Cory Franklin and Robert Weinstein
For the past three years, the COVID-19 pandemic has demonstrated, and will continue to demonstrate in the future, that America is one of the unhealthiest countries in the industrialized world.
Critics on the right and left harp on how the pandemic was handled, but in fact the dismal outcomes in the U.S. do not reflect management of the crisis so much as our underlying health as a country.
With the caveat that the actual figures from China are unknown, in the past three years, the U.S. is the only country in the world that has suffered more than 1 million deaths from COVID-19.
Vaccination clearly saves lives, and this country lags on current booster acceptance, but the U.S. vaccination rate is still in the top third of world. Moreover, the comparatively high U.S. death rate began in the first year of the pandemic before vaccines were available.
The key reason for the lethal impact of COVID-19 here is the health of the American people. Age is certainly a factor, but Canada has an older population and a per capita death rate less than half that of the U.S.
A much more important set of factors is the twin American demons of obesity and diabetes, which often coexist. This “twindemic” has been the scourge of elderly Americans and accounts for a significant fraction of U.S. COVID-19 deaths.
Now a study from The Journal of the American Medical Association reports that diabetes and obesity are rising among U.S. adults between ages 20 and 44. Because a serious excess of heart disease and strokes is now emerging in COVID-19 patients long after recovery, this means another generation of Americans will be at greater risk of premature death.
Another speculative reason the U.S. may be having such bad COVID-19 outcomes is because our immunity to COVID-19 might be less than that of people in other countries.
If so, poor immunity in the population could be genetic or a function of less exposure to related viruses. Whether this is true is unknown because our current understanding of immunity is rudimentary and we cannot measure it easily. However, it is now known that obesity impairs the body’s immune response. In addition to the well-known short-term advantages of better cardiovascular health, losing weight may benefit an individual’s immune system years into the future.
This leads to another lesson of the pandemic: We must reexamine our traditional concept of health. In addition to weight, fitness, underlying diseases, smoking, alcohol and drug use, we should add to our health model a history of past COVID-19 infection — because of the potentially devastating long-term effects in a sizable portion of the population — and some measurement of our immunity. Developing a reliable measure for immunity should be a top priority for future immunologists. Imagine the value of quantifying an individual’s immune strength, much as we estimate cardiovascular risk or cancer risk.
Failure to prepare is preparing to fail. Unless we address the elephant in the room — the underlying poor health of the American public — all efforts at planning for the next pandemic, whenever and wherever that occurs, are destined to fall short.
COVID-19 revealed that in times of mass contagion we must do more than simply rely on bureaucratic government emergency management teams and health agencies. Becoming thinner and healthier and laying the groundwork for better immune health will be essential to successful pandemic preparation next time around.
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert Weinstein is an infectious disease specialist. They wrote this piece for the Chicago Tribune.
