John Travolta “stayin’ alive” in the 1977 hit movie Saturday Night Fever/Paramount Pictures

The ironclad case for self-medication

With the deadliest pandemic of these times now fading into the rearview mirror, the time has come to consider the biggest element of the story missed by the U.S. media and this is it:

The SARS-CoV-2 virus killed damn few fit and healthy Americans.

The value of basic, physical fitness today stands as the most overlooked and under-reported health reality in the wake of the pandemic. This realization hit me while on a 75-mile bike ride to celebrate a 70-something birthday.

There’s a lot of time to think when grinding up steep grades in the mountains of the American West at 6 or 7 mph, and I couldn’t help thinking what hell the post-pandemic years must be for those suffering postacute sequelae of SARS-CoV-2 or what is commonly called “long Covid,” an ailment that scientific studies link to pre-existing “hypertension, chronic lung disease, obesity, diabetes, and depression.”

All of these health issues we now call “comorbidities” were long ago linked in parts large or small to a lack of regular physical activity. A study published in the World Journal of Diabetes almost a decade ago reported that “walking for at least 30 minutes per day was shown to reduce the risk of Type 2 diabetes by approximately 50 percent.”

Nothing – not physical activity, not vaccines, not genetics, not prayer – offers absolute protection against any disease. We are all preprogrammed to die, and illnesses, like life, are not fair.

That said, the evidence supporting physical activity as protective against illnesses from A-to-Z is overwhelming. And, in the wake of the pandemic, it should be recognized that it was responsible for saving far more lives than vaccines, because the fit and health were at low risk from the beginning and stayed that way through to the end.

Also badly overlooked

The second most overlooked reality of the pandemic surrounds the evolution of the SARS-CoV-2 itself – something the best virologists accurately predicted in April 2021.

“Our findings demonstrate that the continued evolution of SARS-CoV-2 leads to less virulence,” they said then. “Given that our study period was during the initial weeks of the pandemic, it is unlikely that differences in survival were due to differences in patient care protocols, limitations of supplies or equipment, ICU (intensive care unit) bed space availability, or the use of antiviral medications.”

Their conclusions fit with the theory of natural selection, which dictates that organisms survive by evolving. Viruses are pushed toward less virulence rather than more because, as they become increasingly deadly, their hosts sicken and die quickly.

Hosts that die quickly can’t help spread the virus to other hosts. And possibly just as importantly, at least at the human level, hosts that sicken quickly are easily identified.

Thus public health officials confronted with SARS-CoV-1, which killed about one out of every 10 people it infected, could quickly identify those infected and isolate them while tracking down their contacts, checking to see if they had also become infected, and isolating them as necessary.

Between the deaths from SARS-CoV-1 and the actions of public-health officials to stymie the virus by stopping its spread, SARS-CoV-1 faded into history.  Then along came SARS-CoV-2, a much milder but still deadly coronavirus that spawned Corona Virus Disease of 2019, the acronym for which became Covid-19.

Though still deadly, the virus driving Covid-19 was weak enough that the immune systems of the vast majority of the fit and healthy were able to fight it off and a goodly number became asymptomatic carriers of the virus.

By definition, those who are asymptomatic show no symptoms, which makes it impossible to identify them without testing. The need to find the asymptomatics to try to stop the spread of SARS-CoV-2 drove the Covid-19 testing frenzy in 2021 and 2022, the thought being that everyone got themselves tested and self-isolated if found to be infected, humans could do to SARS-CoV-2 what they did to SARS-CoV-1.

Things didn’t work out that way. The Centers for Disease Control in August 2022 reported that “10.7 million test results were voluntarily reported by users of four manufacturers’ self-tests; during that period, 361.9 million laboratory-based and point-of-care test results were reported,” but all of the testing didn’t produce much in the way of results.

All the CDC could report of these tests was that they provided “strong situational awareness” of the disease in the U.S. They didn’t slow its spread, however, and eventually almost everyone was infected by a virus that has never stopped evolving.

Though vaccines have been given all the credit for stopping the pandemic and clearly helping to save lives, especially among those with immune systems already compromised by chronic diseases or age, the evolution of SARS-CoV-2 played a role that was arguably even bigger in bringing the pandemic to an end.

A different virus today

As the BBC reported in January, “some indications suggest that Covid in 2025 is a milder disease. The once-common symptoms of loss of taste and smell are becoming less common. And though some people are being hospitalised and dying,” Peter Chin-Hong, a professor in the Health Division of Infectious Diseases at the University of California, San Francisco, says “the vast majority of people will either be asymptomatic or experience a cold so mild that some might well mistake it for a seasonal allergy, such as a pollen complaint. While immunocompromised individuals are still particularly vulnerable, he believes that the major risk factor for more severe Covid is now simply being over the age of 75.”

Covid-25 might almost be considered a different disease from that faced in 2020 though we still know it as Covid-19. But the Sars-CoV-2 virus is not now what it once was, having followed the evolutionary track of four other coronaviruses along with a variety of rhinoviruses, enteroviruses, adenoviruses, parainfluenza viruses and  metapneumoviruses connected to what humans long ago came to call “the common cold.”

