The risk from the COVID-19 virus, while real, seems to be very dependent on a person’s pre-existing health status. With hand sanitizer, masks, and other PPE in short supply, more emphasis should be placed on how maintaining your general health is also a key to fighting the virus. Here’s why…
[Lawsuit Disclaimer: Nothing in this article is intended to be construed as medical advice. Talk to your doctor about any topics in this article. The reader is responsible for his or her own choices.]
COVID-19 provides a perfect example of one of the many reasons maintaining your “health preparedness” is so important.
By “health preparedness” I don’t mean stockpiling medical supplies, I mean optimizing your health so your body is ready for any health challenge you might face, including infection. Because there will always be things that will challenge you health, that can make you very sick, or even kill you. A virus is only one scenario, but there are many others. It could be cancer. It could be a broken bone or other injury from a fall. It could be a stress-induced heart attack when you lose your job or a loved one. There are too many potential challenges to a person’s health to list them all. But here is the key point: if you are starting from a point of health (or as healthy as you can get), you will be much more likely to survive and recover better from whatever new challenge to your health you may face.
In contrast, if your start off from a position of already being sick: heart problems, lung problems, a compromised immune system, etc, your body will be much less able to fight off or recover from whatever (new) health challenge you may face. You will be more likely to get seriously ill. You could be more likely to die. And the deaths that have occurred from COVID-19 are a perfect example of this.
A Quick Review Of COVID-19 And Underlying Health Conditions
One Chinese study found that among COVID-19 deaths, 72.5% had pre-existing medical conditions, compared to only 41.5% among people who recovered from the virus. (Note: statistical data on COVID-19 is very much in flux regarding its accuracy.) A study in The Lancet identified hypertension, diabetes, and coronary heart disease as being most commonly associated with COVID-19 fatalities. A study from the CDC found the following:
- 78% of patients who required ICU care had a documented pre-existing health condition.
- 71% of all COVID-19 patients who required hospitalization had a documented pre-existing health condition.
- In contrast, most people who do not have pre-existing health conditions either have symptoms mild enough to care for at home, or may have no noticeable symptoms at all.
- This CDC study also identified the following risk factors for severe COVID-19 infection: diabetes mellitus, chronic lung diseases, and cardiovascular disease.
Update: A study published in the Journal of the American Medical Association (JAMA) found that the most common co-morbidities include: hypertension, obesity, and diabetes. One concerning statistic from this study is that “Mortality for those requiring mechanical ventilation was 88.1%.” This could simply be interpreted as ‘if a patient was so severe that s/he needed to be put on a ventilator s/he was very likely to die.’ But it could also potentially imply that ventilators are not a “magic bullet” for patients with severe infection. This is speculative, but it could also be that in some patients, ventilators may produce yet to be identified confounding factors that reduce their assumed ability to help COVID-19 patients.
It is important to point out that the COVID-19 virus uses a cell surface receptor called Angiotensin-converting enzyme 2 (ACE2) to enter cells. ACE2 is involved in regulating blood pressure. Therefore, cells that either have a high density of ACE2 receptors, or organs that depend on ACE2 blood pressure regulation, are the most susceptible to damage from COVID-19. These organs include: lungs, arteries, heart, and kidneys. Therefore, having a compromised cardiovascular system or cardiovascular disease (heart, lungs, or arteries) is a significant risk factor, as pointed out by this article in Nature. Also note that males are likely affected more by ACE2 activity than females.
A different CDC study found that people over 70 years old have a much higher fatality rate. This is not surprising, since people of that age have senescent immune systems that do not respond very well to infection. It almost goes without saying that anyone who has a compromised immune system will be at greater risk. This includes: cancer patients, pregnant women, and people who take immunosuppressent drugs – such as organ transplant patients and those with autoimmune disorders.
Along a similar line of medical science, inflammation helps to fight infections, and therefore drugs that reduce inflammation may reduce the effectiveness of a person’s immune response. Thus it is not surprising that a study published in the British Medical Journal points out that use of NSAIDs like ibuprofen should be avoided (since they reduce inflammation), and the authors recommend using acetaminophen (which does not reduce inflammation) for pain and fever instead. Apparently there are some cases of COVID-19 patients becoming much worse after using ibuprofen. (Important note: this does not mean that acetaminophen will help you fight the virus, only that other NSAIDs could inhibit your immune response. So no need to buy up all the Tylenol at the pharmacy.)
