The grim reaper/Wikimedia commons

With almost everyone except the Chinese now in agreement the SARS-CoV-2 virus is here to stay (who woulda thunk it), and the medical community debating what to do about news vaccines and boosters as the virus mutates to avoid them, maybe it’s time for a look back at the big fact about the SARS-Co-2-driven pandemic of the disease Covid-19 that seems to have been ignored.

And is still being ignored.

This hasn’t been a general pandemic like the Spanish flu of 1918-19 that devasted “usually healthy young adults in the 20 to 40 age group” as the journal Medical History records. 

This has been a pandemic of the unfit and unhealthy, and the unusually high death rate in the U.S. goes to the heart of what is wrong with the American health care system.

It is not about health. It is about selling services, primarily drugs, surgeries and insurance.

Yes, the pandemic killed a few fit and healthy people for whatever reason. At the individual level, luck or destiny, take your pick, plays a role in whether we live or die and when.

At the population level, however, the data is clear that the SARS-CoV-2 virus killed the unfit and the unhealthy. A good share were, of course, rendered unfit in part by age.

Nature at work, sadly

This is fundamental nature. It wants us dead, and it wants us dead more the older we get.

The process by which it topples us over time is called immunosenescence, a fancy word for the decline of the immune system as we age. This process starts early, probably in one’s 30s if not before, but the rate at which it progresses is linked to environmental and behavioral factors.

“During the chronological aging process, the most remarkable changes are observed in the adaptive immune system, particularly in T cells,” Japanese researchers observed in a peer-reviewed paper published in Cells last year, and “there is no doubt that T cells are strongly affected by aging….”

If you’ve been paying attention to the pandemic at all, you’ve read or heard about the importance of T cells. These are the “utility fielders,” in baseball terms, of the human immune system, and like old baseball players, their performance inevitably deteriorates with age.

“The impact of age-related changes in the immune system was clearly not an issue when the average human life span was approximately 40 years,” researchers in the United Kingdom (UK)  wrote in the peer-reviewed journal Immunology 15 years ago. “However, over the past 150 years, advances in medical sciences and nutrition have resulted in a dramatic increase in life expectancy to an unprecedented 80 years.

“Currently, in the UK more than 18 percent of the population are 65 years or older, and this percentage is expected to rise to 25 percent by 2031; a trend predicted worldwide. Thus, in the absence of any major evolutionary pressure, an immune system that was designed to function for approximately 40 years now has to continue for an additional four decades. Therefore, it is unsurprising that the increased susceptibility to cancers and infections seen in older persons points to severe deficiencies in the immune system.”

The new disease Covid-19 only underlined that old observation about the susceptibility of old folk.

Natural defenses

Healthy, so-called “naive” T-cells – those that haven’t become specialists in the lifelong battle against the diseases trying to kill us every day – have the ability to adapt to fight off a wide range of pathogens.

In some people, their infection-fighting properties are astounding. A professional cyclist named Wout Van Aert from Belgium caught Covid-19 at the start of April and was out of action for two weeks before coming back to grab a surprise second in the legendary Paris-Roubaix bike race.

By July, the Jumbo Visma rider was setting the world of professional cycling on fire by winning three stages of the Tour de France and, though not a climber, cracking defending Tour champion Tadej Pogačar on the slopes of the Hautacam to open the door for Jumbo-Visma teammate Jonas Vingegaard to win the stage and cement ownership of the famous “yellow jersey” claimed by the overall Tour winner in Paris. 

Everyone should be so young, fit and lucky, but they’re not.

Since the pandemic began, according to the U.S. Centers for Disease Control, Covid-19 has killed about 7,500 Americans of Aert’s age, 27, or younger. It is a small number, about 0.75 percent of the now the more than 1 million reported dead in this country. 

Covid-19 has focused its major death toll on Americans age 65 and older. About 75 percent of the Americans dead of Covid-19 had reached 65 before they died, according to the CDC.

Again, some of them were just unlucky, but a significant number set themselves up for early deaths due to obesity or lack of fitness or both. Other countries reflect age-related death trends, too. But their former citizens died at even older ages.

Italy was much in the news early in the pandemic because of the deaths there. But they were to be expected; Italy had one of the oldest populations in Europe.

Eighty-five percent of the 167,082 dead in Italy were age 70 or older, according to the data website Statista.

Or to put this another way, only 15 percent of those under the age 70 died of Covid-19 in Italy while the number in the U.S. is closer to 39 percent of deaths coming among those under age 70.

Or to put this yet another way, the Covid-19 death rate for Americans under age 70 is more than two and half times greater than in Italy, which helps explain why the U.S. is the Western world leader in per capita Covid-19 deaths.