Most of our species today think of the common cold as a drippy nose nuisance rather than a threat to life, but the common cold can still kill.

Of the common cold viruses, the European Journal of Internal Medicine decades ago reported that “despite their benign nature, they are a major cause of morbidity and mortality on a worldwide basis.”

“Coronavirus accounts for 7 to 26 percent of all upper respiratory tract infections in adults,” that study added.  “An important feature of coronavirus infection is the short-lived immunity, resulting in a high reinfection rate.”

The latter fact also proved true of the new coronavirus SarsCoV-2, and this, coupled to the steady and so far constant evolution of the virus, has hampered the use of vaccines against the disease despite the early claims of Covid-19 czar Anthony Fauci that if people got vaccinated they “become a dead end to the virus. And when there are a lot of dead ends around, the virus is not going to go anywhere.”

That was the case for SARS-CoV-1. It did not prove to be the case for SARS-CoV-2, which is still “around,” as Fauci put it, and has jumped from humans to so many other species of mammals – cats, dogs, deer, mink and more – that it is destined to be around forever like all the other viruses now involved in causing common colds.

That these common colds – along with all-too-common heart disease, diabetes and more – still kill people is one of the reasons the American College of Sports Medicine started an “Exercise is Medicine” initiative way back in 2007.

If you haven’t heard of this initiative, don’t feel bad.

It’s arguably the worst-sold initiative in a country made so lazy by technological conveniences that the American Heart Association is now suggesting that encouraging people to use fewer, everyday, energy-saving devices and engage in “active transport, household activity, or work-related interventions may be more viable for behavior change for adults who are less motivated or otherwise disinclined to engage in structured exercise.”

This idea arose as the result of a Heart Association-sponsored study reporting that “few middle-aged and older adults engage in regular leisure-time exercise. Incidental physical activity encompasses (IPA) activities of daily living outside the leisure-time domain.”

The study concluded that “any daily IPA amount of vigorous or moderate intensity was associated with lower cardiovascular disease risk in a dose-response manner….Our findings highlight the potential cardiovascular health value of incidental physical activity, especially for people who struggle to do structured exercise.”

So-called “active travel” such as walking or cycling to or from work – something the American transportation system tends to discourage – can be incorporated into either structured or unstructured exercise.

I was personally lucky to stumble into this sort of exercise as a lifestyle not long after taking the job as the outdoor editor at the Anchorage Daily News in the early 1980s. The newspaper was then at the forefront of broadening outdoor sports coverage beyond the traditional, subsistence-oriented realms of hunting and fishing into backpacking, mountain biking, climbing, wilderness trekking, cross-country ski touring, mountain running, packrafting and more.

It is a lot more fun to engage in those activities when you are fit than when you are not, and so I put enough time into fitness that a certain photographer at the newspaper accused me of acting as if I were on an athletic scholarship at the newspaper, and smarter than anyone editorial writer Matt Zencey regularly tried to mock me as the “leisure writer,” apparently finding the idea of outdoors sports and activity-related fitness training somehow unbecoming for a serious journalist.

He was, sadly, not the only one thinking this way. I remember trying to get Alaska Supreme Court Justice Robert “Bob” Eastaugh – a cyclist, skier and runner capable besting men half his age while in his 60s – to participate in a Daily News profile highlighting the importance he put on fitness as a way of life, but he thought it would look undignified for a justice to be portrayed as a sweaty amateur athlete.

Hard work

When, where and why America, a country which once valued hard work, became a place where sweating is unseemly is hard to say, but there is a correlation with the nation’s transition into the world’s largest drive-everywhere society.

Few walk or cycle much anymore, and thus the Heart Association’s interest in trying to make exercise out of everyday chores in its losing war with cardiovascular disease (CVD), long the nation’s biggest killer.

One in every five deaths in the U.S. were attributed to CVD in 2022, according to the CDC, which reported “one person dies every 33 seconds from cardiovascular disease.”

In 2023, the Journal of Clinical Medicine, reported heart disease accounted for 26.2 percent of all U.S. deaths with the Covid-19 kill rate was already down to about a quarter of that at 6.9 percent behind cancers at 22.7 percent and unintentional injuries at 8.5 percent.

Unintentional injuries are the leading cause of death for Americans under the age of 45 with  drug overdoses, which the country seems unable to do much about, leading the way, and motor vehicle crashes close behind in a country where bad, illegal and even dangerous driving are now tolerated as the norm.

Bad driving is one of the few causes of death here for which exercise is not protective. And sadly, all the bad drivers on the roads these days are discouraging some number of people from engaging in physical activity in the form of walking or cycling becuase of the risks of  being rundown by motor vehicles.

Whether this compounds the problem of deaths from drug overdoses has never been studied, but it is worth noting that among the 22 percent of overdoses found to be linked to “a non–substance-related mental health disorder,” the CDC reported 13 percent suffered from depression and 9 percent from anxiety, both illnesses that can be treated with exercise.

Recently joining that long list of exercie-related diseases for is young-onset dementia. A peer-reviewed study published in the journal Neurology this week linked dementia to metabolic syndrome in Koreans aged 40 to 60.

