Our dangerous burden/Craig Medred photo

Eighteen months into the worst pandemic of the 21st century, with a newly evolved (or created) pathogen now threatening a miracle prophylactic vaccine, one might think there would finally be some discussion about better preparing Americans to fend off contagious diseases.

And you would be wrong.

Forget for a moment all the hype about breakthrough cases, which are either “significantly higher” than expected or “rare” depending on what media you’re reading, and consider the nature of the people in hospital or dead.

Vaccinated or unvaccinated, the vast majority have one thing in common: co-morbidities.

Since SARS-CoV-2 arrive on the scene in late 2019 or early 2020, it has preyed on the unhealthy, primarily – to be blunt – those that might in another time have been called fat and out of shape.

It would be politically incorrect to use such terms now, so let’s not. Let’s use the term “inactive” as was used in a peer-reviewed study in the British Journal of Sports Medicine in June.

It reported the the “inactive” had a 2.26 times greater chance of hospitalization than the “active” and a 2.49 times higher chance of death. The standard for “active” in this study was not exactly a high bar: 150 minutes or more per week, or approximately 21 minutes and 26 seconds per day.

A lot of folks could chalk up 150 minutes per week simply by walking or cycling to work, but they don’t. And there is hardly a government entity in this country doing what is necessary to encourage them to do so despite the well-documented, health-protective value of exercise.

Across the pond

Give the Europeans some credit here. The Scandinavian countries, in particular, have long been building infrastructure to make it easier for people to use muscle power to get from Point A to Point B.

And the French are now busy creating bike lanes in Paris.

Meanwhile, in the United Kingdom, Conservative Prime Minister Boris Johnson is pushing a $2 billion pound ($2.77 billion) plan to “boost cycling and walking.”

“Tackling the causes of ill health, not just the symptoms, is vital to help reduce demand on the National Health Service, and taking up cycling has been proven to offer huge benefits for people’s physical and mental health,” according to 10 Downing Street.

In both France and England, there has been the predictable pushback from those who don’t want to give up the comfort of their motor vehicles with critics charging Johnson’s plan “totally ignores the needs of major segments of the population such as the elderly or infirm, or those who rely on vehicles to transport goods, tools or multiple passengers.”

A better answer, they argue, is to build more roads to reduce congestion and along with it air pollution, a scheme that largely mirrors the American approach for decades.

The result in this country has been a steady increase in the average miles driven per year, going from just over 1 trillion in 1971 to more than 3 trillion by 2019, according to the Federal Highway Administration.

The 200 percent increase in miles driven far surpasses the country’s 56 percent growth in population over the same period. The increase in traffic has left a goodly number of Americans fretting about the environmental consequences of motor vehicle exhaust pumping large volumes of carbon dioxide into the atmosphere.

Largely overlooked has been the very real damage the ease of travel, now compounded by the easing of doing almost everything online without ever leaving the comfort of your easy chair, is doing to us.

As  Dr.Jean-Pierre Després from the University of Laval in Quebec, Canada, wrote in Nature earlier this summer, “the worldwide progression in the prevalence of obesity is a marker of the ‘evolution’ of our lifestyles (the overall quality of our diet and our sedentary habits) that is not always compatible with human health, and many of our living environments have become more obesogenic.

“Indeed, the physical demands of many of our jobs have substantially decreased, which has not been accompanied by a compensatory increase in physical activity during our leisure time. As a consequence, it was highlighted several years ago that the worldwide prevalence of physically inactive individuals was greater than the prevalence of smokers, with a sedentary lifestyle potentially being a greater cause of mortality than smoking.”

Now, to again be blunt, the sedentary lifestyle has teamed up with the SARS-CoV-2 virus to make us pay a price for these changes, a too often deadly price.

Too many dead

As of today, the World Health Organization (WHO) reports 610,180 deaths in the U.S. due to COVID-19. It is unrealistic to think a national fitness program could have reduced that by a factor of 2.26, which is well more than half.

But if the number of deaths had been cut by even a third, the more than year-long death toll would be down to 407,000. That’s still a big number, but it is an 18-month total significantly below the more 659,000 Americans the Centers for Disease Control reported died from cardiovascular disease in this country in 2019, and the almost 600,000 dead from cancer that year.

Cardiovascular disease and some cancers have, like COVID-19, been linked to obesity and lack of exercise. The dose-related consequences of time spent sitting on our asses were well-established before COVID-19, which has only underlined the risk for the few people paying attention.

A 2015, peer-reviewed meta-analysis in the June issue of the Annals of Internal Medicine looked at 41 studies of the sedentary lifestyle up through that date and reported “significant hazard ratio associations were found with all-cause mortality, cardiovascular disease mortality, cardiovascular disease incidence, cancer mortality, cancer incidence and type 2 diabetes incidence. Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.”

None of those hazard ratios, however, came close to the more than two-fold differences documented for COVID-19, a new disease.

One must naturally ask why COVID-19 hit so hard on the unfit, and the most logical answer is in the immunity-boosting nature of fitness. Nature invariably favors the fittest animals, and though humans often forget, we are still a part of nature.

COVID-19’s probable intersection with inherent, natural immunity is tied to a data point hard to ignore: age. It is well known that natural immunity declines in general with age for everyone.

