Sick nation

As a child of post-war America, I grew up witness to the growth of a nation of largesse writ large. Nature is now making us pay the price.

Nowhere has the SARS-CoV-2 virus hit harder than in the comfortable Western world, and it is hard to avoid the reality that this is in part because of health issues related to the comfortable, sedentary lives we’ve learned to enjoy.

Consider what John Hopkins University Dr. Martin Makary told MedPage Today about the comparatively few fit people he and his colleagues found dead of COVID-19, the disease caused by SARS-CoV-2, when they combed the rolls of millions of U.S. Medicare beneficiaries in an effort to assess the disease’s danger to the elderly.

“In our study, we identified 2,500 patients in the non-Medicare Advantage population who have been without comorbidities, using the chronic condition warehouse definition of comorbidities, and died of COVID. Two-thousand-five-hundred Medicare beneficiaries out of the entire Medicare population. I think that can help us inform some of our messaging because we knew that mortality was skewed towards those with advanced age and comorbidities, but we didn’t realize it was skewed this much.”

Of the more than 38,000 Medicare recipients who died, the study found about 95 percent had significant medical problems before they came down with COVID-19.

Big pool

There are today, according to the Kaiser Family Foundation (KFF), 59.9 million Americans on Medicare, the insurance program created in 1965 to provide health insurance to older and disabled citizens.

Just under 20 million of them are in the Medicare Advantage program, according to KFF, a non-governmental organization that monitors and advocates for better health and better health-care in the U.S.

About 40 million people are on what KFF calls “original Medicare,” or what Makary referred to as the non-Medicaid Advantage group. It provided Makary and colleagues at John Hopkins University a big pool for study.

What they found in the pool were 534,023 original Medicare enrollees over the age of 65 – or about 17 percent of beneficiaries – diagnosed with COVID-19 between April 1 and August 31.

Of these more than 534,000 people, the study reported 148,151 (27.7 percent )…were hospitalized and 38,066 (7.1 percent) died in a hospital.”

Of the dead, only 5 percent were people who would have been considered fully healthy before contracting COVID-19. The rest suffered from – alone or in combination – sickle cell disease, chronic kidney disease, leukemias and lymphomas, heart disease, diabetes, cerebral palsy, obesity, lung cancer and a handful of other diseases.

Some of these diseases, sadly, just happen, but others are tied directly to lifestyle. Some interact to create new co-morbidities.

For instance, diabetes, high-blood pressure, cardiovascular disease, smoking and obesity are among the causes linked to chronic kidney disease. 

Diabetes itself – along with cardiovascular disease, obesity and some cancers – are among what are now considered “lifestyle diseases.” Lung cancer is one of the cancers on the list because of its link to smoking.

Diabetes, which some health authorities were calling an epidemic in the years leading up to the SARS-CoV-2 pandemic, has been driven in the U.S. by the so-called “sedentary lifestyle.”

“More than half of all Americans may develop diabetes or prediabetes by 2020, unless prevention strategies aimed at weight loss and increased physical activity are widely implemented,” WebMD warned a decade ago.

Similar warnings have been issued about obesity itself. And dozens of studies have now identified it as a major risk factor for death from COVID-19. The Harvard School of Public Health labeled obesity another epidemic in the years before the pandemic hit.

“In 1990, obese adults made up less than 15 percent of the population in most U.S. states,” it warned. “By 2010, 36 states had obesity rates of 25 percent or higher, and 12 of those had obesity rates of 30 percent or higher.

“Today, nationwide, roughly two out of three U.S. adults are overweight or obese (69 percent) and one out of three is obese (36 percent).”

Harvard emphasized the direct link between obesity, heart disease and type-2 diabetes, or what was formerly called adult-onset diabetes.

Denial

The U.S. response was to worry more about the “Shame of Fat Shaming,” as the New York Times put it than the health problems associated with obesity.

“Donald Trump brought the issue of fat shaming to the fore during and after last week’s (Presidential) debate when he disparaged a former Miss Universe winner who gained weight and when he said the hacking of the Democratic National Committee’s emails might have been done by ‘somebody sitting on their bed that weighs 400 pounds,'” the Times reported in 2016.

Ironically, president-elect Joe Biden – the man who defeated Trump in this year’s election – has been similarly criticized for fat-shaming.

“Joe Biden’s fat-shaming is nothing to laugh off,” the New York Daily News headlined last year. Biden’s crime was to suggest a critic was oversize because he spent too much time sitting down watching TV. 

This is not to suggest anyone should be publicly berated for their appearance, be it due to weight or anything else. The author is among the many Americans judged “overweight” and now under doctor’s orders to lose 15 or 20 pounds.

When this is mentioned to friends, however, the common reaction is “you’re not fat,” which can only be attributed to the fact we are today a society where obesity has become such a norm that people have to look seriously fat before they are considered overweight.

And now it is among the factors helping to kill us.

A meta-analysis of 75 studies examining the link between obesity and COVID‐19 found the obese had a 46 percent greater chance of developing the disease, a 113 percent higher chance of being hospitalized, a 74 percent greater chance of ending up in an intensive-care unit, and a 48 percent greater chance of dying. The study was published at the end of August in the peer-reviewed “Obesity Reviews.”

No one has calculated how many lives would have been saved if the country’s obesity epidemic had been dealt with before the SARS-CoV-2 virus materialized, but the number is sure to be significant given that 245,600 Americans are dead of COVID-19 as of this writing, according to the University of Oxford’s Our World in Data counter. 

Considering that the SARS-CoV-2 virus doesn’t look to be disappearing anytime soon, there are steps you can take now to minimize your risk. You can eat better and less to get your weight down. You can start a socially distanced fitness program to increase your physiological health.

The options, of course, are better if you are young and thus already somewhat protected from the disease, old people, in general, being much more susceptible than young people. But it doesn’t hurt for younger Americans to start living healthier now to be prepared for the next pandemic.

And if you’re 65 or older, particularly if you’re old and suffering so-called comorbidities, you can go to the “COVID-19 Mortality Prediction” at predictcovidrisk.com developed by Makary and colleagues at John Hopkins to get a handle on just how much danger you are in. 

It will gauge the risk you face because of your age and health issues. The higher the number, the more important it becomes that you stay away from others as much as possible.

No one knows exactly how much protection masks provide. It may be considerable; it may be little. What is known is that people who put themselves in environments where they are likely to be exposed to SARS-CoV-2 come down with COVID-19 whether everyone is masked or not.

Bars and restaurants are particular hotspots, according to the U.S. Centers for Disease Control (CDC), but they are not the only danger zones.

A study of grocery store workers in Massachusetts, where masking is mandatory, found 20 percent of them had been infected with SARS-CoV-2 in a community where the general prevalence of infection was 0.9 to 1.3 percent.

The study was published in the BMJ Journals Occupational and Environmental Medicine. It noted that 90 percent of the grocery workers with COVID-19 “had a position with significant direct exposure to customers” and warned that given the evidence showing “probable transmission from asymptomatic or mildly symptomatic carriers, these workers as a cluster carry significant risk to their customers, colleagues and families. Our findings further strengthen the retail cluster transmission observed in a previous study from China, which involved supermarket employees.”

If you are in a high-risk category, you might give that some thought and consider having groceries delivered to your house or into the bed of your pickup truck outside the store while you stay in the enclosed cab.