Chronic diseases make Covid-19 even more dangerous in Bermuda, a doctor said yesterday.Annabel Fountain, an endocrinologist at Fountain Health, explained that non-communicable diseases were dangerous on their own, but made sufferers more vulnerable to acute diseases such as Covid-19.Dr Fountain said: “Chronic disease is the greatest health crisis to have faced Bermuda. There are many people with diabetes, hypertension and heart disease, which makes us vulnerable as a population. “If we were all slim and healthy, without these chronic diseases, then our immune systems would be in a much stronger position to manage this.”Dr Fountain added that people with chronic diseases were not more likely to contract Covid-19, but they were more at risk of death from the disease, if their existing conditions were not controlled.She said high rates of diabetes and other non-communicable diseases and the gap between rich and poor had contributed to the island’s medical problems.Dr Fountain explained that poorer people were less able to afford healthy food and medical treatment focused in disease prevention, so even if conditions were diagnosed, they might not be able to manage them properly.She said: “Bermuda is an expensive place, and we have a lot of people who have to work several jobs.“In many cases, they are underinsured and, when you’re working three jobs, you’re probably not getting time to exercise or cook healthy meals for you and your family.”Dr Fountain added that people with chronic conditions should contact their doctors for assistance. She said that she and other doctors had started to practise “telemedicine” and many had reduced co-pay charges.Dr Fountain added: “We are all trying to work together. Anyone who is worried about their blood pressure or their diabetes should be proactive about their health. Anyone who has a chronic disease should be making sure that they are under control.”A total of 48 people had contracted Covid-19, and four had died by Thursday,Kim Wilson, the health minister, said the high mortality rate in Bermuda was linked to poor health in Bermuda.Ms Wilson added: “Unfortunately, we do have a population that is unhealthy and there is quite a number of non-communicable chronic diseases within our population.“That makes those persons even more susceptible to the respiratory challenges that come with people who test positive for Covid-19.”The latest fatality, a middle-aged man, was one of nine new Covid-19 cases confirmed on Thursday.The World Health Organisation has estimated Covid-19 is fatal in about 3.4 per cent of reported cases, but health experts highlighted it was difficult to compare countries because of different recording methods and test levels.David Burt, the Premier, spotlighted the island’s high percentage of elderly people on Wednesday as he warned that more than 700 Bermudians could die from the virus if people did not follow shelter-in-place rules enforced by the Government.Mr Burt later warned that some Covid-19 carriers did not have symptoms.He said: “With four deaths, if you look at the global rate, that would imply that there are a larger number of cases that we have not captured or caught yet.“That’s why it’s important as we implement more aggressive testing and that people stay in place.“I cannot express it enough. If you decide to go to the grocery store for a social outing, recognise you may be putting your family at risk. It’s that simple.”He also questioned some of the applications for exceptions to the shelter-in-place regulations — including some for pool cleaners.Mr Burt said: “This suggests to me that some people don’t understand that cleaning a pool is not more important than saving a life.”He added that Bermuda was working alongside other jurisdictions, such as the Cayman Islands, to make sure they all had adequate supplies of equipment.The Cayman Compass newspaper reported that the country was prepared to sell 35,000 of its own Covid-19 test kits to Bermuda.Mr Burt said: “As we are all looking to procure certain items, there isn’t a need for us all to keep working to procure the same items.”He added that one of the problems discussed with Alden McLaughlin, the Cayman premier, was a worldwide shortage of swabs for the tests.Mr Burt said: “We are perfectly capable and confident we will have an aggressive testing regime here in Bermuda.“A lot of people want to focus on volume — he said he bought all of those sets when he knew he didn’t need them because that was the minimum order they could provide and we were happy to share in that particular load.”Mr Burt also confirmed that returned Bermudians who had been on board the Coral Princess cruise were in quarantine.He explained that the group could not to travel with other residents on Tuesday’s repatriation flight from Florida because the US Centres for Disease Control insisted that people who had come off cruise ships could not share flights with other passengers.The Premier also announced that Government would launch a mental health hotline for people suffering from stress caused by the crisis.The hotline — 543-1111 — will launch today and operate from 9am to 9pm, seven days a week.Mr Burt paid tribute to the people on the front line of the war against Covid-19.He said: “I would like to make sure that we all remember our essential workers who are doing everything they can to ensure that this country is able to operate, and we all remain safe.Mr Burt added: “Over the next few days, please take some time to send a message, a nice voicenote, or maybe even make a quick phone call or video call to a healthcare professional, because they are the true heroes that are working day and night to keep us safe.”Mr Burt added his next public statement on Covid-19 would be delivered on Monday, but the Ministry of Health would deliver an update tomorrow.•To read the Premier’s statement in full, click on the PDF link under “Related Media”