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Reopening Northern Virginia: Should Comorbidities Be Considered?

 

In recent weeks, a number of new studies have shown that COVID-19 related hospitalizations are associated with several underlying medical conditions or comorbidities. This week, most of Virginia continues to reopen under “Phase One,” while many Northern Virginia localities successfully sought a delay in reopening restrictions. Does the delayed reopening of Northern Virginia have something to do with regional differences in underlying health conditions in the population?

We looked at the most recent available data on obesity, diabetes, and hypertension, which are among the most common comorbidities associated with COVID-19 hospitalizations, for areas in Northern Virginia compared to the rest of the state. Data on obesity rates and diabetes prevalence come from the newly released 2020 County Health Rankings.  Data on adults with high blood pressure come from the Centers for Disease Control and Prevention (CDC) and PolicyMap, whose data were recently published in The New York Times.    

Obesity:  According to the 2020 County Health Rankings data, 30% of Virginia adults age 20 or over are obese.  Six of Northern Virginia’s localities had some of the lowest rates of adult obesity in the state, with Arlington and Falls Church at 20%, Fairfax County and Loudoun County at 22%, and Fairfax City and Alexandria at 24%. In 27 localities outside of Northern Virginia, rates of adult obesity are between 38%-52%. 

Diabetes:  2020 County Health Rankings data put the prevalence of adult diabetes in Virginia at 11%.  As with obesity, Northern Virginia localities ranked among the lowest of all Virginia localities in adult diabetes.  Arlington, Falls Church, and Manassas, for example, had the lowest diabetes rates at 4%-5%, and Fairfax County, Loudoun County, and Alexandria were at 6%. In 46 localities outside of Northern Virginia, rates of adult diabetes are between 15%-23%.

Hypertension:  The CDC reports that 32% of Virginia adults have high blood pressure.  
Compared to the rest of the state, Northern Virginia localities are much healthier on this particular measure.  In Arlington County and Manassas Park City, just 25% of adults have high blood pressure, while in Prince William County and Fairfax City, 28% of adults do.  In 21 localities outside of Northern Virginia, the rates are as high as 40% or more. 

These data suggest that adults living in Northern Virginia are less likely to have these three comorbid conditions related to COVID-19, and they have better overall health outcomes, compared to Virginia adults as a whole.  In fact, Northern Virginia localities occupy six of the top 9 healthiest areas in the state, according to the 2020 County Health Rankings.  And compared to the national average on increased risk for severe COVID-19 illness based on five comorbidity measures used in PolicyMap’s health risk index, eight of the nine Northern Virginia localities have either a lower or lowest risk for severe illness when compared to the U.S. average, while 19 localities outside of the Northern Virginia area have a higher health risk for severe illness compared to the national average.

However, the delayed re-opening in Northern Virginia was influenced by other types of health data.  In requesting the delay, local leaders from the affected counties, cities, and towns cited evidence of percent positivity and number of COVID hospitalizations in Northern Virginia when compared to the rest of the state. In granting the delay until May 28, Governor Northam acknowledged: “On any given day, 70% of the Commonwealth’s positive cases are attributable to the Northern Virginia Region.”   

Though COVID-19 cases are generally lower in other parts of the state, not all groups agree with the decision to re-open those areas. In fact, leaders from two localities outside of Northern Virginia – the city of Richmond and Accomack County – successfully sought an additional two-week delay based on total case growth of COVID and percent positivity.  In addition, black lawmakers in Virginia oppose Phase 1 re-opening on the grounds that it will place people of color at particular risk.  National and state data do show that blacks and Hispanics have higher rates of certain COVID-related comorbidities -- obesity,  diabetes, and hypertension -- than non-Hispanic whites. According to Virginia data, the obesity rate is 28% among white adults, compared to 41% for black adults.  In the case of adult diabetes, non-Hispanic whites nationally had a prevalence of 8% compared to 12% for blacks and Hispanics.  And in the case of high blood pressure, black adults in Virginia had rates at 45% compared to 33% for white adults.

The decision to reopen Virginia has both proponents for opening immediately and opponents who argue for a more delayed rollout.  Measures of the prevalence of certain COVID-related comorbidities, such as obesity, diabetes, and hypertension, are some of the many metrics that elected leaders use in making these important decisions about when, and where, to reopen Virginia.