And now ‘long Covid’ can be added to the list/Pulse Cardiology graphic

Some ‘long-Covid’ tied to lifestyle issues

Add Post-Covid Syndrome, or what many now just call “long Covid,” to the lengthy list of ailments compounded by the American Slothdemic.

Swedish scientists who examined the medical records of more than 1 million people in that Scandinavian country are reporting they found long-Covid strongly linked to hypertension, one of the many comorbidities tied to what Dictionary.com describes as a “habitual disinclination to exertion.”

The Swedish study published in the peer-reviewed BMJ (formerly the British Medical Journal) revealed that people suffering from hypertension were more than eight and half times were likely to suffer from long Covid than those without.

The researchers could not determine if all of these people had what is commonly called “high blood pressure” before infection with the SARS-CoV-2 virus, but they reported “73.5 percent of the post-Covid syndrome individuals had received this diagnosis prior to Covid-19, indicating hypertension was not a new diagnosis following Covid-19.”

Given how widely underdiagnosed hypertension, it is probable that a significant proportion of the 26.5 percent who were not known to have high blood pressure before infection likely did as well.

The prevalence of hypertension, both diagnosed and undiagnosed in the U.S., has led Dr. Paul Reed, director of the U.S. Office of Disease Prevention and Health Promotion, to label hypertension America’s “silent pandemic.”

This puts it among a swarm of American epidemics – the obesity epidemic, the opioid overdose epidemic, the childhood obesity epidemic, the depression epidemic, “The Epidemic of the 20(th) Century: coronary heart disease,” and, of course, the Covid-19 pandemic,  a pandemic being the mother of all epidemics.

All of these epidemics have links to what has politely been called the “sedentary lifestyle.’‘ It was first recognized as a health threat in the 1950s, but it took almost 40 years for the medical community to fully accept sitting on one’s butt too much as a factor increasing almost all known causes of death, according to the history of  “Sedentarism, a disease from XXI century.”

A lot more has been learned about the risks of lounging about all day since the Sedentary Behaviour Research Network was established in 2011, but the network has forever been swimming against the tide of age-old cultural desires for “comfort” supercharged by technology. There is almost no daily task in the Western world today that hasn’t been made easier by mechanical or electronic means.

The modern man doesn’t need to get out of his easy chair to change channels on his television, and if he wants, he can even get a refrigerated coffee table to put within reach to avoid the walk to the kitchen to grab another beer.

And the biggest cost – his health – is among the easiest costs to ignore in today’s society.

High blood pressure

“Though it’s not a contagious threat in the traditional sense,” Reed wrote in February, “hypertension needs to be addressed with even greater attention and urgency. The statistics clearly define the problem.”

He went on to cite medical records indicating that “in the United States, hypertension affects nearly half of adults – more than 119 million people. In 2021 alone, hypertension was the primary or contributing cause of over 690,000 deaths, roughly 275,000 more deaths than from the Covid-19 pandemic in that year.

“High blood pressure costs our nation between $131 to $198 billion each year, not accounting for lost productivity due to non-fatal illnesses associated with high blood pressure. By 2035, total costs related to uncontrolled hypertension are projected to balloon to $220 billion annually. And as with many other diseases, inequities exist in hypertension prevalence and control — impacting Black and Hispanic people in particular.”

Hypertenion’s link to long-Covid can now be considered a huge multiplier on that $131 to $198 billion in cost and possibly even a bigger multiplier on lost productivity. The Brookings think tank in 2022 estimated somewhere around 16 million Americans aged 18 to 65 were suffering from long Covid.

“Of those, 2 to 4 million are out of work due to long Covid” Brookings said. “The annual cost of those lost wages alone is around $170 billion a year (and potentially as high as $230 billion).

The Swedish study would indicate a significant amount of this financial loss, not to mention the suffering of 16 million Americans, could have been greatly reduced if only Americans were fundamentally healthier.

As Reed noted, managing the silent pandemic of hypertension involves a “relatively less complex solution set than managing novel viruses,” but short of putting blood-pressure medications in U.S. public water systems, the solution requires that Americans alter their lifestyles.

America is, however, the nation that largely pioneered the sedentary lifestyle with the world’s first drive-thru eating establishment in 1947 followed by the first drive-through liquor store in 1955 on the way to creating a country of drive-through everything before the Internet burst onto the scene to make life even easier.

Today, there’s no real need to even walk to the car and drive somewhere. Almost everything can be ordered online for delivery to your home.

Against this backdrop, Reed’s suggested solution to the health problems caused by the minimization of physical activity required to survive sounds simple and equally unlikely to work.

As he sees it, all physicians need to do is talk to their patients “about the importance of hypertension prevention and control in the context of personal health and resilience, (conduct) more regular hypertension screening, (suggest) more self-monitoring of blood pressure, and (focus on) more promotion and education of preventive measures such as increased physical activity and healthier eating patterns.”

