Health in the Time of Coronavirus

David L. Katz, MD, MPH, FACPM, FACP, FACLM
LinkedIn
Believe it or not, now- with the acute threat of COVID19 constraining our activities and propagating our anxieties- there may have never been a better time to address and improve the chronic state of our health, both as a population, and as individuals. Timing, timelines, and the newfound time at our disposal- really are of the essence.
Sabertoothed tiger looking towards the left side of the camera and roaring ferociusly. Health in the Time of Coronavirus

Paleoanthropologists- experts in the early origins of human kind- might seem to have little to offer as we confront a modern viral pandemic, traversing oceans on cruise ships and jets. But they, uniquely, illuminate our perceptions of peril along timelines tethered to the ancient imperatives of survival. In that, there is a timely lesson of singular importance.

Perception of menace is related to survival, as, ultimately, everything is that eons of natural selection have baked into our physiology, metabolism, and DNA. All of us here today are descendants of distant ancestors who reacted well to the dangers that mattered most, survived to adulthood, and procreated successfully, passing along their winning genes to us. People who don’t survive to adulthood and procreation make decidedly poor ancestors.

So however modern our troubles, many of our traits and tendencies are still rooted in the Stone Age, or the long sweep of earlier human evolution stretching back before it. In a world of tooth and claw, fang and venom- threats to survival were generally measured in seconds and minutes and occasionally days; rarely weeks- and perhaps never anything longer. The savannas home to predator and prey were the incubator of the flight or fight response we have all felt calling when an alarm, or siren, or sudden fright has triggered that prickly, invigorating irritation emanating from our adrenal glands.

This may help explain the level of fixation, anxiety, anguish, and upheaval resulting from the acute threat of SARS-CoV-2, relative to, say, the threat of heart disease. As I write this, the global mortality toll of the coronavirus pandemic globally is roughly 120,000; and in the United States, it is just less than 24,000. I hasten to append that these numbers will be higher when you read this, and more important still- these numbers veil the loss and grief of people just like you and me, families mourning a painful vacancy. I regret that the anonymizing “statistics” we need to understand population patterns can so readily obscure the humanity that underlies them. I convey my heartfelt condolences.

That pertains, too, to the families mourning losses to other causes- such as heart disease. In the United States alone, heart disease – all but entirely preventable, and known to be so for more than a quarter century – claims some 650,000 lives a year, every year. Those deaths are concentrated in much the same population most at risk of coronavirus mortality- and greatly exceed by multiples the worst-case projections for the pandemic. Why is the lesser threat so viscerally alarming, the other so prone to seeming contempt? Familiarity may be a factor, but time, it seems, is of the essence. Heart disease stalks us at a crawl; coronavirus, at an alarming sprint.

There is almost certainly more to the divide in our perceptions of, and responses to, risks than their native cadence. There is also the means of their transmission. We are prone to discount risks we feel we could control, even if we seldom actually do so- while magnifying risks that engender a feeling of helpless vulnerability. Heart disease and diabetes seemingly fall into the former category; coronavirus, decisively in the latter.

But this, too, is a distorted perception. Studies suggest that the so-called “non communicable” chronic diseases are communicable after all, propagating through social networks. Obesity, heart disease, and diabetes are, in a sense, contagious. The singular mortality toll of diet in America is transmissible as well, via marketing, culture, and willful manipulations of the food supply rather than via droplets through the air. We are vulnerable either way, and if time trends in obesity and diabetes are any indication- all but helplessly so. That the propagation of disease and death by diet is profit-motivated, rather than inadvertent as in the case of coronavirus, would seem to call for more, rather than less, commitment to robust interdiction. Our actions, or rather lack thereof, tell a different story.

These considerations bring us to a timely lesson configured into the peril of this pandemic; we may come to view it as crisis or silver lining, irony or opportunity. Maybe it is best filed under all of these. The acute threat of coronavirus that triggers our fear, and activates the ancient flight or fight response- preys particularly upon the chronic health threats exacting their even greater, neglected toll upon us all along. In the acuity of its menace evoking our anxiety, SARS-CoV-2 exploits, and evinces, a chronic menace long evoking only apathy.

Along with age, and apparently sex (men are at greater risk), the presence or absence of major chronic disease- notably hypertension, heart disease, and diabetes– exerts a major influence on the acute risks of a bad outcome if infected with SARS-CoV-2.

Goaded by the present, clear, acute danger that operates within our ancient perceptions of menace- perhaps we will finally have cause to address the dire toll of the relentless, inexorable scourges that stalked us perennially in slower motion.

There is much the body politic might do over time to safeguard us against the threat of a next pandemic. But there is something each of us can do right now, one body at a time, to help protect ourselves acutely, and in the long term as well. We can use this very strange interlude to pursue our own health- with diet, exercise, sleep, and every way we can manage. Fully 80% of all major chronic disease and premature death is preventable by using lifestyle as medicine. Enhancements to metabolic health and immune system responses from diet and exercise accrue over time, but are discernible in days, and even hours. Where acute and chronic threats converge, perhaps you can find new motivation to pursue your best health. This really is the perfect time.

-fin

This article was first published on LinkedIn.

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