The coronavirus pandemic has emerged as the most important health risk in 2020 which has affected millions of people across the globe. This novel virus causes a predominantly respiratory illness which may progress to multi organ failure in severe cases due to unregulated systemic immune response. There is currently no effective treatment for this illness and the mainstay of cure is prevention by means of wearing masks, social distancing and periodic hand sanitisation. The development of an effective vaccine is under way but may take time.
The coronavirus infection can occur in people of all age groups and ethnicities but the disease manifests in a severe form in a select subset of individuals. These are the elderly people, those suffering from morbid obesity and those having pre-existing diseases like diabetes, hypertension, stroke and other systemic illnesses. This may be linked to a poor immunity in these subset of patients which predisposes them to the complications of this disease.
A study in Wuhan district of China from where the coronavirus originated revealed that the majority of patients who were hospitalised as a result of COVID-19 had a higher BMI than normal. Obesity by itself leads to a proinflammatory state in the body due to excess of visceral fat which is metabolically active. Besides this, obese people have a poor lung capacity and compliance and their lungs are not able to effectively expel the accumulated secretions and fluids as a result of respiratory infection which makes them more prone to develop pneumonia. They usually also have a number of comorbid illnesses like diabetes, hypertension and sleep apnea all of which decrease the immune capacity of the individual. Studies have also found the presence of increased number of ACE-2 receptors in the fat cells of the body of obese people which are the receptors allowing the entry of coronavirus infection inside the human body. The usage of ant diabetic medication also increases the number of these receptors further augmenting the chances of infections in obese diabetics.
All these factors are responsible for increased chances of infection in obese people along with increased hospitalisation due to severe disease. Obesity has emerged as the major risk factor for ventilator support in such individuals with a study revealing that 85% of people on ventilator with coronavirus were obese. The admission into ICU also directly translates into increased risk of mortality.
Bariatric surgery is the most effective, long term treatment of morbid obesity along with amelioration of obesity related comorbidities. Bariatric surgery can be safely conducted even during these pandemic times in COVID free centres taking all the necessary precautions. The patient along with their attendant undergoes a RT-PCR test for COVID-19 two days prior to their scheduled surgery. The number of visitors in the hospital is curtailed and patients are accommodated in private rooms with minimal disturbance and visits from hospital staff. The patient rooms, wards and OT complexes are sanitised periodically to combat the risk of infection and all hospital staff including doctors and paramedics are tested regularly to detect infection. During surgery, the operating team makes use of PPE kits and respirators to avoid the risk of infection and only one case is posted in a day to avoid cross contamination. The post operative stay in the hospital is minimised and the patient is advised a self quarantine period of 14 days after the surgery to avoid getting infection in the post operative period.