The talking part is easy, as is the testing whether it is done in a doctor’s office or at home. The same for “promotion and education,” which are just so much more talk, which is – to repeat, easy.

The problem comes in the doing. Americans have a love affair with convenience that saves them any effort to do anything. American urban design revolves around making cities ever more convenient for motor vehicles and ignores human-powered movement. And American “health care” is focused on selling people medicines and operations rather than figuring out how to encourage them to improve their level of fitness.

The pharmaceutical industry – a powerful political entity which Zippia, a career advice website, has reported to be a $550 billion per year U.S. business that accounts for 43.7 percent of all legal, drug sales on the planet – has no interest in making Americans truly healthy because the money is to be made in treating their diseases.

Likewise for the automotive industry, another powerful political entity valued at more than $100 billion per year. It helps drive a national transportation agenda embraced by the vast majority of Americans who find it is easier to drive than walk or pedal a bicycle with no thought as to the long-term consequences for their health.

Knowingly or unknowingly, they seem happy to ignore a few hundred thousand years of human evolution in that belief that there are no medical issues modern medicine and Big Pharma can’t fix.

The two did come up with a solution to the latest pandemic after only 7 million deaths, right? And on a planet now home to 8,045,311,447 people, 7,000,000 – or 0.08 percent – is rather a pittance, isn’t it?

The data would indicate a 99.92 chance of survival for the random individual. Given the numbers, even if you were among the 50 percent or greater number of people who’d just let your body go to hell, you still had a better than 99 percent chance of surviving the pandemic.

So why change your lifestyle?

Convenience is good

Face it, convenience is in the American view good and physical activity is, at best, sweaty and tiring and, at worst, really sweaty and strenuous. These are reasons Americans drive almost everywhere and gobble up less-than-healthy, but tasty convenience food as happily and regularly as cattle graze grass.

Some find themselves hostage to a Ford F-150 pickup truck and Chester Cheetah.  Others are in love with their Teslas and Tostitos if you believe the survey that pegged the average Tesla owner as a Generation X male making over $130,000 per year and the Food Institutes’ observations on the snacks of Gen-Xers. 

Whatever. It doesn’t matter. We all love convenience food. It’s an American thing.

All of which explains why, convenience foods are now a $51.3 billion business in the U.S., according to the data tracking website Statista. And why, according to the National Association of Convenience Stores (NACS), there are now more than 152,000 convenience stores in the country, which is almost eight times the number of high schools in the country.

On top of this, nearly every supermarket and grocery in the U.S. is now busy selling convenience food along with the historic fast-food businesses.

“The demand for convenience food is now changing the food industry where almost everything is packaged and sold as food that requires minimum preparation or none at all,” according to the Simplot Food Group, a food service provider. “They are mainly ready-to-eat meals such as salads and wraps, or reheatable sets.”

Some of these foods are healthy. Many are not; they’re short on beneficial nutrients and high in sugar, salt, saturated or trans fats, and preservatives. They’ve also been linked to the most visibly obvious of American epidemics: obesity.

It is another costly disease that the U.S. Centers for Disease Control (CDC) pegged at “nearly $173 billion in 2019 dollars. Medical costs for adults who had obesity were $1,861 higher than medical costs for people with healthy weight.”

Along with all the old chronic diseases – cardiovascular disease, some cancers, diabetes, hypertension, and more – linked to a basic lack of fitness, obesity helped explain why the Centers for Medicare & Medicaid Services last year reported U.S. spending on drugs, medical procedures and hospitals had reached “$4.5 trillion or $13,493 per person.  As a share of the nation’s Gross Domestic Product, health spending accounted for 17.3 percent.”

Globally, spending on drugs, medical procedures and hospitals has been trending upward for years as the rest of the world increasingly adopts the U.S. model of drive-more, eat-worse, but America remains the Western-world, spending leader.

According to World Bank numbers, healthcare spending in the U.S. costs the economy about 35 percent more than France or Germany; 42 percent more than Japan, despite that country having one of the oldest age populations in the world; 49 percent more than Finland, which is considered one of the fittest countries in Europe; and 70 percent more than China, the country vying to overtake the U.S. as the world’s biggest economic power.

China’s quest for global power would seem to make the goal of getting Americans fitter not only an issue of health but of national security, given the losses in worker productivity due to sickness and obesity.

“In the past two decades, China has reemerged as a major power, with the world’s second-largest economy and a world-class military. It increasingly asserts itself, seeking to regain its centrality in the international system and over global governance institutions,” according to the U.S. Council on Foreign Relations.

“President Xi Jinping, the most powerful Chinese leader since Mao Zedong, has called for China to “lead the reform of the global governance system,” transforming institutions and norms in ways that will reflect Beijing’s values and priorities.

