The parents and two brothers of Silvia Deyanira Melendez, 24, are all in therapy after losing their daughter and sister to COVID-19 on March 28.
“I don’t have the words to say how beautiful and nice to the family she was,” her father, Marcos Melendez, said Friday.
She weighed more than 300 pounds with a body mass index of 60, double the BMI considered obese. This most likely contributed heavily to her Type 2 diabetes, hypertension and a heart condition that required open heart surgery two years ago.
The chronic conditions that increase the risk of serious illness and death of COVID-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 adults considered obese increased from 30% to 42% between the 1999-2000 period and 2017-2018. Nine percent had severe obesity, up from 5% in 1999-2000.
“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.
The editors of the medical journal Obesity last month said coronavirus created a “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 on COVID-19 deaths confirm the link. The extra weight on people in the 40-plus BMI range who contract COVID-19 increases 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 to intensive 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 went the other way in a big way’
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 chat due to to 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, a University of Utah Health pulmonologist who treated Melendez, said the young woman’s size prevented Brown and the ICU staff 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 allowing patients to use the less-damaged part of the lungs.
When Melendez was on her stomach, her ability to take in oxygen worsened.
So rather 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 wasn’t 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.