GDD, Obesity, and COVID> why do fat people die and GDD not so much?

My observation over the last 5 years of directly seeing and treating GDD patients, is that many of them at baseline are quite lean. This is unlike the great American pandemic of Obesity where something like 1/3 of the adult population is obese. I will qualify this blog and say that this is almost pure conjecture and based on my personal experience with GDD sufferers, which although is likely greater than anyone else, is still not nearly fully comprehensive.

I will jump to the end of the movie, and then walk backwards, and I will expand this blog over the coming days.

It is because GDD sufferers have immune system exhaustion and obese people have immune system weakness. To be effective at killing a person, Covid requires that the immune system be relatively functional because it requires a strong cytokine storm to kill > obese people have a weakened but still quite functional immune system, so obesity is the first punch (to make them susceptible to doing badly with any insult), and cytokine storm the knock-out punch. In GDD, the immune system exhaustion that GDD creates, translates into: they are susceptible to get Covid, even severe Covid, but their immune system is too exhausted to give the body the George Foreman knock-out punch. So GDD sufferers, in my opinion, are especially sensitive to getting Covid, and also sensitive to reacting to Covid vaccine, because their immune system is dysregulated. So they are less likely to block getting a disease process than a healthy lean person, but their immune system is so dysfunctional it cannot deliver the knock-out punch.

Let us take a step back in time to the great Flu of 1919. I must admit I was puzzled for years, even with getting an MD and progressing on in studying, how is it that the 1919-Flu primarily killed young healthy people, and not so much the old and the very young. When for most things, the very young and the very old tend to die the easiest. It is because the first iteration of that virus was extremely effective at eliciting a cytokine storm. The most effective cytokine storms are generated in individuals approximately from 15- 50 years of age. The cytokine storm that the virus was able to elicit was the death blow, not so much the simple process of getting the virus. This also explains why most autoimmune disease (rheumatoid arthritis, Crohn's, Psoriasis,) effects people in that same mid-age range, they require a fully mature and aggressive immune system to wreak havoc.

Obese people, probably all of them (research I am also now involved in) have an underlying smoldering chronic immune disease, which is damaging enough to make them more susceptible to all forms of disease, but not so damaging that they cannot mount a cytokine storm powerful enough to kill them.

In thinking of Covid and likelihood of dying from disease, my estimates are that 15-60 year olds who are slim and basically well have a 1 in 100,000 chance of dying from the first iteration of Covid, whereas age-matched obese people have a 1 in 100 chance of dying from it, so all told as a population a 1 in 1,000 chance of dying. It was true of the 1919 Flu, and is seemingly true of the current Covid pandemic, and probably true of all viral pandemics of all time: the first iteration is the most lethal, then over a period of a few years, a level of heard immunity develops and simultaneously successful viral variants are ones that are more transmissible but less lethal. It is almost as if they are thinking entities, but if a virus is too lethal then it can't be that transmissible because generally for viruses dead people don't transfer infection to others as well as live people do.... and while less lethal viral forms are circulating, more herd immunity develops without individuals dying, so there is less susceptibility to getting any virus, and the viral pandemic dissipates in 3-5 years.

Basically every foreign particle/ antigen is potentially immunogenic, and even normal host antigens can become immunogenic if they have first, as a partial population, been altered by viruses or toxins to be different (the basis of auto-immune diseases). So any molecule can result in a cytokine storm in the right environment. It is baffling to me that the majority of people, including in the scientific and medical community, don't seem to understand: in a small subset of individuals, often influenced by co-existing factors, GBCAs can be highly immunogenic (reactogenic), and by the same token so can vaccines. It is critical to understand this, and to investigate in sufferers, what are the cytokines that cause this reaction, by comparing to the cytokine profile of non-reacting individuals (often the great majority of the exposed people) to identify what cytokines prevent this.

So back to the ending: obese people are just immunologically sick enough to die from Covid in relatively high numbers, and GDD sufferers are too immunologically sick to die from Covid.... But Covid will make them sicker still, but not with the George Foreman punch.

Richard Semelka, MD