Despite this, American politicians both right and left remain bound to constituencies that cling to the sedentary lifestyle. Climate-change panicked California, the bluest of American states, has mandated that by 2035 100 percent of all new cars and light trucks sold there will be zero-emission vehicles, primarily electric, but it continues to build ever more roads to accommodate these vehicles rather than redesigning communities to encourage people to walk or bicycle.

Caltrans, the state transportation agency, proclaims “More Climate Adaption, Bike and Pedestrian Elements Added to Projects,” for 2024, but has most of its $16 billion budget directed at motor vehicles with “$8 billion (slated) to improve more than 6,000 lane-miles of pavement.”

Less than 2 percent of the budget – or $280 million – is earmarked “for bicycle and pedestrian infrastructure.”

Why? Because for whatever talk there is about wanting healthier Americans, no American politicians are willing to tell Americans what they need to do to get healthier: “Get off your lazy asses and move!”

It’s not by accident that the U.S., long a world leader in chronic illnesses (or what are now called comorbidities) is one of the world leaders in per capita cases of “long Covid.” About 7 percent of Americans reported they were suffering from long Covid-19 as of March 2024, according to the Kaiser Family Foundation, a nongovernment entity that tracks U.S. healthcare policy. 

The Office of National Statistics for the United Kingdom puts the rate there at 3.1 percent. Germany’s federal disease prevention and control agency was in 2022 reporting that 5.8 percent of Germans infected with Covid-19 remained on sick leave after four weeks, but the number at six months after infection fell to 1 to 2 percent. 

Meanwhile, back in the U.S., the New York State Insurance Fund, that state’s largest carrier of workmen’s compensation insurance, reported that approximately 33 percent of infected New York workers “suffered or are suffering from long Covid” and that “approximately 18 percent of workers with long covid – or about five percent of (all) Covid-19 claimants – could not return to work for more than one year.”

“Nearly all workers with comorbidities or those hospitalized for their initial infection experienced long Covid,” the fund added.

That observation parallels what is known about the Covid-19 death count. It found the vast majority of those who died from Covid-19 were suffering from comorbidities – hypertension being one of them.

Thankfully, the death rate from Covid[19 is continuing to fall, according to the Centers for Disease Control, and vaccinations have been shown to drive “especially large reductions in mortality for obese and severely obese patients and for older patients,” according to peer-reviewed study in the The Journal of General Internal Medicine even though the effectiveness of vaccines has been shown to fade much faster in the obese than in those of normal weight.

Still, it is easier to vaccinate people than to help them get healthy, so public policy has moved to more boosters for larger Americans. As for alterations in urban design that could in many ways be altered to subtly make people fitter and leaner,  forget it.

Sacrifice the children

Urban design continues to maintain its focus on the machines – in this case motor vehicles – rather than people.

Children are the ones paying the biggest price. The 48 percent of them walking or biking to school in 1969 is now down to 11 percent, according to a Rutgers University study that also found that children who started going to from school under their own power at an early age were seven times more likely to continue doing so as they matured. 

As ever smaller numbers of them walk or bicycle to school, or, for that matter, play in their neighborhoods because of safety concerns tied to motor vehicle traffic, the resulting diminishment of day-to-day exercise helps to fuel the epidemic of childhood obesity.

“Over the past three decades, childhood obesity rates have tripled in the U.S.,” according to the T.H. Chan School of Public Health and Harvard University, “and today, the country has some of the highest obesity rates in the world: one out of six children is obese, and one out of three children is overweight or obese. 

“In the 1970s, 5 percent of U.S. children ages two to 19 were obese, according to the CDC’s current definition; by 2008, nearly 17 percent of children were obese, a percentage that held steady through 2010.”

As the CDC notes, this predisposes many of these children to a lifetime of likely comorbidities – “high blood pressure, high cholesterol, type 2 diabetes, breathing problems such as asthma and sleep apnea, and joint problems.”

Plus hypertension.

“Do children really get hypertension?” John Hopkins Medicine was compelled to ask on its web page. The answer was “yes, and pediatric hypertension is on the rise.  Over the last 30 to 40 years, pediatric hypertension in the United States has increased fourfold. Currently, up to 4.5 percent – or 3.34 million – of children in the United States have this condition.”

Most of them are so for the same reasons adults are so; they eat too much and exercise too little. Simply walking to school could help alter the dynamic, but in many, if not most American cities, the idea of merely slowing down traffic to make the streets safer for children to get to school or play is anathema to motorists no matter whether they are politically blue or politically red.

Their motonormativity rules the day, and dare be the politician who tries to lead the country to a healthier place. The last one who seriously tried to do that was President John F. Kennedy, and his presidency was short.