There is a logical and likely reason for this difference, too. Europeans, in general, use significantly more muscle power and less motor power to get around on a daily basis which helps boost their fitness.

When Bryn Huxley-Reicher at Frontier Group looked into driving habits, he found that the average American drove “1.98 times more miles on the road each year than the average resident of France, 2.06 times more than the average German, and 2.23 times more than the average person in Great Britain. Residents of those countries often enjoy communities where more destinations can be accessed on foot.”

Frontier Group is all about global warming and pollution, and Huxley-Reicher wrote that “road travel produces environmental and quality of life impacts around the world, but those problems are particularly severe in the U.S. and a lot of public money is spent to protect the transportation status quo. Shifting to electric vehicles and making our roadways safer can reduce many of the negative impacts of driving.”

Or at least this would be the case if one were to ignore the obvious link between Covid-19 deaths in the U.S., a country largely designed around motor-vehicle transportation, and Europe, a country largely bound to transportation systems built before motor vehicles arrived on the scene.

World death leader

The U.S. death rate from Covid-19 now stands at 313 per 100,000, according to the John Hopkins University Covid-19 tracker. Only 15 countries, led by Peru, have higher death rates. 

Fourteen of those 15 countries are on the list of second- and third-world nations.

Sweden, a first-world country castigated by former President Donald Trump and then sidekick and still Covid-19 czar Anthony Fauci for failing to mask up and lockdown when the pandemic began, now has a death rate of 192 per 100,000 – 61 percent of the U.S. death toll, according to John Hopkins.

Spain, along with Italy, an earlier leader in per capita deaths is now at 237 per 100,000 – 76 percent of the U.S. death rate. And there – as in Italy – the death rate was driven up by the large number of very old people dead.

Twenty percent of the population in Spain was over 65 when the pandemic began, according to The World Bank. In Italy, it was 23 percent. The U.S. was at 16 percent.

Simply put, those European countries contained a lot more people, on a per capita basis, at risk because their immune systems were wearing down due to age.

They should have much larger death rates now than the U.S., but they don’t.

There is one logical explanation for why. Immunosesense is only based in part on chronological age. You can actually accelerate the rate of aging by eating too much and doing too little.

Both obesity and lack of exercise have been linked to early death in a variety of forms as the UK scientists researching T cells noted. And the Japanese scientists studying T cells weren’t looking at Covid-19; they were looking at cardiovascular disease (CVD), the number one killer in the U.S. even now.

“Accumulating evidence demonstrates the significance of immunosenescence associated with aging and obesity in the pathogenesis of CVD,” they concluded, and they had some interesting observations of what happens to T cells in the aging and obese.

“The T cell population shows skewing from naïve” cells to so-called “memory cells,” those directed at dealing with known threats, they reported. That could raise some questions about Covid-19 vaccines pitched for their ability to program T-cells to be on the lookout for SARS-CoV-2.

Could artificially enhanced protection against the pathogen of the moment compromise the ability of our T cells to respond to the next new pathogen? That is an unknown.

What is known is that obesity and lack of fitness speed immunosenescence, leading to all sorts of health issues along with possible death by Covid-19 or the even more common death by CVD.

Researchers who last year recruited 54 people ages 65 to 88 and willing to have their T cells sampled found that those who passed basic physical fitness tests defining them as active had immune systems in far better shape than those who were inactive.

“In this study, we demonstrated that major features of immunosenescence were driven by lifestyle exercise. Physical activity sustained throughout life enhances the immune system…” they wrote in the peer-reviewed journal BMC Geriatrics.

The benefits of fitness, they added, accrued to “physically active older adults regardless of their body weight, which classified them as successfully ageing older adults, contrary to the inactive and obese older adults.”

Early in the pandemic, a massive study of 412,596 people in the UK Biobank reached much the same conclusion. Researchers there classified the fitness of study participants by their walking pace, given that fit people generally walk faster than the unfit because they can, and reported that while obesity was a risk for severe Covid-19 and death, inactivity was an even bigger risk.

Among those more than 400,000 people with a median age of 68, “slow walkers had the highest risk regardless of obesity status,” the researchers reported in the peer-reviewed International Journal of Obesity in February 2021. “For example, compared to normal weight brisk walkers, the odds ratio of severe disease and COVID-19 mortality in normal weight slow walkers was 2.42  and 3.75, respectively. Self-reported slow walkers appear to be a high-risk group for severe COVID-19 outcomes independent of obesity.”

Science ignored

There is no telling how many lives could have been saved in this country by getting people up, moving and healthier when SARS-CoV-2 arrived on the scene instead of locking them down, but the American health care system isn’t geared to this approach.

It is geared to medication.

“Dear Insurers: It’s Time to Cover Weight Loss Drugs,” Medpage Today headlined in its “Second Opinions” sections just days ago.

