COVID-19 Explanations: Why Are Overweight People and Older People at Higher Risk?

by Noach Nestor Bittelman, LAc

Understanding why a particular population is at higher risk for suffering from any specific illness is key to developing a successful treatment strategy. In this paper I will analyze some of the factors which contribute to the overweight and the elderly being at higher risk for suffering serious complications or dying from the current Coronavirus.

The Overweight:

The current novel Coronavirus, responsible for COVID-19, is categorized from the perspective of Chinese Medicine as primarily an assault by a “damp” pathogen; this damp pathogen is variously described as being a cold-damp, a toxic-damp, or an epidemic-damp. (Chinese Medicine categorizes the pathogenic factors which can attack and penetrate the body as having different natures; there are cold, damp, wind, dry, hot, and extreme heat pathogenic factors.) After the damp pathogen penetrates the body it moves to attack the Lung and Spleen systems of the body. Spleen symptoms include body aches, fatigue, diarrhea, frontal headache, loss of appetite, and loss of sense of taste. Lung symptoms include cough, wheezing, shortness of breath, and loss of sense of smell.

Other body systems may also be involved, either through also suffering along with the Lung and Spleen from the damp attack, or through participating in the defense of the body; symptoms of this sort may include fever, alternating chills and fever, low back ache, changes in heart rate, skin conditions, etc. Weakness of any system in the body makes that system vulnerable to attack by the pathogenic factors. Likewise, latent underlying pathologies extant in any body system are ripe for being “joined” by the attacking pathogenic factors, exacerbating an already clinical or sub-clinical situation.

One of the primary medical challenges with COVID-19 illness is its severe attack on lung function. The pathogenic factor, the dampness, enters the body and typically goes to the Lung and Spleen, as mentioned above. The damp pathogenic factor (this particular Coronavirus) after typically causing relatively low-key flu symptoms for the first few days, begins to rapidly cause a build up of fluids in the lungs (dampness). As the fluid stagnates heat may develop as an attempt by the body to deal with the fluid. In many cases there is latent heat already pre-existing in the lungs, either from earlier illnesses which were never fully cleared, or from dietary, drug, alcohol, or other habits such as smoking which cause there to be latent heat in the lungs. Either way the heat combines with the fluid in the lungs, drying and congealing the fluids into very thick, viscous, sticky phlegm. This phlegm coats the alveoli, preventing the exchange of oxygen from the lungs to the blood, and likewise preventing the exchange of carbon dioxide from the blood to the lungs.

The heat can additionally scorch the lung tissue itself, drying out the lubricating, nourishing fluids which keep the lung tissue supple and functional and thereby bringing about a stiff, fibrosis-like state (think of skin which has been burned, either by the sun or by some other factor, it becomes dry and stiff and must be moistened and lubricated in order to restore flexibility and function). This second factor, whereby the heat dries out the normal lubricating fluids which keep the lung tissue supple and flexible, is particularly important in regards to older people, who already have a fluid deficiency as a part of aging (a clear example of this is the dryness associated with elderly skin).

The Spleen is also centrally involved in issues involving dampness. Overweight people very often have a weak Spleen, meaning their digestive system doesn’t function up to par. According to Chinese Medicine the Spleen is tasked with transforming food and drink into Blood (a catch-all term used here to include all body fluids) and qi or energy. A Spleen system which is functionally sub-par will transform food and drink into some Blood, some qi, and some dampness. (A useful analogy can be made to the process of baking a cake—one assembles the cake ingredients, mixes them together to make a cake batter, pours the batter into the cake pan and puts the cake pan into the oven, which has been heated to 175˚ Celsius. The recipe calls for cooking the cake for 25 minutes; after 25 minutes you pull the cake out of the oven, and presto…the cake is soggy. The oven, even though it was supposed to be cooking at 175˚ C, never got hot enough, so you end up with a soggy, “damp” cake. The edges of the cake may be done, but much of it is not fully cooked. This is similar to what happens in the body when the Spleen system is not burning hot enough. Rather than cleanly transforming the food and drink into Qi and Blood, , there is collateral production of detritus, phlegm, fat, etc. from the food and drink which have been consumed.)

