Muscle mass alone isn't enough. Obese people have far less aerobic headroom (lower VO2_max per kg), so viral pneumonia that decreases their lung efficiency even

Muscle mass alone isn't enough. Obese people have far less aerobic headroom (lower VO2_max per kg), so viral pneumonia that decreases their lung efficiency even further is harder to survive. There are many factors: "Fat in the abdomen pushes up on the diaphragm, causing that large muscle, which lies below the chest cavity, to impinge on the lungs and restrict airflow." "the blood of people with obesity has an increased tendency to clot—an especially grave risk during an infection that, when severe, independently peppers the small vessels of the lungs with clots" "Immunity also weakens in people with obesity, in part because fat cells infiltrate the organs where immune cells are produced and stored" "people with obesity also suffer from chronic, low-grade inflammation... Those effects may compound the runaway cytokine activity that characterizes severe COVID-19" https://www.sciencemag.org/news/2020/09/why-covid-19-more-deadly-people-obesity-even-if-theyre-young https://www.sciencemag.org/news/2020/09/why-covid-19-more-de...