Risk factors

We've had several posts questioning if having a pacemaker constitutes a risk factor for Covid19.

Since I am in the age group to be vaccinated now, last night I made a vaccination appointment through our local health department. After the ususual data collecting questions about age, DOB, and address, the form listed risk factors and asked me to check off all the conditions I had.

What intersted me most about the list** was what wasn't there. Although diabetes, obesity, overweight, hyperlipidemia, and hypertension were mentioned, pacemaker and arrythmia were not.

In the end the only box I checked was "Asthma."

So there you have it folks. Having a pacemaker is not considered a risk factor by the NC Dept of Health.

**I am so sorry I can't post the list here. Unfortunately, I didn't think of copying the list at the time, and the website is closed now.

 


12 Comments

Thank you for the info

by Persephone - 2021-01-09 18:45:18

Hi GRhythm - good to know this information that you've.shared. I am looking forward to getting vaccinated as soon as eligible.

Risk Factors: pacemaker perhaps not, but arrhythmia, not so sure?

by Gemita - 2021-01-09 18:50:25

Hello Gotrhythm,

I am getting mixed messages over here in the U.K. from my treating doctors particularly since developing what they now believe are long Covid symptoms.  I agree a pacemaker doesn't seem to be a risk factor on its own (depending of course on reason for the pacemaker).  I also believe an arrhythmia if present and if well controlled (let us say AFib) should pose no real harm, but the problem is the nature/behaviour of an arrhythmia like AFib can change very quickly in response to any acute illness (like Coronavirus), potentially making recovery more complicated and prone to risk.

I honestly don't think there is enough evidence yet to say whether or not an arrhythmia puts us at higher risk of coronavirus complications.  Certainly when I had symptoms of the virus last April my arrhythmias worsened substantially, so did my health and recovery has been long and complicated so I personally would respectfully challenge the view that an arrhythmia is not a risk factor.  Certainly Coronavirus could be a risk factor for worsening arrhythmias since this was my experience which was closely observed and confirmed by my EP last spring/summer.  

So glad to hear you will be vaccinated very soon Gotrhythm.  Please take good care

Covid Risks

by Marybird - 2021-01-09 19:46:50

I've seen those risks listed on a couple sources ( including the CDC list, our state Department of Health, and a couple others) and noted that they included "heart disease", and specified heart failure, coronary artery disease, and cardiomyopathies in this category. I'd figure many people who have pacemakers or ICDs fall into this category by virtue of their underlying heart conditions. But it may be that for those whose hearts are otherwise healthy, except for arrhythmias that have not ( at this point, anyway) been associated with the other heart conditions, and have pacemakers implanted for control of bradycardia and management of other arrhythmias, covid doesn't present any increased risk ( other than an individual would have based on other factors, that is).

I'd think a person's general health, affected as it is by the presence of the arrhythmias, and how well they are controlled, would be the concern in regards to increased risk for covid complications. That's a discussion to have with the person's doctor(s), I'd think. But I wouldn't think just the presence of an implanted cardiac device would in itself put someone at increased risk.

Here's the CDC site showing the risks for severe covid:

Certain Medical Conditions and Risk for Severe COVID-19 Illness | CDC

Getting old is one of the most risky things we can do !

by IAN MC - 2021-01-10 07:12:56

Fascinating discussion on risk factors.

We all know that Covid risks increase with age but why is this ?

Is it simply because, as you age, the chances of having co-morbidities increase or are there other reasons ?

I do believe that the honest answer to so much about Covid is " We don't know ".

Ian

Probably just lack of reserves, Ian

by crustyg - 2021-01-10 07:35:45

I wondered the same when I was chatting to a colleague about an 85year old man fighting for his life on ICU after his car had been rammed on his, the driver's side.  He'd been fit, well, active and completely independent and yet there he was, falling O2 sats, clearly not going to make it.

And she gently explained to me that he just didn't have any reserves, so even a slight lung injury would tip him over the edge.

A little later I was discussing the same issue (metabolic reserves) with the Prof of Human Nutrition, who was a big advocate of the general idea that animals do *not* have oodles of spare to cope with life's insults.  His logic started with 'why do we lose our appetite when seriously ill' (compare the Common Cold with Influenza A) - answer, the liver needs to make lots of different proteins to fight the infection/support the B-cells making antibodies and T-cells doing the killing of infected cells, and there isn't the spare capacity to process the daily tsunami(s) of new chemicals arriving from the gut (food).  The logic then extended to 'essential' versus 'non-essential' amino acids, which in his opinion had come to mean 'important' and 'unimportant' and that's a huge mistake.  The 'non-essential' amino acids aren't essential in our diets because they are so essential for life that we have to be able to make them ourselves - any embryo that inherits a defect preventing synthesis of glycine (to use a silly example) would die days after fertilisation, while others we don't need to make, we can get buy on what turns up in our diets - usually.  This was radical stuff in the early 1990s.