Recent update: It seems that COVID-19 may also cause or contribute to excessive clotting problems. We have been keeping an eye out for any studies that might show if blood clotting issues put people at greater risk from the virus, because someone we knew that did not recover from COVID-19 happened to have this underlying health problem. While it is too soon for much published research to be available on this point, anecdotal and case study data suggests this is true. One study involving autopsies of COVID-19 patients has shown some people’s lungs fill with hundreds of microclots. This article on Yahoo news and this article on hematology.org also provide some evidence of the clotting problem.
Recent update: This Washington Post article on the clotting problem warrants considerable attention. Here are several notable excerpts:
“The concern [about clotting] is so acute some doctor groups have raised the controversial possibility of giving preventive blood thinners to everyone with covid-19 — even those well enough to endure their illness at home.”
“Then came the autopsies. When they opened up some deceased patients’ lungs, they expected to find evidence of pneumonia and damage to the tiny air sacs that exchange oxygen and carbon dioxide between the lungs and the bloodstream. Instead, they found tiny clots all over.”
“[M]any came to believe the clots might be responsible for a significant share of U.S. deaths from covid-19 — possibly explaining why so many people are dying at home.”
“[…] due to the unique demographics of U.S. patients, including large percentages with heart disease and obesity that make them more vulnerable to the ravages of blood clots.”
“A Dutch study published April 10 in the journal Thrombosis Research provided more evidence the issue is widespread, finding 38 percent of 184 covid-19 patients in an intensive care unit had blood that clotted abnormally.”
“Some medical centers have begun giving all hospitalized covid-19 patients small doses of blood thinners as preventive measures, and many are adjusting doses upward for the most seriously ill. The challenge is the more you give, the greater the danger of upsetting the balance in the other direction and having the patient bleed to death.”
So this raises a tricky and potentially contradictory point: while NSAIDs may reduce a person’s immune response to the virus, taking low dose aspirin (and/or fish oil supplements) may help to prevent the clotting problems. The Washington Post article referenced earlier even mentions this possibility. So you may want to talk to your doctor if taking low dose aspirin (and/or fish oil supplements) may be right for you to prevent such clotting problems. If you are already on anticoagulant medications, you may want to discuss with your doctor if you should take extra precautions to attempt to avoid virus infection.
What is interesting about this COVID-19 virus from a medical perspective is, that it can have such vast differences in effect on people – depending on an individual’s prior health status. Healthy people can be infected with the virus, yet be completely without symptoms. Meanwhile, for people with certain pre-existing health conditions, the virus can be deadly. That says a lot about the power of prevention, and healthy lifestyle.
Biology is funny like that. You can accomplish a lot with prevention. While sometimes no amount of treatment after the fact is enough. Therefore prevention is key. And contrary to popular beliefs, many health problems can be prevented. They can be prevented through careful selection of what one puts in their body, how often one exercises, how much sleep one gets, and stress management.
What exactly is an underlying health condition?
But let’s back up a second here. Let’s first answer a question that many are asking, but few dare speak of. What is an underlying health problem? At what point, is a person considered to have an “underlying health problem” that can result in the COVID-19 virus to become serious? Do you have to have ischemic heart disease? High blood pressure? Clotting problems? Lung problems? Kidney problems? What about type II diabetes? Are you immunosuppressed from too much stress and not enough sleep?
I think here is where it needs to be discussed that if you’re on blood pressure medication, you have a potentially preventable underlying health problem. If you are on anticoagulants (“blood thinners”), you have a potentially preventable underlying health problem. Smoking creates preventable health problems. And obviously poor diet, lack of exercise, lack of sleep, and excessive stress can all create preventable health problems. Poisoning your body with unnecessary chemicals (via food or personal care products) also leads to preventable health problems.
Numerous recommendations are provided below for things you can do to prevent or ameliorate many of these health problems. You may not be able to change your chronological age, or some of these health conditions, but you can still make the healthiest choices possible with what you’ve got.
When this pandemic is over, if a proper (accurate and honest) study is ever done about the people who died from this virus, it is my educated guess that the majority (90%+) will be found to have had an underlying medical condition that made them more susceptible to the virus. And that is truly tragic, because many of those underlying medical conditions could have been prevented or (better) treated, and many of those people could have been in better condition to withstand and recover from the virus.
Health Preparedness (AKA Health Resilience) is a choice
Since one never knows when they may face some new health challenge (like a virus), one must always have their body ready. Or to put it more directly, we always need to maintain our health to the best of our ability, to be ready for whatever may come.
