COVID-19 and its impact on South Asians

Sakthivel Sadayappan, PhD, MBA

A person wearing a suit and tie smiling at the camera

Description automatically generated

The focus of this article is to understand how the COVID-19 impacts South Asians, in particular, those with underlying medical conditions, such as diabetes, hypertension, heart and lung disease, and compromised immunity, which contribute to morbidity due to COVID-19. The article will also discuss the current status of vaccine development and pharmacotherapies.

According to the John’s Hopkins database, 188 countries had 7,142,462 confirmed cases of COVID-19 and 407,009 deaths as of June 09, 2020. COVID-19 is defined as an upper respiratory disease caused by a novel coronavirus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). People suffering from COVID-19 may have symptoms such as cough, shortness of breath, fever, including chills and muscle pain, sore throat and loss of taste or smell. Less common symptoms include nausea, vomiting, or diarrhea. These symptoms may appear 2 to 14 days after exposure to the virus. Individuals should seek emergency medical attention upon experiencing trouble breathing, persistent chest pain, or other severe symptoms. 

Older adults aged 80 and over are at higher risk for developing serious complications from COVID-19 illness including death. The overall case fatality rate for COVID-19 infection ranges from ~1 to 4%. Currently, no specific FDA-approved drugs are available to combat COVID-19 infection, and it will likely take 12 to 18 months for an effective and safe vaccine to become available. 

According to the Center for Disease Control (CDC) and Prevention guidelines, the best way to prevent COVID-19 illness is to avoid exposure to the virus. People are strongly encouraged to maintain social distancing practices, use a face covering, wash hands often (preferably with hand sanitizer with 60-70% alcohol), avoid touching eyes, nose, and mouth, cover coughs and sneezes, and monitor their health. Based on the literature, patients with COVID-19 have a high prevalence of cardiovascular disease, including acute cardiac injury with a significant elevation of cardiac damage biomarkers, such as cardiac troponins. COVID-19 patients have poor prognosis in the presence of cardiovascular comorbidities, such as hypertension, diabetes and coronary artery disease. Disease outcome is aggravated by the presence of acute cardiac injury, heart failure and arrhythmias. A few studies have shown that patients may develop myocarditis and cardiac arrest. 

COVID-19 knows no socioeconomic, race, and or geographic boundaries. However, African Americans account for 60-70% of COVID-19 fatalities. It is believed that the higher rates of comorbidities like hypertension and diabetes in African American might be tied to the higher incidence of COVID-19 complications. Other contributing factors may include less spatial segregation and poor access to testing and treatment in this group.  Worldwide reported death rates due to COVID-19 vary with incidence rates of 6% in the USA, 15.2% in France, 14.4% in the UK, 14% in Italy, and 11.9% in Spain.  On the other hand, the reported death rate in South Asian countries is lower with fatality rate of 3.3% in India, 2.2% in Pakistan, 1.5% in Bangladesh and 1% in Sri Lanka. In China, where COVID-19 was first detected, the reported death rate is 5.5%. Therefore, one might ask why South Asian countries which collectively have 20% of the world’s population, have a COVID-19 related fatality rate of less than 3%. 

One can start by asking if the data are based on proper testing and reporting.  It is well known that these countries have a relatively younger population as compared with developed countries. Having been exposed to many infectious diseases, malaria included, it is also possible that South Asians have improved immune defenses. Another hypothesis is that South Asians consume lots of spices in their diet, such as pepper, ginger, garlic, turmeric powder, lemongrass, oregano, coriander, and basil, which may afford protection against COVID-19 complications. It is also possible that the tropical climate of South Asian countries which results in higher average temperatures (80˚F and above), more sunlight and related ultraviolet radiation (UVR), might slow the spread of disease, thereby contributing to lower death rates. However, these assumptions and hypotheses need to be validated, tested and documented properly. 

In conclusion, COVID-19 is still spreading worldwide; therefore, the precautions noted above should be heeded and the established CDC guidelines should be followed.

Sakthivel Sadayappan, Ph.D., M.B.A.