Glycine is interesting, because it forms fully one-third of collagen, it's massively used to detoxify chemicals/poisons in our diet (e.g. sodium benzoate) and it's a major component of the Healing and Repair process - but what governs how much any individual can make?  Almost certainly intra-uterine conditions (after David Barker's work).  Prof and I did some human experiments on this (sadly never published due to my mistakes) - he couldn't cope with a glycine drain as well as we could - very different intra-uterine history.  Lower metabolic reserves.

Age, *alone*, has been massively over-stated as a risk factor for Covid-19 death.  Age PLUS an existing underlying issue => big increase in CFR.  But even in 85year olds, CFRs are only 10% or so, if you remove the underlying diseases, possibly less.  The overall death rates from Covid-19 in healthy folk are really quite small (although the SA variant sounds worrying).

It seems that the trick is to get to ones 80s without anything serious!  Now, where did I put that book on Healthy Living.....?

Cognitive decline

by Gemita - 2021-01-10 08:20:38

I believe cognitive decline is probably the single biggest problem that many of us have to face as we age.  If we can keep our minds healthy and active, even physical impairment may not be insurmountable.  Unfortunately as we age not only do we run out of cognitive reserve, we may run out of the will to live and give up the fight of struggling with our health conditions.

It is easy to keep active physically and mentally when we are well, but of course not so easy when we have mounting co-morbidities.  In the meantime, even if we don’t feel like it, it is never too late to start building cognitive reserve to help us live a better quality of life.

It was interesting to read "why do we lose our appetite when seriously ill" crustyg.  Thank you for your post which I enjoyed.  Hubby lost his appetite twice in his life and both times were due to sepsis!  I knew he was really poorly when he refused to eat and I didn't waste time getting him into hospital.  It saved his life apparently since the doctor told me to wait until morning . .

But I agree with you Ian, the effects of Covid-19 are still largely unknown which is why it is so important to get that vaccine.

Thank you for your comments Crusty.

by IAN MC - 2021-01-10 08:23:19

As a relatively fit  "senior citizen'  I found your observations on Case Fatality Rates to be re-asssuring.

Interestingly, I have a good friend who is a retired consultant geriatrician and I asked him why I can't run as well as I did in my sixties. He said it is PROBABLY because the walls of every blood vessel in my body now have less elasticity

The fact that both he and you used the word " probably" reinforces my view that much is still not known about most things medical.

Now , on which supplement should I spend ( waste ? ) my hard-earned pension to build up my abysmal reserves  ?

Best wishes

Ian

PS   You  must have been talking to my wife, Gemita.  She accuses me of cognitive decline every time I lose my car keys.

Oxidative damage looks to be the worst

by crustyg - 2021-01-10 10:43:29

But I'm probably decades out of date.  Free-radical damage to cell membranes was considered one of the most important cellular degradation mechanisms associated with age back in the 1990s.  Perhaps telomere shortening has overtaken it now.

Free radicals are mopped up by specialised enzymes: the only one I recall is superoxide dismutase, which needs an atom of selenium to work, hence the interest in selenium yeast as a food supplement.  Bad news: oxidative damage to cell membranes is irreversible.

The 'probably' caveat: well, because early on in any medical career one learns that there are no 'Never' and 'Always'.  One can only say <x> is why you can't run as fast as 10years ago when it's been proven by proper scientific experiment.  Medicine is littered with examples of assumed cause=>outcome which turned out not to be correct.  And most us us, here, don't have the time to wait for solid answers.

Perhaps I read too much science fiction (or perhaps it's more correctly called Horror) - the idea of living forever is clearly a curse and not a benefit.  There's a reason why we are programmed for a finite duration: for me, the aim is to stay as fit and healthy as possible until that Number 13 bus gets me in one go.  John Wyndham wrote a book about prolonged life (Trouble with Lichen), which was a different, and thought provoking look at the changes this might bring.  But actually we already have something much worse: 1960 3.5BN, 2020 7.8BN.  It's scary when you recall that Malthus predicted eventual mass famine in 1798 (population growth is geometric, food supply growth is linear).  So far we've managed to stave off the Four Horsemen, who have always stood ready to help with overpopulation.  But they're sadddled up and ready to ride.  SARS-CoV-2 looked, for a while, as though it might be The Big One.  But, so far, thankfully not.