[As an aside, there is another kind of overweight which is not related to a weak Spleen, but is rather a technique whereby the body protects itself from internal toxicity. In situations where the body cannot discharge or transform the toxicity it will create non-essential fatty tissue where the toxins get deposited and thereby prevented from damaging essential organs and structures.]

Overweight people in general are already suffering from a state of excess internal dampness, too much fluid and too much phlegm. The pathological mechanism of the damp novel Coronavirus, as described above, produces dampness/fluids. When the body of an overweight person is penetrated by the damp novel Coronavirus, the excess fluids produced by the pathogen combine with the pre-existing dampness/fluids, rapidly inundating the lungs and leading to the typical cough and shortness of breath seen with COVID-19. Heat can then come into play, as outlined earlier, and the characteristic pattern of blood gases showing low oxygen and high CO2 show up as the alveoli are covered and obstructed by viscous phlegm. This ultimately leads to the organs and tissues of the body being starved for oxygen and unable to maintain function.

The Elderly:

Understanding why the elderly population is more susceptible to suffering serious consequences at the hands of the novel Coronavirus is much less complicated than understanding why overweight people are highly vulnerable.

The primary factor at play is aging, which in general involves diminished organ function, including the organs responsible for forming the immune system (the Wei Qi in Chinese Medicine). Aging often involves a “cooling” of the body; the Yang energy which warms the body and motivates the circulatory, transformative, eliminative and other functions is diminished. (The well-known movement of people to warmer climates as they age is a response to the diminishment of internal warmth.) This brings about a situation of both excess and deficiency. Excess build up of fluids (edema) and toxins, along with stagnation of blood and energy, and deficiency of organ function and the production of energies and substances which both nourish and clean all parts of the body.

So we can see how many of the elderly are already in a challenging situation vis-à-vis dealing with an attack of any pathogenic factor, but when faced with a particularly virulent pathogenic factor which is damp by nature they become even more susceptible. The novel Coronavirus, as part of its attack, rapidly degrades the immune system, as well as exerting the negative effects described above in regards to fluid and phlegm build up in the lungs, and the scorching of the lubricating fluids by the heat which follows the accumulation of fluid in the lungs.


The overweight population is at greatest risk for severe complications or death from the novel Coronavirus because of pre-existing excess dampness/fluid which combines with the fluids produced by the pathogenic factor, which is then transformed into viscous phlegm that obstructs the exchange of oxygen and carbon dioxide in the alveoli. The treatment strategy in these situations needs to be weighted primarily towards clearing of fluids, transforming phlegm, clearing heat (if present), and opening up the lungs.

The elderly population, on the other hand, is at greatest risk for severe complications or death from the novel Coronavirus as a result of the extensive degrading of the immune system. Without a properly functioning Wei Qi and immune system there is no hope of successfully battling the pathogenic factor, of clearing fluids and phlegm, of keeping circulation to vital systems happening. The treatment strategy when dealing with the elderly COVID-19 patient, generally speaking, should be weighted primarily towards strengthening the immune functions.

Postscript: The above two distinct strategies could easily be adopted as prevention strategies, with the potential to save numerous lives. For a presentation of prevention and treatment strategies geared towards those without access to Chinese herbal medicine or acupuncture, please see Covid-19 Prevention and Treatment: A Chinese Medicine Doctor's Guide at

Noach is a direct lineage disciple of Master Young Wei Chieh, who himself is a direct lineage disciple of Master Tung Ching-Ch'ang and the foremost authority in the world on Master Tung Acupuncture. Noach studied Chinese Medicine and Acupuncture in Taiwan and has run a practice in California and Israel for over 30 years. He is fluent in Chinese, Hebrew, Spanish and English and teaches courses in Master Tung Acupuncture internationally. He can be reached at