To the extent that people don’t do so, they (and the medical establishment) shouldn’t be surprised with their own fragility. And let’s face reality: the broken medical industry as it exists in the US puts almost no emphasis on (inexpensive) prevention, and much emphasis on expensive treatments after the fact. Because the incentives involved reward expensive treatments and do not reward prevention. To an important degree, health fragility and health resilience are both choices. Neither happen by accident. And regardless of the medical industry, that responsibility falls on us as individuals.
For example, a common response I get to my “no thanks” when offered unhealthy food such as fast food or desserts is, “we all gotta die of something”. But then when that “something” starts killing people in waves, all of a sudden it’s a problem? Yet it’s a largely preventable problem. Just a matter of choosing to not eat that poisonous “food”. Or choosing to not buy packaged foods without evaluating the ingredients. Or choosing to not smoke. Or choosing to exercise regularly. Or choosing to not smear or spray phthalates all over your body. (Among other choices.)
Simple (but difficult) things you can do to improve your health
You are probably tired of hearing about diet, exercise, smoking, etc. But we’re going to say it again, because during this pandemic, no one is talking about things that can be done to prevent, reverse, or improve certain health conditions. So here they are (again).
- Stop smoking. Give your lungs a break and just quit. Recall that COVID-19 is hardest on your lungs.
- Stop vaping. Research is coming out showing that vaping is not healthy either. For good summaries, see here and here.
- Stop eating foods if you don’t know what ingredients they contain.
- Learn which ingredients are healthy and unhealthy, and learn how to read a nutrition label. (Additional resources provided below).
- Make meals from whole foods from scratch, so you know all the ingredients.
- Practice portion control. Only eat the correct portion for your height and activity level.
- Do some type of exercise daily. Take the dog for a longer walk. Learn and practice yoga or martial arts. Set up a workout program (weights and/or cardio) on your phone so you get reminders. Even a half hour a day can make a big difference in improving health. Whatever it takes.
- Learn stress management techniques. Everyone is different regarding what will work for you. Try some different techniques and do what works for you.
- Get enough sleep so you are not sleep deprived. Again, this is very individualized. If you have trouble sleeping, supplements like melatonin and valerian can help.
The great news is, any of us can start making healthier choices and develop health preparedness or resilience today. We provide informational resources for doing so (keep scrolling down). And it is something you can do to make use of the additional time you have while most of the world is on pause.
Additional Nutritional Resources
Here are some basic references for reading food labels: (Disclaimer: just because I link an article on one of these sites, does not mean I endorse the entirety of the content on those sites.)
The Basics of the Nutrition Facts Label
Rob’s “Cliffs Notes” Oversimplified Nutrition Guide:
- Realize that dietary needs are somewhat individualized. What is ideal for one person, may not be ideal for another. (E.G. one person may do well as a vegetarian, while another will do well on a Paleo diet.) This is due to differing genetics, different lifestyles, and different activity levels. (Some people need more carbohydrates, some more fats, and others more protein.) There is no one size fits all perfect nutrition plan. However there are certain universal guidelines which I touch upon below.
- Do eat (most) vegetables, (many) fruits and (most) nuts. Avoid peanut products – they tend to be allergenic, and considering they are frequently contaminated with aflatoxin, they are not healthy.
- Avoid most processed and pre-packaged foods.
- Do eat enough protein, from sources suitable for your genetics, immune system, and digestive system.
- Avoid refined carbohydrates that spike blood sugar and insulin (these include basically all baked goods, bread, pizza, muffins, pancakes, chips, cakes, and candy).
- Source reference materials that list the nutritional content of foods: how much protein, carbohydrates, and fats, and which types of fats they contain. Knowing that walnuts contain a mix of Omega 3 and Omega 6 fats, or the ratio of carbohydrates to protein in beans is useful information. So are glycemic index and insulin index charts (not just for diabetics).
- Drink enough pure water. Reverse osmosis and carbon filtration are good to eliminate toxic chemicals from your water.
- Do eat a balance of fatty acids: Omega 3 (fish oil, flax oil, walnuts), Omega 6 (sunflower seeds, sesame oil, walnuts, most vegetable oils), and Omega 9 (olive oil, almonds, avocado).
- Update: Avoid consuming too many Omega 6 fatty acids (most of the time) which are pro-inflammatory. Foods with Omega 6 fatty acids include most vegetable oils, like corn oil, soybean oil, safflower oil, canola oil. Chronic inflammation not only leads to numerous health problems, it will also make your immune system less ready to respond to infections. Inflammation is intended as a temporary response to infection or injury, not continuous. (An analogy: If you’re running all the time, you will be too tired to sprint from the bear that suddenly tries to eat you.)