Noting a recently published study in the Journal of the American College of Cardiology concluding “that just 6.8 percent of Americans are in optimal cardiometabolic health,” nurse practitioner Elizabeth Simkus argued that it’s time for the country to medicate its way out of the obesity epidemic that pre-dated the Covid-19 pandemic.

As she rightly observed, “nine of the top 10 leading causes of death in America have obesity and excess body weight as a risk factor. These include heart disease, certain cancers, COVID-19, stroke, chronic lower respiratory diseases, Alzheimer’s disease, diabetes, influenza, and nephrotic syndrome. Heart disease alone costs the U.S. hundreds of billions of dollars each year between treatments, medications, and lost wages due to death. In fact, 90 percent of healthcare spending in America is related to chronic disease and mental health.”

Maybe the government could mandate weight-loss drugs for anyone with a body-mass index (BMI) over 30 to protect the healthcare system from being overrun with the obese in the way the government mandated vaccinations to save the healthcare system from being overrun with Covid-19 patients.

Why not?

Americans are big believers in the idea that health care equals medicine, and think that is why we were enjoying average lifespans longer, prior to Covid-19 at least, than any of our ancestors could have imagined.

This is, unfortunately, a myth.

Researchers who in 2021 took a deep dive into what determines life expectancy concluded that what had been, prior to the pandemic, a generally increasing human lifespan was “driven largely by changes in pre-adult mortality.

“The maximum human life expectancy has increased since the mid-1800s by three months per year,” the wrote in a peer-revied paper published in Nature Communications. “These gains have resulted from shifting the majority of deaths from early to later and later ages, with no evidence of slowing the rate at which mortality increases with age.”

The simple translation here is this:

There have long been people living into their 70s, 80s and beyond, but average life expectancy was for centuries weighted down because of all the people dying as children, teens or young adults.

Modern medicine played a small role in alerting this dynamic. Access to more and better food, a focus on job site safety, improved sanitation, and maybe, most importantly, clean water made the big differences.

Americans were dying at the rate of 800 per 100,000 from water-related infectious diseases in 1900, researchers observed in Water, a peer-reviewed journal, in 2021.  The rate is now down under 100.

For comparison’s sake, the rate of 800 deaths per 100,000 per year dwarfs Covid-19 death rates in this country. Arizona, the Covid-19 deadliest state in the U.S., reports 423 deaths per 100,000 since the first death there on April 5, 2020.

Annualized over the 28 months that have followed, this works out to an annual rate of death of approximately 1`81 deaths per 100,000 per year, or more than four times fewer deaths than bad water caused in 1900.

Alaska, meanwhile, has had a Covid-19 death rate only 41 percent the size of Arizona’s.

“There are other factors, along with water purity, that affect life expectancy and quality (for example, child mortality, diseases, medicines, nutrition, environmental and other risks, and standards of living),” the Greek, Finnish and Chinese authors of the Water paper noted. “However, several lines of evidence support the theory that the dramatic increase in life longevity during the last two centuries (from 30 to over 80 years) is partly due to improved sanitation and water quality, taking into account that for millennia (since prehistoric times), life expectancy was approximately 30 years.”

Counter-productive medicine

Now we might have reached the point in the U.S. where it is reasonable to wonder if our belief in pills isn’t undermining our health.

One cannot hide from evolution, and homo sapiens evolved over the millennia as actively moving animals with physiological systems to match.

The concept of “use it or lose it” is hardwired into our biology no matter whether one looks at cardiorespiratory fitness, muscle mass or T cells.

Drugs can help boost both of the former as Lance Armstrong and a long list of weight lifters notoriously have shown, but the boosting can’t begin to match what comes naturally through exercising the way our agent ancestors did.

Armstrong might not have been telling the whole truth when he asked “what am I on?” and answered “I’m on my bike, busting my ass six hours a day” in a Nike commercial long ago, but he was telling 95 percent of the truth.

There was a time when Americans seemed to understand this. President John F. Kenney had the country up and hiking in the 1960s, and there was a “running boom” in the 1970s.

Today? With all those Covid-19 deaths staring Americans in the face with the message “get fit or die?”

A group of the nation’s top cardio researchers, writing in the Journal of American College of Cardiology are forecasting a 31 percent increase in heart disease, a 33 percent increase in heart failure and a 34.3 percent increase in strokes by the year 2060 as the sedentary lifestyle happily marches on.

But at least Republicans and Democrats aren’t fighting over this issue.

Republicans don’t much seem to care about what people allow to happen to their bodies through neglect, and Democrats, though happy to order Americans to mask up and get vaccinated, aren’t about to tell them to get their fat asses off the couch and exercise.

That it might save their life, or extend the functional life of their brain cells, who cares?