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May 24

As obesity’s link to COVID-19 grows, one family that lost 24-year-old daughter diets together – USA TODAY

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The U.S. is currently facing a shortage of ventilators. Here's how they work and why they are so important in fighting COVID-19. USA TODAY

The parents and two brothers of Silvia Deyanira Melendez, 24,areall in therapy after losing their daughter and sister to COVID-19 on March 28.

"I dont have the wordsto say howbeautiful and nice to the family she was,"her father, Marcos Melendez, said Friday.

She weighed more than 300pounds with a body mass index of 60,double the BMIconsidered obese.Thismost likely contributed heavily to her Type 2 diabetes, hypertensionand a heart condition that required open heart surgery two years ago.

The chronic conditions that increase the risk of serious illness and death ofCOVID-19 are by now well known: diabetes, heart disease, hypertension and being older than 65.Obesity is less well known or understood. The Centers for Disease Control and Prevention groups "severe obesity," defined as having a BMI of 40 or higher, with the other known "risk factors for serious illness" for COVID-19.

CDC data show the percentage of adultsconsidered obese increased from 30% to 42% between the 1999-2000 period and 2017-2018. Nine percent hadsevere obesity, up from 5% in1999-2000.

"Before we had COVID, we had an obesity epidemic going on in the U.S. and we've had this for some time," said Dr. Robert Fildes, a pediatric kidney physician.

6. Body fat percentage     • When to get tested: Every few months Body mass index (BMI), which is a measure of body fat based on height and weight, is the standard doctors use to diagnose obesity or if a person is overweight. BMI, however, has limitations. It does not distinguish fat from muscle and does not take into account how much of the weight is actually fat. Too much body fat can increase the risk of health issues such as high cholesterol, heart disease, and even depression. Excessive abdominal fat may increase the risk of type 2 Diabetes, hypertension, and coronary artery disease. Men store more fat around the stomach, which is more dangerous than storing it on the hips and thighs as women generally do. Visceral fat increases the risk of cardiovascular disease, insulin resistance, high blood pressure, diabetes, colon cancer, and sleep apnea. A more comprehensive body fat calculator takes into account age, gender, weight, height, as well as skinfold measurements of the thighs, triceps, and suprailium (above the upper bone of the hip). The healthy range for men is between 2% and 24%, depending on age and level of physical activity. ALSO READ: The Biggest Worries About Childrens Health(Photo: turk_stock_photographer / iStock via Getty Images)

The editors of the medical journal Obesity last month said coronavirus createda "dual pandemic threat" and urged health care providers to "take up the cause" of fighting obesity with their patients.

A growing number of studies and data onCOVID-19 deaths confirmthe link. The extra weight on people in the 40-plus BMI range who contract COVID-19increases the chance they will require hospitalization, most likely in the intensive care unit. It also hampers the ability of physicians to treat them, especially with ventilators, doctors say.

A study by French researchers in the journal Obesity showed a high frequency of obesity among patients admitted tointensive care with coronavirus.The severity of the disease increased along with BMI.

Along with making mechanical ventilation harder, being severely overweight can make it harder to breath, reducing the patient's own ventilation, said Dr. Kevin Kavanagh, a Kentucky physician and founder of the patient advocacy group Health Watch USA.

It also reduces the amount of oxygen per breath, so patients have less of a reserve when they get sick.

Marcos Melendez said he was heartened when his daughter seemed to be improving in the hospital, where her mother also was being treated for COVID-19. Melendez had to communicate with both of them by video chatdue toto the risks in the hospital and because he and his sons were quarantined at home.

"The coronavirus was making big damage in her lungs and after that, the virus went to her heart," Melendez said. "She was responding good with oxygen and then the virus started attacking her heart. It went the other way in a big way."