Now, where did I put my car-keys?

Great Thread!

by Marybird - 2021-01-10 12:32:56

There is a lot to think about, and to learn, always!

Just my two cents here. I'm well onto the old age portion of the continuum of life, and while the 25 yr old psyche that lives in this 73 yr old body is still fighting to think we're still invinceable, it's hard to ignore the realities of old age and its changes ( both physical and mental), when they continue to smack you right in the face, LOL. And life is terminal, we aren't meant to live forever. Not that we want to go prematurely, but the reality is there.  I figure the fight to maintain one's health, and to be in as good shape as possible, is not really about living longer, but about the quality of life, being as good as we can be, for the time we are here.

I also have to put in a plug for the pacemakers, I guess in response to Gemita's comments about dementia. I went through about two years of progressively worsening bradycardia before I got my pacemaker. There were times that I seriously believed I was sliding down the rabbit hole into dementia, when I found myself unable to complete a simple task, or even complete a sentence, or complete a thought. It wasn't just from the chronic tiredness lightheadeness, shortness of breath, it just seemed to me that my whole mind would go blank, into nothingness ( really embarrassing when you're in the middle of a community volunteer activity) until my heart rate would climb enough to get some circulation back. That mental "nothingness" was the worst part of that whole experience for me, I was frightened and depressed about the possibility that this would be how dementia would descend on me, and I'd never get out of it.

This all changed when I got the pacemaker, and when the settings were adjusted ( especially the rate response) and I think I got my mind back! It made all the difference in the world. It came back enough that I can now pursue challenging mental activities ( I do editing and other writing for a medical continuing education company), which keep the old age mental cobwebs even further at bay.

We'll get that vaccine- I don't know when hubby and I will get ours, but I'm not worried about it.

Mary

 

Marybird

by Gemita - 2021-01-10 14:11:13

Mary, no we are certainly not meant to live forever and nor would we wish to.  We will know when it is time to go and hopefully we will go with dignity, but we aren’t ready just yet, are we?

I had a similar experience prior to my pacemaker implant with brain fog and was beginning to think I was losing it.  Hubby had the same experience and this was particularly worrying because he had had a history of strokes.  I was even beginning to look into a Care Home for the two of us because it looked as though we needed some serious help.  

To be honest Afib was partially to blame for my brain fog.  The chaotic beating of my heart during AF certainly seemed to decrease/inhibit proper blood flow to my brain causing loss of cognitive function.  And the chronic fatigue was just as bad and combine that with a low heart rate and I was really struggling to keep up at times.  I gather Afib can lead to an increased risk of dementia although this risk is reduced by taking anticoagulants.

Anyway glad to read you are keeping busy Mary.  We are still on standby to receive our vaccine which should be any day now. 

Losing car keys

by AgentX86 - 2021-01-10 20:59:34

I haven't done that in a long time.  ...since they invented the Tile.  ;-)

I never lose my work keys, ear buds, or phone either.  ;-)

I have a similar story but mine was sleep deprivation.  I thought I'd have to quit working because I couldn't think.  I had simple calculations that any freshman engineer should be able to do in his sleep, that I simply couldn't do.  Once the flutter was brushed under the rug, I was back immediatly.

Risk Factors

by AgentX86 - 2021-01-12 15:48:07

Our first round included

    1. The usual front-line health workers,

     2. Everyone, regardless of age with an underlying health risk

     3. Everyone over 65.

An appointment was needed (first call basis, on Saturday - I called 46 times before getting through, my wife called 76 times and didn't). Proof of employment or age (driver's license) were to be shown the day of vaccination.  What was odd that neither were checked. 

One drove up to one station and gave name and time of appointment, then to another station to fill out some forms, then to another to get the shot, through the open window, then on to a queue to wait 15min.  If there was a problem while waiting, we were instructed to flash lights and honk horn.  Pretty efficeint but the holes are obvious.  It was a miserable day and I felt for all of the workers standing outside all day in the 40F rain.  There were at least 25 people manning all of the stations (with one on each side of the car giving the injections).

Reaction: I felt like crap this morning and had really sore left shoulder and hip.  After a few hours sleeping it off, it's all gone but slight, moderate to the touch, injection site discomfort.  My wife, who normally gets whacked by vaccines, has only a little discomfort.

You know you're wired when...

You can feel your fingers and toes again.

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