Metabolic snydrome is a new, epidemic disorder tied to a lack of physical activity and obesity. Just prior to the pandemic, Bangladesh Medical College trained Dr. Mohammad G. Saklayen has described it as “the major health hazard of modern world,” adding that “though it started in the Western world, with the spread of the Western lifestyle across the globe, it has become now a truly global problem.”

Globally, the pandemic killed a lot of people suffering from metabolic syndrome, but many also survived and the authors new Neurology study, who examined the medical records of almost 2 mllion people, are reporting that those with living with metabolic syndrome today face a 24 percent greater chance of “all-cause, young on-set dementia.”

“Our findings suggest that lifestyle changes to reduce the risk of metabolic syndrome – such as eating a healthy diet, exercising regularly, maintaining a healthy weight, quitting smoking, and reducing stress – may help reduce the risk of young-onset dementia,”  Dr. Minwoo Lee, one of the researchers involved in the study, told MedPage Today.

The same could be said of the findings of so many studies on the declining health of Americans with lifespans now rapidly falling behind those of the rest of the western world.

The disrupters

Enter U.S. Health and Social Services Director Robert F. Kennedy Jr. and the Make America Healthy Again campaign endorsed by President Donald Trump.f

Given all the evidence as to the root causes of American health problems, one might have expected the American medical community to embrace this idea, but they are so caught up in Kennedy’s misguided opposition to some vaccines and skepticism of others doctors seem willing to largely ignored the fact the present approach to American  isn’t “healthcare” working.

And it isn’t working because it isn’t really healthcare, it’s sickness treatment.

As Trump accurately noted in an official statement establishing a MAHA commission, “health burdens have continued to increase alongside the increased prescription of medication….

“Seventy-seven percent of young adults do not qualify for the military based in large part on their health scores.  Ninety percent of the Nation’s $4.5 trillion in annual healthcare expenditures is for people with chronic and mental health conditions.  In short, Americans of all ages are becoming sicker, beset by illnesses that our medical system is not addressing effectively.  These trends harm us, our economy, and our security.

“To fully address the growing health crisis in America, we must re-direct our national focus in the public and private sectors toward understanding and drastically lowering chronic disease rates and ending childhood chronic disease.  This includes fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety.  We must restore the integrity of the scientific process by protecting expert recommendations from inappropriate influence and increasing transparency regarding existing data.  We must ensure our healthcare system promotes health rather than just managing disease.”

Unfortunately, many if not most of those ideas do not require “fresh thinking,” they require action to remedy what is already known. And few in America are committed to such action at either the personal or governmental levels.

Less than half of American adults now meet the guidelines for aerobic physical activity, according to the CDC, and less than a quarter meet the guidelines for the combinatoin of aerobic and muscle-strengthening activity.

As for the contribution of goverrnment, well, Saklayen pretty well laid out what needs to be done in his paper on “The Global Epidemic of the Metabolic Syndrome” pubished in the peer-reviewed journal of Current Hypertension Reports in 2018:

“The two basic forces spreading this malady are the increase in consumption of high calorie-low fiber fast food and the decrease in physical activity due to mechanized transportations and sedentary form of leisure time activities,” he wrote. 

“The present trend is not sustainable unless a magic cure is found (unlikely) or concerted global/governmental/societal efforts are made to change the lifestyle that is promoting it. There are certainly some elements in the causation of the metabolic syndrome that cannot be changed but many are amenable for corrections and curtailments. For example, better urban planning to encourage active lifestyle, subsidizing consumption of whole grains and possible taxing high calorie snacks, restricting media advertisement of unhealthy food, etc. Revitalizing old fashion healthier lifestyle, promoting old-fashioned foods, using healthy herbs rather than oil and sugar, and educating people about choosing healthy/wholesome food over junk are among the steps that can be considered.”

Kennedy, for his part, has pushed some of those dietary changes, but Trump, despite showing some understanding of the health problem in his MAHA initiative, has working for him a Secretary of Transportation who is trying to undo what little has been done to alter the American transportatoin system to encourage people to walk or cycle rather than drive everywhere.

And no one in this country would dare suggest “restrict media advertisement of unhealthy foods,” and most especially the electronic media which generates much of its revenue through the “advertisement of unhealthy foods” and the advertisement of medicines to treat those suffering from physical problems related to bad diets and lack of physical activity.

Welcome to America where the only good news is that this is a free country, and there is a whole lot individual Americans can do on their own to self medicate if only then can find the motivation.

This isn’t Belgium where the government is incentivizing active travel by paying cyclists 0.35 euros per kilometer, up to a limit of 3,500 euros ($3992) per year, to use pedal-power to get themselves from home to work and back again.

The subsidy was promoted as helping to improve public health, ease traffic congestion by reducing the the number of motor vehicles on the raod, and lower greenhouse gas emmissions. Saklayen argued the cost-savings related to health along would more than justify the program.

“The total cost of the (metabolic syndrome) malady including the cost of health care and loss of potential economic activity is in (the) trillions,” he wrote. In this country, according to the CDC, “inadequate levels of physical activity are associated with $117 billion in annual health care costs.”

But who cares?

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