This article was originally published as a guest editor post at foodpharmacy.se

By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.

Published: 08/04/2020

COVID-19, the highly infectious novel coronavirus spreading throughout the world, is leaving a path of destruction in its wake and shutting down entire societies. As I write this on March 28, it’s currently responsible for over 30,000 deaths around the world and 18,000 deaths in the EU¹. Initially, age was considered the biggest factor based on data from Wuhan, China, where the virus started².

Due to its older population, Italy has been hit hard. Currently, more than 10,000 people have died from COVID-19 in Italy. Early data in Italy indicates that the average age of those infected with COVID-19 is 63 years old, and the average age of those who have died is 78.5 years old³.

Much of the early data focused on age as the predominant factor in poor COVID-19 outcomes. This is consistent with the general trend of decreasing viral immunity with age (our immune system becomes less effective and therefore risk of complications becomes worse as we age). But what has been very interesting to me, is that further data outlines that age isn’t the only important factor predicting death of COVID-19.

Data out of Italy indicates that 98.8% of those who died of COVID-19 had a pre-existing condition that contributed to their death. Furthermore, over 75% had 2 or more comorbidities³ (a comorbidity is one or more diseases or condition/s that exist with other conditions e.g. high blood pressure with COVID-19). This should be a massive wake-up call to everyone and governments in the realm of chronic disease prevention.  

Table: Most common comorbidities observed in COVID-19 positive deceased patients³

As you can see from the image, the top 3 comorbidities for death from COVID-19 are hypertension, ischemic heart disease, and diabetes. Conspicuously, chronic obstructive pulmonary disease (COPD), which in most cases is caused by chronic smoking, is 7^th. How can a progressive and chronic inflammatory lung disease be so far down the list? COVID-19 is a lower respiratory infection that becomes fatal most often due to respiratory failure. As we shall see, systemic inflammation seems ‒ somewhat surprisingly ‒ to play an even bigger part in COVID-19 mortality than COPD.

Metabolic health and COVID-19 outcomes

As we get older, several changes increase our risk and severity of viral infections. One in particular is a gradual increase in systemic inflammation often referred to as inflamm-aging⁴. Interestingly, changes in the gut and microbiome are considered important drivers of this chronic inflammation.

Obesity promotes a chronic inflammatory state similar to that seen with aging. Again, the microbiome is considered a primary driver of this effect⁵. Recent evidence indicates that the western lifestyle may be the cause of this inflammatory state by promoting an inflammatory microbiome⁶.  

As a result of chronic inflammation, our risk for chronic disease increases as we age. That’s why chronic diseases such as type 2 diabetes, hypertension, and cardiovascular disease are often referred to as the chronic disease of aging. However, age is not a prerequisite for chronic disease. It’s becoming more and more common for younger people to become afflicted with the chronic diseases of aging. 

As such, people with chronic metabolic diseases are at an increased risk of poor outcomes from COVID-19 infection, regardless of age. Thus, addressing specific aspects of the Western Lifestyle is important for reducing the risk of COVID-19 infection and improving outcomes. This includes:

• Consuming a diet high in vegetables and fiber
• Addressing circadian rhythms (our evolutionary preferred wake/sleep patterns)
• Being active/exercising
• Maintaining a healthy weight
• Prioritizing sleep
• Managing stress
• Limiting alcohol intake
• Not smoking

These are all areas that currently our healthcare system is terrible at giving advice on. I have seen thousands of patients at Nordic Clinic Stockholm and I can barely count on one hand patients that have reported to me that their doctor is providing them with any substantial advice in any of these areas.  

While age is a factor that you have no control over, lifestyle is not. Thus, a healthy lifestyle may be your biggest weapon against death from COVID-19 infection. Considering this information, I am now becoming very worried to see the impact of COVID-19 on the US, UK and even Sweden’s population. The US has extremely high rates of obesity and the UK and Sweden are not far behind. As it stands, although I am sure there will be some outliers, I believe we will continue to see the people most affected by this pandemic as having some sort of underlying chronic health condition.  

Functional medicine, the model we follow at Nordic Clinic, is not a model for acute care. Luckily, those that have COVID-19 and that are in acute trouble could not be under better care with our standard healthcare system in Sweden. But the same healthcare system is failing miserably at preventing chronic disease and needs to do better to test and educate the population for risk of chronic disease. Doctors are given close to zero training in nutrition, exercise, sleep and other lifestyle factors that undoubtedly are the cause of poor cardiometabolic health. At the heart of Functional Medicine we measure, track and advise patients on their currently chronic disease risk, preventing it before it has a chance to happen. 

Lifestyle and preventative health need to be taken more seriously

Initial reports out of both China and Italy indicate that COVID-19 will hit older populations hard. Unfortunately, in the EU, this gives young people a false sense of security. Looking at all the data, it’s clear that, while age is one important factor, established metabolic disease is another.

Therefore, it becomes increasingly important for people of all ages to maintain metabolic health. Hypertension, type 2 diabetes, and cardiovascular disease seem to be particularly harmful and predict poor outcomes from COVID-19 infection. Addressing lifestyle should be a first line of defense in the fight against COVID-19 infection and people and governments need to take preventative health more seriously. 

We need to utilize measurement tools and more sophisticated testing of lifestyle, and have doctors who are better equipped to understand that data and give evidence-based advice. It is out there, but Sweden continually refuses to embrace it, deciding to try and manage chronic disease once it has happened.  

Functional Medicine is a system that could fill this void and work alongside the current acute care system, and it is about time our politicians take this more seriously.  

References

1. https://www.statista.com/statistics/1093256/novel-coronavirus-2019ncov-deaths-worldwide-by-country/
2. https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/
3. https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf
4. https://www.ncbi.nlm.nih.gov/pubmed/30046148
5. https://www.sciencedirect.com/science/article/pii/S1568163719302880
6. https://www.nature.com/articles/s41577-019-0156-1?fbclid=IwAR3jEVbq918MMVcGfT5pvJ71CJcLDCBfZg4acaL9tasYS1jCHACBIZcxlv8#citeas