It is being reported that patients who have NAFLD are about twice as likely to have a more serious illness than patients who are obese but do not have NAFLD if infected with COVID.

NAFLD is more likely to result in serious symptoms than obesity without NAFLD. This distinction is important for proper risk stratification.

I know that when you read about the risk factors associated with COVID they rarely mention liver disease. There have been some early reports that essentially say that liver risk is limited.  In the early turmoil of a crisis like the COVID pandemic a lot of information is fragmented and based on very small samples.

A study has just been uploaded to a pre-release server which takes a much more effective look at the question of whether NAFLD should be considered to be a risk factor for hospitalization should you become infected. 

Did you know that 20,000,000 Americans don't know they have asymptomatic liver disease?

Did you know that disease called COVID-19 is caused by the virus 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 if you have advancing fatty liver disease without any symptoms your risk of death from SARS-2 is higher than average?

I have some concern about writing this.  When we face a crisis, panic and reactions driven by fear can do great harm.  I do not wish to contribute to that, however, as an advocate for people faced with chronic illness, such as liver disease, I feel compelled to inform my community about the details.

I have been helping several groups doing research on what is happening with liver disease patients and I have been surprised by a trend that I have noticed.  When a person first learns that they have a serious liver disease they reach out to Dr Google, our forum, and significantly to FaceBook support groups.  I don't have numerical data, but I interact with multiple forums that reach thousands of patients so I have a window into what the day to day is like.

A problem we have focused on is that it has been the standard of care not to screen for liver disease at the primary care level, in the absence of symptoms.  That means that the first time many people learn of their risk is being told that they have cirrhosis.  Much of our effort has been spent trying to illuminate this as an issue.  We are particularly concerned as the disease is showing up in younger people in the death rate statistics but we hadn't really seen movement in when people learn about the disease.

There are so many things about the way we deal with health in general and liver disease specifically that get my goat that the poor thing has the blind staggers from all of the abuse.

Our society has become a case study in death by excess.  We have too much food, too much leisure, too much convenience, too much marketing, too much image manipulation, too much feckless government, too much misinformation, too much profiteering.  I should stop as I've probably already said too much.

Our focus here may seem too limited to justify sweeping comments like this.  It paints me as a wild eyed crazy man for some. In my defense, my perspective comes from the very un-glamorous view from the liver.  Since there have been no treatments for the most common cause of liver failure and death, the glamor diseases like diabetes, heart failure, cancer, various genetic problems, and so on get the attention.  The problem, in its simplest form is that the liver is like an abused but uncomplaining spouse who lives under constant threat but perseveres in silence.  Our body is bio-chemically very complex and could not exist without the quiet workhorse that is the liver going about its 500 or more jobs.

Think of that.  A liver cell that is about one fifth as wide as a human hair is constantly involved directly or indirectly in 500 different functions and you will suffer some health consequence if any of them are not done.  This also explains why we have no treatments.  It is so complex that we simply have not had the ability to act against a problem without doing harm somewhere else. I'll expand on this in a future article but for now just keep it in mind as you think about liver disease.

I'm optimistic that a new goat will have a better chance.  There is a tremendous pressure for more and better patient advocacy and it is happening when medicine is simply exploding with innovation and discovery.  We have a vast array of current problems to deal with but I am convinced that we are on the brink of a golden age for medicine and patients.  Our biggest challenge will be taking what we know and delivering it in a useful way to the population as a whole.  A key to that will be patients who are engaged in their own care and who actively participate as their own advocates.  It will not always be pretty but the future is bright in spite of the great confusion within the government right how.