And death rates for COVID-19 reflect this decline. Here are the latest, age-based infection fatality rates (IFRs) for COVID-19 from researchers at Stanford University:

• 0.0027 percent, ages 0-19
• 0.014 percent, ages 20-29
• 0.082 percent, ages 30-39
• 0.27 percent, ages 50-59
• 0.59 percent, ages 60-69

Yes, as everyone has read too often by now in the mainstream media, anyone (not to mention their pets) can get COVID-19, but the risks of dying from the disease are low for young people and especially low for fit young people.

Professional cyclist Peter Sagan had COVID-19 and suffered no serious consequences. The same for Egan Bernal and Simon Yates and Fernando Gaviria and Micheal Matthews and Steven Kruisjwijk and more world tour cyclists.

These are among the fittest people in the world, competing in a business where the competition is such that you can’t go back to work if your physical performance is in the least bit compromised because of what has come to be called “long Covid.”

There are now indications long Covid (like severe COVID-19) is tied to obesity, a disease that tends, in turn, to be tied to lack of physical fitness. A peer-reviewed study published in June in Diabetes, Obesity and Metabolism found long covid 25 percent more common in the moderately obese and 39 percent higher in the severely obese.

Whether one can be fit and fat and avoid such risks is still open to debate, but it may not matter anyway. After University of Washington researcher Glenn Duncan looked at national health data in 2010 he concluded “that a small percentage of U.S. adults can be considered fit but fat, and that obesity is independently associated with reduced cardiovascular fitness. The likely explanation for the low proportion of U.S. adults who can be considered fit but fat is a low level of physical activity, which constributes to both a positive energy balance and low fitness.”

Nothing appears to have changed since then. Simply put, all people put on unnecessary weight because they eat too much and exercise too little. It’s a simple matter of calories consumed and calories burned.

Human differences

There are undeniable genetic differences that mean some people might have to reduce their caloric intake more than others or work harder to burn more calories in order to lose weight.

But as Harvard University’s T.H. Chan School of Public Health notes, “genes are not destiny….Many people who carry…so-called ‘obesity genes’ do not become overweight, and healthy lifestyles can counteract these genetic effects.”

Healthy lifestyles can also help push back age-related losses in immunity, theoretically shifting one up or down in those age-based zones delineating the risks of death.

“What is seldom considered when examining the immune response of an aged individual is that the immune system is profoundly influenced by physical activity,” scientists from the U.S. and the UK observed in a peer-reviewed study published in Nature just months before the pandemic began.

“Habitual physical activity levels decline with age, with significant consequences for muscle mass and function,” they wrote. “Skeletal muscle is a major immune regulatory organ and generates a range of proteins, termed myokines, which have anti-inflammatory and immunoprotective effects.

“Several studies indicate that maintaining physical activity has immune benefits in older adults, for example, it reduces the systemic inflammation associated with chronic age-related diseases. Here, we discuss how physical activity can prevent or ameliorate age-related multi-morbidity by boosting immune function, and we consider whether physical activity could improve immunotherapy outcomes in age-related conditions such as cancer.”

“Multi-morbidity….”

Most of the people who have died from COVID-19 suffered from multi-morbidity, and all indications are that the vaccinated people destined to die – because the vaccines are better than scientists could realistically have hoped for yet still short of perfect – will be people with multi-morbidities.

The late President John F. Kennedy saw this coming 60 years ago. In December 1960, the then-president-elect penned an essay for Sports Illustrated magazine titled “The Soft American.”

“…The knowledge that the physical well-being of the citizen is an important foundation for the vigor and vitality of all the activities of the nation is as old as Western civilization itself,” he wrote. “But it is a knowledge which today, in American, we are in danger of forgetting.”

JFK bemoaned the fact that “despite our unparalleled standard of living, despite our good food and our many playgrounds, despite our emphasis on school athletics, American youth lagged far behind Europeans in physical fitness. Six tests for muscular strength and flexibility were given; 57.9 percent of the American children failed one or more of these tests, while only 8.7 percent of the European youngsters failed.”

Were he still alive, he’d probably be shocked by the decline in fitness now.

Obese children were rare when JFK was president, and they numbered only one in every 20 by 1978, according to a 2019 study published in Economics and Human Biology.

Today the Centers for Disease Control (CDC) puts the number at near one in every five. Obese children generally become obese adults and suffer all the consequences that go along with disease, including suppressed immune systems.

Though there is a tendency in this country to make obesity about appearance, it isn’t about the way anyone looks. It is about fundamental health, and the costs to the nation – as JFK observed – of failing health.

“…Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity,” he wrote. “The relationship between the soundness of the body and the activities of the mind is subtle and complex. Much is not yet understood. But we do know what the Greeks knew: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong; that hardy spirits and tough minds usually inhabit sound bodies.

“In this sense, physical fitness is the basis of all the activities of our society. And if our bodies grow soft and inactive, if we fail to encourage physical development and prowess, we will undermine our capacity for thought, for work and for the use of those skills vital to an expanding and complex America.”

It might be a good idea to heed his advice today because vaccine or not, it is unlikely the SARS-CoV-2 virus is going away. The best of England’s scientists concluded in a report published near the end of July that the pathogen is here to stay.

The report also concluded that the development of new variants “that eventually leads to current vaccine failure…(is) almost certain.” 

New vaccines are sure to be developed to counteract those new variants, but in the interim, there seem a lot of people – whether vaccinated or not – could do to decrease their risks of dying if they do become infected.

The only problem is that it will take some effort.