Did you know that most liver disease patients don't know they have it?
Did you know that COVID-19 is officially called SARS-CoV-2?
Did you know that COVID-19 or SARS-2 is more dangerous to society than SARS-1.0 which hit in 2003 and killed 9.6% of those infected?
Did you know that 20,000,000 Americans don't know they have asymptomatic liver disease?
Did you know that if you have advancing fatty liver disease without any symptoms your risk of death from SARS-2 is higher than average?
This is a completely new virus but it causes Severe Acute Respiratory Syndrome so it is officially a SARS type virus but it is not just a variation of the earlier one. This is a new human pathogen so we have no immunity.
A key difference between the earlier SARS and this virus is that while SARS was more deadly it didn’t spread easily. SARS-CoV-2 is a very efficient spreader so even though it isn’t as dangerous individually it is a far greater risk for society broadly and will kill far more people as a result.
Sadly, most potential victims may not know that they are part of a high-risk group. How high? We still have limited data but if you are over 50 the mortality rapidly climbs to 2% and accelerates rapidly from there with age. That makes sense as old people seem to die a lot. However, if you have NASH, nonalcoholic steatohepatitis, your risk will rise rapidly with your disease stage.
We have to think about any people whose health is compromised. Just as an example, let’s think about NASH and the fibrosis that is the result. This accompanying table is about the hazard ratio of different diseases compared to the four stages of NASH. Stage 4 is otherwise known as cirrhosis.
To keep this simple, the HR (Hazard Ratio) shows the probability of death from some disease compared to the general population. You can see that Fibrosis stage 1 at 1.88 is more likely to kill you than diabetes which is 1.61. This provides a frame of reference.
You might wonder how many people have Fibrosis stage 1 or higher. Might it surprise you that we don’t really know? The disease is usually symptom-free until well advanced but it is the hazardous form of nonalcoholic fatty liver disease or NAFLD. We believe that about 100 million Americans have NAFLD. We believe that about 20 million have NASH. The reason we don’t really know is because we don’t screen for the disease. That is a topic for another time but it is a problem with our healthcare system. One other thing you might notice in the chart is that it is more dangerous to have fibrosis than it is to be old.
So why would this virus be particularly dangerous for someone with NASH? It is, after all, a cold virus that attacks the lungs and causes pneumonia. This is the normal pathway for a coronavirus. There may be several answers but one of them is that this virus also attacks a receptor or gateway on the surface of some cells. Those cells are found in a variety of organs and the receptor is called ACE2. It gets complicated, but one location is in cells called cholangiocytes. Big word but the important fact is that these cells are in the lining of the bile ducts of the liver
The liver is also an important part of the immune system so as the body fights its battle in the lungs the liver is also defending itself. If a person happens to have a damaged liver, as 20 million of us do, you might suspect that our risk from COVID-19 will be higher than that of a healthy person. Since age brings with it liver damage as part of aging the idea that this virus would be a hazard for older people isn’t surprising. A challenge is that for most victims neither they nor their doctors know that they have NASH or any of the other liver diseases that are mostly silent and asymptomatic.
The problem is that this virus is about twice as infectious as SARS was. Another fact that simply amplifies the danger is that unlike SARS this virus can be spread by asymptomatic people and by people with very mild cases. It has the potential to simply explode where SARS did not.
We have about 100,000 critical care and ICU beds in the country. If this virus gets out of control we won’t be able to care for all the patients. If we infect 30% of the at-risk NASH patients, which is the potential, that is 2 million people and about 400,000 are likely to need critical care. The system can’t manage that and this doesn’t consider other patient populations. With that background, this message is directed to anyone who knows they have any kind of liver disease or its companions of diabetes or any of the comorbidities that plague the community. Do not take chances. This virus will spread throughout the country. We do not have the tools to stop it yet. Taking yourself out of the line of fire, for now, is the best defense.
28 yr old female, 135 lbs and fatty liver?
Understanding a LIVER MRI report regarding IRON (or not)
You can reverse fatty liver!
I’m new here; wondering if others have reduced NASH stage 3 fibrosis?
Covid and NASH
