Pandemic Perspective #11     May 30, 2020

COVID-19 Lemonade

“When life hands you a lemon…” We all know that old saw but in spite of all the jokes and cartoons that fill our email box every day (I’m not complaining, just sayin’) it seems hard to come up with something really positive as deaths increase. Life’s lemonade may not always be so sweet but it does present us with some valuable lessons. Some relate to health, some relate to work and some relate to being ready for the next pandemic. And you can be sure that there will be more pandemics that afflict the human race unless we extinguish ourselves first.

Perhaps the greatest lesson is the most tragic. The vast majority of deaths from SARS-CoV-2 have occurred among the elderly – or so it seems. Yet stories of centenarians from around the globe who have survived the infection are popping up on a regular basis. The risk is not old age; according to the CDC nearly 90 percent of patients, including those in middle age or even younger, have one or more lifestyle-related medical conditions. A report in early April, 2020 listed hypertension in more than 70 percent of those over the age of 65. Half had cardiovascular disease; nearly as many were obese or had chronic lung disease. The great majority were overweight. Among those between the ages of 50 and 64 years those conditions were nearly as common.

With very few exceptions, such as asthma and some genetic conditions, these “comorbidities” are the result of lifestyle, not the aging process. Since the middle of the last century physicians and other health authorities have been pounding their heads in frustration, warning us that the modern American diet, high in salt and refined grains, and the lack of physical activity, are literally killing us. It is just possible that COVID-19 is the proverbial smack alongside the head that will make us more aware of what we can do to avoid the non-infectious chronic diseases that have become actual epidemics and that kill more than a million of us every year.

Obesity is a driving factor in mortality in general and infections in particular. Obesity has two immune-related effects. It lowers the ability of the immune system to protect against several infectious diseases. This has been observed in influenza as well as the current COVID-19 pandemic.

The second malfunction of the immune system is cytokine storm, in which the immune system overreacts and attacks several organ systems. Fat tissue harbors cytokines, chemicals that produce inflammation. The excess body fat in overweight and obese individuals is the source of cytokines that are associated with this uncontrolled and usually fatal immune response.

The lemonade? It’s my hope that 2020 will be a turning point, the year in which the lessons of the new coronavirus pandemic will lead to a realization that we can reverse the twin epidemics of obesity and type 2 diabetes and their lifestyle-destroying complications.

In coming Saturdays’ Pandemic Perspectives I’ll address more of the positive – and less morbid — fallout of COVID-19.