While Americans continue to feud over face coverings, a huge new meta-analysis is out pointing to what really drives the burden of Covid-19 in the Western world: obesity and so-called comorbidities.
The former, according to the study published in the peer-reviewed BMC journal Systematic Reviews, fuels the overcrowding of hospitals while the latter is responsible for the vast majority of death attributed to the disease caused by the SARS-CoV-2 virus first discovered in China in late 2019.
Survival rates for those suffering with obesity were, thankfully, not that much worse than for those of normal weight, according to the study, unless the obese were also suffering from some of the West’s most common chronic illnesses, or what are now more often referred to as comorbidities.
“The highest observed risk ratios of death were found for cerebrovascular disease, cardiovascular disease, chronic renal disease, and hypertension,” the study reported.
The study itself was massive with a team of researchers led by Nathalie Verónica Fernández Villalobos from the Helmholtz Centre for Infection Research in Germany combing through nearly 7,500 Covid-19 studies to find 190 that warranted a full review for the meta-analysis in order to find 75 that finally passed a risk bias assessment.
The researchers did, however, warn that despite this effort the data they used was often based on hospital records, implying some “bias in a sense that more severely symptomatic patients are more likely included. Although our assessment revealed high to moderate study quality, studies based on hospital records are highly selective regarding the population included.”
The big killers
Hypertension, which most people know as high-blood pressure, was found to raise the risk of death from Covid-19 by 2.6 times. Chronic renal disease, better known in this country as chronic kidney disease, boosted the danger by a factor of two and a half.
Cerebrovascular diseases – primarily strokes, transient ischemic attacks and aneurysms, the fifth leading cause of death in the U.S. before the pandemic, according to Medical News Today – were linked to a 2.7-times greater risk of death from Covid-19.
And cardiovascular disease (CVD) – which rose to the rank of the country’s number one killer in 1930 and has stayed there ever since – proved the most dangerous comorbidity of all. It increased the risk of death from Covid-19 by 3.2 times, according to the new meta-analysis.
As cardiologists Marc Gillinov and Steven Nissen observed in a 2012 guide to heart health later excerpted in The Atlantic magazine, the early 20th Century marked the rise of heart disease to pandemic proportions as pneumonia, the leading cause of death in the 19th Century, was subdued.
Not long after the 1928 discovery of penicillin, which provided doctors a powerful new drug with which to treat pneumonia, Gillinov and Nissen observed that “the heart gave out.
“By 1930, average life expectancy in America had risen to about 60, and heart disease had become the number one cause of death. These statistics reflect an important feature of coronary heart disease (CHD): the incidence of the disease increases strikingly with age. Longer life means more time for arterial plaques to develop and cause problems. The risk of an 85-year-old man having a heart attack is 25 times that of a 45-year-old.
“Longer life does not by itself cause CHD, but the combination of longer life and damaging lifestyles increases the risk of developing coronary heart disease. Contemporary lifestyles have created a minefield of risk factors for CHD. Liberated from the grip of infectious diseases, too many of us fill our extra years of life with smoking, eating, and many excuses not to exercise.”
Easy road to early death
A decade on from their publication of “Heart 411: The Only Guide to Heart Health You’ll Ever Need” and with a new infectious disease having killed an estimated 6.24 million people around the globe, the Gillinov-Nissen warning about the dangers of what has come to be called “the sedentary lifestyle” now sounds prophetic.
Unfortunately, the dangers of said lifestyle have also crept backward through the population with not only older Americans filling their “extra years of life with smoking, eating, and many excuses not to exercise,” but with a lot of younger Americans early on filling their lives with “eating and many excuses not to exercise.”
As to the relationship between declining fitness and increasing comorbidities, the authors of the meta-analysis warned that the “effects of comorbidities on (Covid-19) disease severity increased for several comorbidities with young age….”
The dangers of these comorbidities and their role in the deaths of the 25 percent of Americans under age 65 dead from Covid-19 have been obvious since almost the beginning of the pandemic.
Despite all the media fear-mongering as to how SARS-CoV-2 can kill anyone (which, of course, it can), the new study makes clear the fact the burden of the disease falls most heavily on what the authors of the study classified as “vulnerable populations.”
Some of these are in decline in the U.S., and some aren’t.
Smoking, thanks to government campaigns warning of its dangers and taxes that now make smoking one of the country’s most costly habits, has dramatically declined among all Americans, but eating and lack of exercise have trended in the opposite direction.
