The intersection of COVID-19 and chronic disease

In 1900, the top causes of death in the United States were acute infectious diseases, including pneumonia and influenza, tuberculosis and gastrointestinal infections. Pre-COVID-19, the leading causes of death were heart disease and cancer, both chronic diseases. Based on currently available data, older adults and people of any age who have serious underlying chronic medical conditions might be at higher risk for severe illness from COVID-19. At present, our priority is finding treatments and a vaccine. Laying the foundation for a healthier population through the prevention of chronic diseases is the next best weapon against COVID-19 and future emerging infectious diseases.

Obesity is perhaps the prototypical “chronic disease” as it contributes to multiple other chronic health conditions including coronary artery disease, type 2 diabetes, cancer, stroke, osteoarthritis, liver disease, sleep apnea, and depression. This discussion is about unhealthy bodies, not body habitus per se. Data suggests that metabolically healthy obesity exists, especially when combined with a high level of fitness.

According to a recent Medscape report, obesity is also one of the biggest risk factors for severe COVID-19 disease, especially among younger patients, increasing the risk for hospitalization and need for intensive care and mechanical ventilation. Adipose tissue or “fat” is a metabolically dynamic organ and, in obesity, produces a chronic pro-inflammatory state by secreting inflammatory cytokines. COVID-19 is cited as a pro-inflammatory process. “Cytokine storm” is one phenomenon that is likely fueling severe COVID-19.

The economic benefits of a healthier lifestyle cannot be ignored. The cost of the coronavirus pandemic could cost the US $ 7 trillion according to estimates. Add to that the cost of caring for those with chronic diseases, estimated at $3.7 trillion, nearly 20 % of the US GNP. Perhaps, we could invest a small fraction of that in health promotion and preparation for the next emerging infectious disease.

Proactive strategies to protect us from the major U.S. food manufacturers of processed foods and media influence is sorely needed, challenging given the unshakeable dominance of lobbying and special interest groups. Schools, while promoting nutrition and exercise more than in the past, are still far from role models. One has to only look at lunch menus, lack of real gym requirements and vending machines in schools.

While there is cause for frustration, we are not powerless. Change must begin with the individual, families and local communities along with health care providers.

The fundamentals of a healthy lifestyle are basic: sleep health, eating more plant-based, movement, stress reduction, avoidance of tobacco and excessive alcohol, along with human connection and a spiritual life. Package these in a pill and we would prevent the large majority of chronic diseases. Lifestyle changes are not easy, and for those with socioeconomic challenges, even more difficult.

But we can help each other, inspire and empower each other to take one step closer to a healthier lifestyle. The CDC and Academy of Nutrition and Dietetics offer educational platforms. Arizona Center for Integrative Medicine offers lifestyle recommendations specific to COVID.

We can find inspiration from the enormous changes that we have witnessed in the weeks since COVID stay-at-home orders began. More than ever, people are cooking at home and showing more interest in learning to cook. With limited places to go and unscheduled time, people are getting outside, walking, hiking and biking, and connecting with nature. We are capable. Small lifestyle changes that are easier to achieve and maintain can lead to results of epidemic proportions.