- Update: When you are fighting off an infection, temporarily eating more Omega 6 fatty acids may help your body fight off the infection. There are many studies supporting this perspective, for example this one and this one.
- Update: In general, Omega 3 fatty acids are quite health beneficial, because they are anti-inflammatory (which is normally good). However, during a COVID-19 infection they could prove a double edge sword. On the one hand Omega 3s may blunt a person’s immune response to the infection. On the other hand, fish oil in particular may reduce the clotting problems that COVID-19 can apparently cause in some people. These are topics you should discuss with your doctor for your particular health scenario. It may be useful to have your doctor review studies that demonstrate that fish oil has anticoagulant effects, such as this one and this one. Then discuss with your doctor how this applies to you.
- Choosing organic foods is not merely a social statement nor environmental activism. Organically produced foods contain far fewer toxic chemicals, such as glyphosate, atrazine, chlorpyrifos, mancozeb, etc, etc. The list of petrochemicals used in agriculture is very long, and many of them likely cause cancer, hormonal and reproductive disruption, and/or neurological and developmental disorders. If such agricultural chemicals were evaluated for toxicology the same way the FDA evaluates drugs, most of them would never be approved for use in FOOD.
- Realize that how a food has been produced, also known as “what has been done to it,” is as important as the food choice itself. I joke around with people that I can make broccoli unhealthy by spraying it with herbicides and fungicides, and then deep frying it trans fats. But that’s not a joke, it’s true.
- Not all meat is is grown equally: are saturated fats in meats really inherently unhealthy, or are they unhealthy because the animals bioaccumulate or bioconcentrate herbicide, pesticide, and fungicide chemicals sprayed on whatever was fed to the animals? Few nutritional scientists or toxicologists dare research such questions because they are politically and economically dangerous to the food, agricultural, and pharma industries. Best to choose organic and avoid the risk.
- IMHO the risks of dietary cholesterol, saturated fats, and sodium have been over hyped. If you avoid most processed food, you will naturally not eat too much sodium, and may have to add some sodium to your diet to avoid deficiency. This is because whole foods do not have much salt in them. So if you eat fresh foods and not processed foods, you are not eating much salt.
- Similarly, the link between dietary cholesterol and cardiovascular disease has been exaggerated. If you have a genetic or familial history of heart disease and hyperlipedemia, of course be mindful. Also consider that refined carbohydrates, such as high fructose corn syrup (HFCS), may actually raise blood lipids far more so than dietary saturated fats. Or to put it in practical terms, that Big Gulp of Coke (sweetened with HFCS) will likely raise your blood triglycerides more than eating a steak or eggs will. This is due to the facts that 1. HFCS must be metabolized by the liver prior to being used, and 2. excess carbohydrates are readily converted into fats for storage, because the human body has a very limited capacity to store carbohydrates (in liver and muscle tissue). Humans largely store excess dietary energy as triglycerides (fats).
- Healthy gut flora bacteria are very important. Eat organic yogurt or other fermented foods, or take a probiotic supplement.
- Update: People will vary in how poorly they tolerate glutens. I think few people actually tolerate glutens “well”. This could be sufficient reason to eliminate wheat, barley, rye, and potentially oats from a person’s diet, or alternately reduce consumption in favor of other calorie sources. Also realize that most grains are contaminated with the likely cancer causing glyphosate due to its use as a “crop desiccant” in farming.
- The so-called “Mediterranean Diet” accidentally incorporates many of these suggestions (but is also overly critical of meat).
- Learn to listen to what your body tells you based on how you feel. Tolerance to certain foods is again, highly variable depending on genetics. Just as some people can tolerate lactose and others cannot, some people can tolerate beans and legumes, or whey, or casein, or certain grains, while other people will get ill from consuming them. Listen to what your body tells you it does or does not need, while still using reason. In other words, if your body is telling you to eat pizza or cookies, that is not what I mean.
- Update: Realize that some of the greatest obesity inducing foods are those that are high in both refined carbohydrates and fats. For example, ice cream, pizza, cake, cookies. Avoid foods that contain both high fat and high refined carbohydrate. Try to formulate meals that always contain protein, while also containing either fats or carbohydrates, but not both in the same meal. This may sound strange, but it works. The hormonal biochemistry of why it works is complex and beyond this article, but send us an email if you would like me to explain it further.
- Finally, of course make sure you are consuming a sufficient amount of essential vitamins and minerals. Take a multivitamin/multimineral and consider educating yourself about more advanced supplements that may improve your health.
This is not on all inclusive list, but a general starting point.
For health (with urgency),
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