Dr. Jeanette Brown is a pulmonoglist at University of Utah Health and a clinical professor.(Photo: University of Utah Health)

Dr. Jeanette Brown, a University of Utah Health pulmonologist who treated Melendez, said the young woman's size prevented Brown and the ICUstaff from placing her on her stomach, which is the safest position for patients with breathing tubes hooked up to ventilators. Brown did not identify the patient by name, but Marcos Melendez confirmed it was his daughter.

Placing patients in this position allows doctors to reduce the amount of oxygen needed from the ventilator by allowingpatientsto use the less-damaged part of the lungs.

When Melendez was on her stomach, her ability to take in oxygen worsened.

Sorather than spending up to 17 hours in that position, "we had to flip to her back and try not to lose the airway," Brown said. "She wasnt even able to tolerate that more a few minutes."

Silvia Deyanira Melendez died about 24 hours later when her heart failed.

"As a provider, you want to help people, but when they are severely obese, the deck is already stacked against you," Brown said.

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Depending on a patient's size, an ultrasound's view is more limited because of the excess tissue. Some of the most obese patients may not even be able to have a CAT scan because the machines have weight limits, Brown said.

"Literally, if they are large enough, you lose some of the tools in your tool box," she said.

Fildes, who recently retired from his nephrology practice in Washington, D.C., and Northern Virginia, worked with children who had diabetes that would turn into renal disease if they didn't comply with their dietary and glucose guidelines.

Fildes said some of his teenaged patients weighed 300 to 400 pounds and some developed high blood pressure as young as 11.

The risk of having a high BMI isso serious that Dr. Talal Munasifi said he and most other plastic surgeons won't perform an elective, cosmetic procedure on patients with BMIs of 35 or higher unless they lose weight. Many surgery centers won't perform even needed medical procedures on people whose BMIs are 40 or higher, he said.

Dr. Talal Munasifi is a Northern Virginia plastic surgeon and clinical professor at Medstar Georgetown University Hospital.(Photo: Joshua Mitchell, Urban Health Media Project)

"Once you go over 35,the complication rate gets high," said Munasifi, also a clinical professor at MedStar Georgetown University hospital. The most likely complications are infection and delayed wound healing.

An estimated 75,000 people die a year from infections they developed in health care facilities, according to a 2014 CDC study.

Excess fat cellscreate other problems, too. They are believed to release inflammatory signals that cause the immune system to overreact to coronavirus, creating something known as cytokine release syndome, according to new research.

Brown, who is Mexican American, said obesity and its risks are a familiar topic, personally and professionally. She'sbeen especially worried about her parents, whom she described as obese, during the pandemic because they have Type 2diabetes.

"The unfortunate thing is we tend to have many of the co-morbidities," Brown said of the Latino population.

She said her parents are eating more carefully now, especially since her father realized he was still eating bread when he had tortillas.

Marcos Melendez said a couple of his friends died recently of COVID-19, and obesity was their only risk factor. He is Peruvian-American and his wifeis from Costa Rica. Their daughter's loss has made everyone in the familyimprove their diets and exercise.

"We need to take care of it all," he said.

Since Silvia Melendez's death, the family drinksprotein shakes in the morning, doesn't drink sodasand stops eating at 6 p.m., with only water until bedtime. They are "walking and doing a lot of things" recreationally, he said.

Silvia Melendez's mother, also named Silvia, hasdiabetes and high blood pressure like her daughter. She has continued the diet she started before her hospitalization and has already lost 30 pounds.

After losing his daughter, Melendez couldn't imagine losing his wife.

"I was really scared about her, too," Melendez said. "That virus is very dangerous. It goes after the weakest thing in your body, especially if you are overweight."

O'Donnell, USA TODAY's health policy reporter, is on social media as @JayneODonnell and email at jodonnell@usatoday.com

Read or Share this story: https://www.usatoday.com/story/news/2020/05/23/obesity-makes-covid-19-risk-larger-hospitals-challenges-much-harder/5221600002/

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As obesity's link to COVID-19 grows, one family that lost 24-year-old daughter diets together - USA TODAY

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