Is COVID-19 an assault on the out of shape American?

(Last Updated On: April 27, 2020)

There are countless studies coming out right now. Here’s one which caught my eye (primarily due to such a big sample size):

–Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

A lot of people are trying to tease out everything they can from this virus. I’ll leave that level of nuance to the experts.

Meanwhile, something us non-immunologists can do is look for big takeaways. After all, the course of the virus is in part predicated on how everyday citizens change their behavior.

The big takeaway of this study: 88% had multiple comorbidities.

Of those comorbidities,

• Hypertension was the most common at 57%
• Obesity next at 41%
• Diabetes next at 34%

We’ve known since February these issues magnified problems with this coronavirus. The evidence appears to be growing, significantly.

-> I would also note how few had other potentially compounding problems. For instance, breathing is clearly a concern in the hospitalized, yet it’s not like this is an attack on asthmatics (only 9% hospitalized). Same goes for immunosuppression.

Some off-the-top-of-my-head comments and questions,

• Is this the crux of the age disparity? Children and teenagers, while they can be obese, they’ve almost never have had enough time to get hypertension.
  • Notice the chart above: having one comorbidity not a big deal. It’s when you have multiple hospitalizations skyrocketed.
• Similarly, is this a big factor in the discrepancy in what minorities are going through? They’re getting hit harder, and are known to be in worse physical shape than whites.
  • Note I am not stating being in-shape is unequivocally the reason here. Minorities are also known to, on average, have lower socioeconomic status, which always impacts health. There can be a chicken or the egg scenario here.
• Can this help explain the differences amongst countries? Is part of the reason America is having such a hard time due to our pre-existing health going into this?
  • One narrative being thrown out by Americans is to all but discount China’s experience. “Yes, they have way more people than us and way less cases, but they aren’t being honest in there case numbers, so I don’t believe they’ve handled it better.” Throwing aside this means you also think American companies like Starbucks are lying when they say, at the end of March, they already reopened 95% of their stores in China, but ok, what about Europe? They have like 750 million people. More than double the United States…yet we’re approaching having the same number of cases, as the continent of Europe. (Source.)
    • Something like 50% of the EU is overweight, while 70% of Americans are. Another way of looking at this: about 50% of EU residents are overweight, while about 40% of Americans are obese.
• The developing world has yet to be hit hard, despite it’s lesser healthcare resources. Will the fact the developing world largely doesn’t deal with obesity, etc. cause it to never be hit hard?
• We’re seeing evidence, based on antibody studies, way more people have had the virus than previously thought. Is this population -got the virus but didn’t need hospitalized care- less prone to having comorbidities related to physical fitness?
• If America, or the world, was in better shape, how much less collateral damage would we have now? Whenever we calculate the cost of obesity on society, we do it with metrics like time missed working, less years life expectancy, etc. What happens if we end up adding “entire world economy drastically altered in 2020” to the equation?
• Should there be a nationwide campaign to get people into better shape right now?
  • I’ve seen a governor or two suggest one reason to keep parks and such open is so people continue to exercise, to help keep them in better health should they get the virus. Should this be getting more attention?
  • There’s been jokes of the “Quarantine Fifteen”. Should that not be a joking matter?
  • If there is a second wave once colder weather returns, that’s about 6 months we have to get in better shape. If the average person loses 20lbs, can we alter the future?
  • What’s the downside of this?
    • It may take years to fully tease all the correlations out, to figure out causation, hazard ratios, etc. (This study did not control for e.g. socioeconomic status.) How is waiting advantageous in this context? This isn’t like a vaccine requiring clinical trials to examine safety. If in five years we find out being poor was much more of a factor than being out of shape, yet we get all these out of shape people exercising because we weren’t sure what really mattered…where’s the negative in that?

Most of those questions are for the nuanced experts to dissect. The final point is a broad takeaway we can all work with. You’re never going to regret you got in better shape during this time, but you might really regret it if you didn’t.