COVID-19 survivability and its root cause

On the road towards endemic with COVID-19, Singapore is currently embracing a wave of infections, with daily cases hovering around 3000. Inevitably, even with the high vaccination rate in the population, the death toll has increased drastically, reaching 315 as of 24 Oct 2021. The majority of the deaths (273, 86.7%) occurred since 10 Aug 2021, when the country entered the “Preparatory Stage of Transition” towards living with COVID-19.

The reporting of daily death due to COVID-19 can be frightening for many. However, the number should be put into perspective of the larger context of a high infection rate. With 84 581 infected individuals over the last 28 days (on 24 Oct 2021), 98.6% had no or mild symptoms while 1.1% required oxygen or were in the intensive care unit and 0.2% succumbed to the illness [1]. At this stage, those who are at risk of falling seriously ill with COVID-19 are anyone unvaccinated or those who are elderly, with underlying conditions or weakened immunity, even if they are vaccinated.

What conditions make COVID-19 dangerous?

What are the underlying conditions that make COVID-19 more dangerous? Evidence has shown that obesity and chronic diseases, including cancer, diabetes, kidney disease, chronic obstructive pulmonary disease (COPD), neurocognitive disorders, and cardiovascular diseases, significantly increase the risk of severity and death with COVID-19 [2]. But they are not unique to COVID-19. If we look at the latest death statistics by cause in Singapore before COVID-19 shown in the chart below, there is a remarkable similarity in risk factors that kill.

Data source:

Note that pneumonia, characterised by acute respiratory system inflammation caused by infectious agents, such as viruses, bacteria, and fungi, was the second most common cause of death in 2019. COVID-19 is an infectious disease that affects the respiratory system and pneumonia is a complication in severe cases that can be deadly. However, in the pre-COVID-19 era, there has already been a steady upward trend of death by pneumonia. The following chart shows the increase in absolute number and relative percentage over the past 10 years.

Data source:

Hence, more people are dying each year due to respiratory infection even before COVID-19. Again, the risk factors of having pneumonia are chronic conditions including COPD, cardiovascular disease, cerebrovascular disease, chronic liver or renal disease, diabetes mellitus, and dementia [3].

What causes the chronic underlying conditions?

The demise of every single life is unfortunate. The point I wish to raise with the supporting data is that COVID-19 does not take life by itself; it is merely a trigger to a severe inflammatory cascade in a body that has already been weakened by chronic conditions. Even without COVID-19, other infectious agents can cause similar detrimental effects, and COVID-19 is just a new kid on the block.

What causes these chronic conditions in the first place? The culprit is an unhealthy lifestyle consisting of an unhealthy diet, lack of physical activity, high stress, and over medications. The cumulative effects of an unhealthy lifestyle can lead to an imbalance in gut microflora, oxidative stress, and cellular injury, which exacerbate chronic inflammation. Chronic inflammation can lead to obesity, diabetes, cardiovascular disease, cancer, and mental health deteriorations [4]. So, the root cause of most modern health problems is one’s lifestyle, and it has been estimated that more than 80% of chronic diseases can be avoided by adopting a healthy lifestyle [4]. Sadly, adhering to healthy living recommendations, including healthy eating, active living, weight management, and mental resilience, is often neglected.


An unhealthy lifestyle affects not only COVID-19 survivability but also mortality risks in all modern countries like Singapore. With the population acquiring immunity towards COVID-19 either naturally or through vaccination, the SARS-COV-2 virus will become yet another infectious agent that poses a deadly threat to anyone weakened with chronic underlying conditions. COVID-19 is not the first and will not be the last pandemic the world will see. Hence, staying healthy through diet, exercise, and maintaining mental well-being is of utmost importance for all.  


[1] Singapore reports 3,383 new COVID-19 cases and 15 more deaths, 2021.

[2] Centers for Disease Control and Prevention, Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Providers, 2021.

[3] A. Torres, W.E. Peetermans, G. Viegi, F. Blasi, Risk factors for community-acquired pneumonia in adults in Europe: a literature review, Thorax 68(11) (2013) 1057-1065.

[4] B.I. Bodai, T.E. Nakata, W.T. Wong, D.R. Clark, S. Lawenda, C. Tsou, R. Liu, L. Shiue, N. Cooper, M. Rehbein, B.P. Ha, A. McKeirnan, R. Misquitta, P. Vij, A. Klonecke, C.S. Mejia, E. Dionysian, S. Hashmi, M. Greger, S. Stoll, T.M. Campbell, Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival, Perm J 22 (2018) 17-025.

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