COMORBID PATHOLOGY IN FATAL CASES DUE TO CORONAVIRUS DISEASE (COVID-19) IN VICTIMS OF THE CHORNOBYL NPP ACCIDENT.

Introduction: The victims of the Chornobyl accident, as well as whole population of Ukraine, have become the object of the COVID-19 pandemic in today's conditions. As of 01.01.2020, 108,898 victims had documented permanent disability (persons with disabilities) and, as a rule, suffered from 4-6 types of non-tumor chronic diseases of internal organs, primarily the circulatory system, as well as oncological and endocrine pathology, that significantly affect the course of COVID-19 in a severe scenario and contribute to death. This determines the relevance of the issue of the impact of comorbid pathology in fatal cases due to coronavirus disease (COVID-19) in victims of the Chornobyl accident.The Objective of the study was to study the nature and significance of comorbid pathology in the victims of the Chernobyl accident who died from COVID-19.Design, object and methods of the study - a retrospective non-randomized, comparative comprehensive analysis of the materials of 134 medical expert cases of male clean-up workers of the Chornobyl accident who died from COVID-19 in 2020-2022 during the pandemic was carried out. The analysis of the materials of expert cases included the study of clinically significant and morphologically confirmed pathological processes. The source of the data was the materials of the Central Interdepartmental Expert Commission of the Ministry of Health of Ukraine on the establishment of causal relationship of diseases, disability and death with the action of ionizing radiation and other harmful factors as a result of the Chernobyl accident.

Results: In the structure of comorbid pathology in the clean-up workers of the Chornobyl accident who died due to COVID-19 during 2020-2022, diseases of the circulatory system dominate, which occurred in 86.57% of cases of consideration of medical expert cases. AH complicated the course and contributed to the development of fatal consequences in 52.24% of cases, ChIHD - in 34.32% of cases. The consequences of acute vascular events in the form of post-infarction cardiosclerosis in patients with ChIHD contributed to death in COVID-19 in 29 (21.64%) cases.Cerebrovascular pathology represented by cerebral atherosclerosis was detected in 76 (56.72%) cases of death from COVID-19. Acute vascular cerebral events in the cerebral basin (ischemic and hemorrhagic strokes) contributed to fatal outcomes in 19 (14.18%) cases. The presence and course of diabetes mellitus also had a significant impact on the course and fatal mortality of COVID-19 - 24.63% (33 cases). Chronic respiratory diseases (COPD) influenced the course of COVID-19 and contributed to death in 6.72% (9) of cases, nephrological pathology (ChTIN) - in 2.98% (4) of cases, peptic ulcer disease of the duedenum - in 2.24% (3) of cases. More than half of the clean-up workers of the Chornobyl NPP accident who died due to COVID-19 had more than two severe chronic diseases of the comorbid component and their complications.

Conclusions: Сlean-up workers of the Chornobyl accident who died from COVID-19 had another severe comorbid chronic disease, or several diseases that influenced the course of coronavirus disease and each other and contributed to the development of fatal consequences. Death from COVID-19 is much more common in clean-up workers of the Chornobyl accident suffering from severe disabling non-oncological diseases of the cardiovascular system (arterial hypertension, coronary heart disease), cerebrovascular diseases with consequences of acute vascular events, as well as diabetes mellitus. Victims of the Chornobyl catastrophe, especially clean-up workers of the Chornobyl NPP accident, are at special risk for severe coronavirus disease and death from COVID-19.