Messaging matters, and a year into the SARS-CoV-2 pandemic the only reasonable conclusion that can be drawn about the health messaging in this country is that it sucked.
The U.S. per capita death rate is now 28 percent higher than that of Sweden – a country criticized by many, including former President Donald Trump, for taking a too laisse fair approach to the virus that causes the sometimes deadly disease COVID-19.
If ever there was a year when Americans should have been encouraged to get off the couch, get outdoors and get moving, the last 12 months was it. The general physiological benefits of exercise have long been documented. And the evidence for mental health benefits has been accumulating for years.
Aware of all of this, research doctors at the University of Bath warned in March 2020 that “keeping up regular, daily exercise at a time when much of the world is going into isolation will play an important role in helping to maintain a healthy immune system.”
The waistline, stupid
The messaging should have been easy. Think political consultant James Carville’s advice to presidential candidate Bill Clinton, and you’ll get the picture. Carville coined the phrase “it’s the economy stupid” to keep the Clinton campaign focused on the recession of 1992.
“Carville told campaign staffers to hammer on the importance of the economy at every chance they got – he even went so far as to hang a sign in campaign headquarters reading, in part, ‘the economy, stupid,”’ the Political Dictionary records.
“The phrase became a mantra for the Clinton campaign,” and Clinton won the election.
Unfortunately there was no Carville to bring clarity to one of the most practical ways to reduce COVID-19 deaths, and so most U.S. states – instead of encouraging Americans to get out and exercise in the fresh air, ordered “lock downs” and encouraged “work-at-home,” which a lot of people took to mean they should stay in the house, order out food, and never do anything that required them to change out of their pajamas.
What little exercise they were getting – the walk from the house to the car, the walk from the car to the office, maybe even a walk down the street to lunch during the day – promptly went away.
As a result, and clearly due to eating more as well given the size of the weight increases being reported by the Psychiatric Association, death rates have gone up, up, up.
“A majority of adults (61 percent) reported experiencing undesired weight changes since the start of the pandemic with more than two in five (42 percent) saying they gained more weight than they intended. Of this group, adults reported gaining an average of 29 pounds (with a typical gain of 15 pounds, which is the median),” the Psychiatric Association said.
There is little about the connection here to COVID-19 deaths. Obesity has been well and directly linked to impaired immune functions and, according to the CDC, “may triple the risk of hospitalization due to a COVID-19 infection.”
“Studies in the United States have shown that having a BMI (body mass index) over 30 – the threshold that defines obesity—increases the risk of being admitted to hospital with COVID-19 by 113 percent, of being admitted to intensive care by 74 percent, and of dying by 48 percent,” The BMJ, the respected British medical journal, reported at the start of the month.
“The US, where obesity rates are also notably high, has the highest number of COVID-19 infections and deaths in the world, and the United Kingdom, where obesity rates are the highest in Europe, has a disproportionate death rate for covid-19 compared with other countries.
“This should be a wake-up call to tackle the obesity burden.”
It wasn’t and still isn’t, even though the CDC officially lists obesity and “severe obesity” among a dozen pre-existing conditions that put people at increased risk of severe COVID-19. Several of the other so-called comorbidities on the list – most notably heart disease, diabetes and some cancers – have been linked to what has been called the “sedentary lifestyle.”
The data would indicate that a national program to get people up and moving in clean, outdoor air could have saved many lives. That didn’t happen, and the post lockdown message became largely focused on “wear a mask” and go on about life as normal.
University of Vermont researchers concluded that message might well have done more harm than good.
“That had relevance for two other findings. Those who wore masks had more of these daily
contacts compared with those who didn’t, and a higher proportion contracted the virus as a result.”
“When you wear a mask, you may have a deceptive sense of being protected and have more interactions with other people,” Eline van den Brock-Altenburg, the vice-chair for Population Health Science at the Larner College of Medicine and the study’s principal
investigator told the website.
If Brock-Altenburg and her colleagues are right, the poor messaging that led many to believe masks make everything safe baited some people to their deaths, and the issue with masks might be bigger than the Vermont researchers found.
Face-coverings distracted from serious discussions of the need for ventilation even after the CDC in early September reported people who dined indoors at restaurants nearly tripled their risks of catching COVID-19 and those who went to a bar or coffee shop nearly quadrupled the risk.
“As communities reopen, efforts to reduce possible exposures at locations that offer on-site eating and drinking options should be considered to protect customers, employees, and communities,” the study said.
It recognized infections “have been linked to air circulation; conceded that “direction, ventilation, and intensity of airflow might affect virus transmission even if social distancing measures and mask use are implemented according to current guidance;” and yet offered no guidance on ventilation.
Authorities in the United Kingdom recognized the ventilation risks and in November changed their messaging to begin a “Hands, Face, Space” campaign.
It featured a video showing a simulation of the virus circulating in rooms like smoke in the smoke-filled bars of old in the U.S. The secondhand smoke problem in bars and restaurants was solved by kicking smokers to the curb.
Little has been done in the U.S. to address the issue of secondhand COVID. The state of Alaska’s website mentions ventilation only in passing in its safety recommendations. The number one recommendation is to wear “a cloth face covering/mask when in public settings” or when around strangers.
The UK offers much more explicit advice on what to do if strangers enter your home:
“Airing indoor spaces is particularly important when:
- people have visitors (when permitted) or tradespeople in their home, for example for construction or emergencies
- someone from a support bubble is meeting with another household indoors
- a care worker is seeing a patient indoors
- someone in the household has the virus, as this can help prevent transmission to other household members.”
The reasoning behind fresh air is simple as the British note; it “is to remove any infected particles lingering in the room.”
Meanwhile, the simple message that the best way to avoid catching COVID-19 is to avoid other people succumbed to a belief in masks even as COVID-19 infection rates were rising across the country.
It’s the message, stupid.