The problem with splitting people into these two rough categories is that a lot of patients, including those with chronic illnesses, don’t fit neatly into either. COVID isn’t just a respiratory disease; it also affects other organ systems. It can make a weak heart beat erratically, turn a manageable case of diabetes into a severe one, or weaken a frail person to the point where they fall and break something. “If you’re on the margin of coming into the hospital, COVID tips you over,” Vineet Arora, a hospitalist at the University of Chicago Medicine, told me. In such cases, COVID might not be listed as a reason for admission, but the patient wouldn’t have been admitted were it not for COVID. (Some people might have chronic conditions only because of an earlier COVID infection, which can increase the risk of diabetes, heart problems, and other long-term complications.) “These incidental infections are not so incidental for people with chronic conditions,” Faust said. “Whether they live to see the age of 60 or 90 depends on things just like this.”
Colds and other viral infections can also land people in the hospital by pushing their chronic diseases over the edge. “But we don’t generally see such infections happening to such massive swaths of the population at once,” Murray said. Omicron (helped along by Delta) is doing what other respiratory viruses do, but with enough speed and ferocity to overwhelm the health-care system. As Arora put it to me recently, “We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time.”
These patients whose problems were exacerbated by COVID are often misleadingly bundled together with the smaller group whose medical problems are truly unrelated to COVID.
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