The international Organisation for Economic Co-operation and Development (OECD) now ranks the U.S. as the world’s fattest major country. There are fatter nations on the planet, but none with a population topping 5 million people. Ten of the top-11 are predominately small island nations home to fewer than 205,000 people each.
National fitness is harder to track than obesity, but the trend in the U.S. does not look good. A 2016 study of the aerobic fitness of children and youth in 50 countries published in the peer-reviewed British Journal of Sports Medicine found kids in the U.S. ranked 47th.
“Kids who are aerobically fit tend to be healthy; and healthy kids are apt to be healthy adults,” Justin Lang, the study’s lead author told Medical Express at the time. “So studying aerobic fitness in the early years is very insightful to overall population health.”
Overall population health in the U.S. was notably in decline even before the pandemic with average life expectancy in the country peaking in 2014.
“Even before the coronavirus disease 2019 (Covid-19) pandemic occurred, the U.S. was mired in a 40-year population health crisis,” a group of the nation’s top health experts warned in an editorial in JAMA, the journal of the American Medical, in February of last year. “Since 1980, life expectancy in the US has increasingly fallen behind that of peer countries, culminating in an unprecedented decline in longevity since 2014.”
By the time that editorial ran, the pandemic had taken a big bite out of life expectancy in the country, and it would take another big bite in 2021 thanks in large part to the fundamentally poor health of many people living in a nation where the focus on “health care” isn’t really about health at all, but about universal insurance to provide medical treatment for an increasingly unhealthy population.
Vax is us
The pandemic has been a case in point. Instead of focusing on getting Americans healthy, something that is protective in a lot of ways beyond SARS-CoV-2, the national emphasis has been on first getting everyone masked and then getting everyone vaccinated, including those at little threat of death from the new virus.
The authors of the meta-analysis subtly question whether such population-wide measures to deal with Covid-19 are the wisest strategy given that most of the danger posed by the SARS-CoV-2 virus focuses on identifiable groups.
In the discussion section at the end of the anaylsis they note they are providing evidence “for the effects of comorbidities on the severity of COVID-19 and effect modification of these effects by age in order to target public health measures towards groups at risk. The detailed analyses on effect modification revealed that effects of comorbidities on disease severity increase for several comorbidities with young age, which has important implications for the planning of vaccine strategies as well as non-pharmacological interventions targeting risk groups.”
Targeted responses to the pandemic were suggested at the start only to be quickly shut down. Those who noted the economic and psychological costs of lockdowns and mandatory masking in the U.S. found themselves vilified by government officials.
Emails released after a Freedom of Information Act request have shown Francis Collins, the director of the National Institute of Health in 2020; Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease in 2020, and others conspiring to torpedo the Great Barrington Declaration, which argued for Covid-19 policies focused on protecting the elderly and vulnerable while otherwise returning to life as normal.
As Vinay Prasad, an associate professor of epidemiology and biostatistics at the University of California San Francisco observed late last year in a commentary for STAT, a website dedicated to reporting on health and medicine, “Americans would have benefited from a broad debate among scientists about the available policy options for controlling the Covid-19 pandemic, and perhaps a bit of compromise. The emails tell us why that isn’t what we got.”
Prasad’s commentary went on to touch on how the politicization of science during the pandemic now threatens to do to science what the politicization of everything did to journalism.
Trust dies when rules are put on what is acceptable and unacceptable for discussion.
“What concerns me about the NIH director’s email and his interview on television is that he appeared unwilling to have this dialogue,” Prasad wrote. “Collins’s day job does not make him the arbiter of scientific truth, the Pope for all scientists. On questions of unprecedented pandemic policy, he is surely entitled to his opinion – as we all are – but his is just one opinion of many.
“When it comes to lockdowns or school closures, the answer to the question of whether the benefits exceed the harms and, if so, under what conditions, is far from certain, and scientists will continue to study this for decades. As a good scientist, Collins should have recognized the massive uncertainty around these policies….
“Jeffrey Flier, the former dean of Harvard Medical School, and I called for dialogue and debate among scientists without demonization in April 2020. I’m disappointed to see a few months later that the NIH director, a man uniquely positioned to foster such a debate, had actively sought to thwart and discredit scientists with alternative ideas to the pandemic response. His ad-hominem comment that the authors were ‘fringe’ was unnecessary and unhelpful. In the weeks that followed, more and more mud would be slung against the authors of the Great Barrington Declaration, as well as against scientists who held alternative policy views, and favored more and stronger restrictions. The vitriol ensured that the country would not have the dialogue it so desperately needed.”
The increasing evidence, of which the new meta-analysis is only a part, would point to the possibility that Prasad was making a very good and important point.