic disease leads to adiposity-based chronic disease through inflammation and hypercoagulable states. These disease-producing pathological states, in turn, contribute to the development of hyperlipidemia, hypertension, and insulin resistance.³  The result of this cardiometabolic syndrome is to place an individual at increased risk of COVID-19 severity throughout the world population, independent of gender, race, or age.  

The key to reducing COVID-19 related acute and chronic severity is a comprehensive preventative measure program aimed at obesity, and downstream diseases of hyperlipidemia, hypertension, and insulin resistance.  There are currently efforts underway to address some of these COVID-19 severity risks.^5-7  Controlling these will take a coordinated, sustained, and targeted program to address all of these parts of the cardiometabolic syndrome.⁷ There needs to be an international priority for these programs.  

How can pharmacy participate in these programs?  The current pharmacy profession focus has been almost exclusively towards providing COVID-19 vaccinations, if and when, a vaccine becomes available.  Clearly, this is an important focus, but the above data and outcomes should give pharmacy pause to provide a more comprehensive cardiometabolic program.  There are multiple outcomes pharmacists can assist patients to reduce their cardiometabolic risks including providing a weight goal with an exercise program and control of blood pressure, lipids, and A1C. These include, but are not limited to, the following: 

1.     Weight within 15% if IDW with a follow-up program for weight loss

2.     BP Goal: < 140/90 or < 130/80mmHg

3.     Lipid Control to Reduce ASCVD risk

4.     Hemoglobin A1C < 7.0% 

Pharmacists should provide clinical services so that if a patient becomes infected with COVID-19, they may be better equipped to reduce the virus health threat.

Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy.  

References

1. 1.9 million years of life have been lost during the pandemic. https://www.modernhealthcare.com/patient-care/19-million-years-life-have-been-lost-during-pandemic Accessed 10/2020
2. Abbasi J. Large Meta-analysis digs into Obesity’s COVID-19 Risks. JAMA. Published online October 15, 2020. doi:10.1001/jama.2020.18637
3. Mechanick JI, Rosenson RS, Pinney SP, Mancini DM, Narula J, Fuster V. Coronavirus and cardiometabolic syndrome. JAMA 2020:78(17):2024-35.
4. World Health Organization.  Obesity and overweight. March 3, 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Accessed 10/2020  Accessed 10/2020
5. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity.  Available at: https://www.ncbi.nlm.nih.gov/books/NBK44206/  Accessed 10/2020
6. The Surgeon General’s Call to Action to Control Hypertension. Available at: https://www.cdc.gov/bloodpressure/CTA.htm  Accessed 10/2020
7. GBD 2019 Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019. Lancet 2019:296:1135-59.