COVID-19 endemic stage: Healthier lifestyle can make a big difference

Vaccines have thus far proven effective in reducing disease severity and mortality. Still, it is also true that low-category Covid-19 can progress into severe categories through underlying health conditions such as obesity and diabetes. In fact, the vast majority of deaths among those fully vaccinated people are those with chronic comorbidities.

Despite this trajectory, there is not enough emphasis on personal responsibility for individual health. It’s time to realise that most severe cases and deaths (aside from older age groups and outlier cases) are associated with underlying diseases that could have been preventable if addressed early on.

According to the World Health Organisation, some 17.9 million people die annually from cardiovascular diseases, making it the biggest contributor of non-communicable diseases (NCDs) deaths. This is followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million).

As observed, genetic predispositions aside, most of these deadly NCDs are generally preventable “lifestyle diseases”. Major contributors to NCDs include smoking, alcohol intake, poor diets and lack of physical activity.

As natural selection gives rise to more resilient virus variants and strains, humans also have to adapt as best as they can. Therefore, Covid-19 has taught us that our lifestyle has to change. After all, staying in shape and being prepared is not an option when “living with the enemy”.

Thus, the following essential items (but not limited to) can significantly improve your chances against Covid-19:

According to a press release by the European Society of Cardiology (ESC), heart disease has been linked with a nearly four-times increased chance of severe Covid-19.

As reportedly mentioned by Dr. Stephanie Harrison of the University of Liverpool, UK: “Many of the cardiovascular risk factors associated with more severe consequences from Covid-19 are potentially modifiable”. Therefore, it is clear that having a healthier cardiovascular system could minimise disease severity, and that this is well within our control.

Covid-19 is primarily a respiratory illness, so it is no surprise then chronic lung diseases can increase the chances of severe Covid-19. One of the biggest risk factors for chronic lung diseases is tobacco smoking. According to the ESC, smokers have an 80% higher chance of severe Covid-19 compared to non-smokers. Additionally, alcoholic intake (such as from beverages) has been linked to an increased risk of heart problems, which in turn, increases the risk of severe Covid-19.

Several studies [1],[2] have indicated that plant-based and pescatarian diets to be associated with reduced risk and severity of Covid-19. That said, these studies may not be proving direct causality. Health is a holistic issue and it would be reasonable to assume that most people following such dietary regimes are also the same people who lead an overall healthier lifestyle and come from a higher income group, which could provide better access to a balanced source of healthy food.

Anyways, the need for a varied and balanced diet is shown in a systematic study led by Iranian researchers that concluded that vitamin D, vitamin C, vitamin A, folate, zinc, and probiotics are the most important nutrients to be considered in Covid-19 management.

Other dietary agents the researchers considered beneficial for the immune system include vitamin E, magnesium, selenium, alpha-linolenic acid and phytochemicals. Additionally, the systematic review also found that protein-energy malnutrition (PEM) is common in severe respiratory infections.

Therefore, one needs variety in food sources to cover all these macro – and micronutrients. Also, because obesity has been found to be associated with decreased immune function, the systematic study also suggested increasing physical activity (exercise) and a “slight caloric restriction”.

Additionally, because high blood pressure and hypertension are significant contributors to disease severity, anything that can worsen the condition such as high-salt and high-saturated fat food should be minimised. Takeaway: A balanced diet taken in moderation is key, and get that quick morning sun.

A study by Kim and colleagues found longer sleep duration was associated with lower odds of Covid-19. Conversely, sleep problems and exhaustion were found to be associated with higher chances of Covid-19 and could be a risk factor healthcare workers.

Recall that high blood pressure is a significant contributor to disease severity, with the ESC reporting “more than doubled odds of dying from Covid-19”, and “more than double” the risk of severe outcomes with hypertension.

It is also widely known that sleep deprivation and stress can lead to increased blood pressure and hypertension, negatively impacting on our immune system. Therefore, we have to rest well through sufficient quality sleep which impacts our mental health, and our body’s ability to heal. A continuous rest deficit equals diminishing returns on our body’s ability to defend itself.

Admittedly, we are merely re-discovering the obvious. None of these recommendations are new, nor are they rocket science. However, the apparent “obviousness” of self-care often (ironically) makes it the most overlooked aspect in disease prevention.

Moving forward, the Government and the healthcare system (both public and private players) have to start promoting and incentivising healthy lifestyles.

Although low-impact exercise, avoiding tobacco and alcohol, and having sufficient rest is something generally doable for everyone, access to high-quality, nutrient-rich natural food in order to have a balanced diet may require a change in the economic system.

For example, currently the choice for “organic” whole foods is only accessible to higher socio-economic groups, and this cannot be the way forward for society. As we strive for universal healthcare, the same mindset of universal access to healthier versions of food is needed.

Agricultural and food production process standards have to change, and this can only be done starting with favourable policies on the matter. For example, there should be mechanisms (legal or otherwise) to ensure “organic” standards to become the “normal” non-premium standard.

Supporting policies such as a hefty sin tax should be created not only for cigarettes and alcoholic beverages, but perhaps many other disease-inducing substances to fund a special budget for lifestyle-related NCDs. Special incentives (beyond tax exemptions) should be made to incentivise healthy food, sports equipment, outdoor activities and gym membership.

In conclusion, one of the many lessons in disease prevention that we can learn from Covid-19 is the need to shift focus towards empowerment of individual health (at scale) as a crucial and indispensable component of social protection, which has the potential to exhibit community-level resilience against current and future health crises.

---

Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.