PROSTEM COVID-19 Health Initiative

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In the midst of the ongoing COVID pandemic, taking responsibility for one’s own health, and specifically their immune system, is vital. The human immune system consists of several major components, each of which works together to keep you healthy and safe. Strengthening and maintaining one’s immune system is a matter of proactively making healthy choices, and having a prevention-oriented mindset. Certain populations and people with immune compromising illnesses are more vulnerable to developing infections and complications from infections. With Covid-19, we’ve seen that African American and Latino populations have had higher rates of illness and death. People with lower income, poorer living conditions, and inadequate access to health care are also more vulnerable. Not only is it important to care for our own individual health, but it is also important to demand a change in policy to improve these social determinants of health.

One of the most important and accessible habits you can start practicing is exercise. In the short term, exercise can help the immune system find and deal with pathogens, and in the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. Next is diet, which often goes hand in hand with exercise. Studies show vitamins C, A, E, B6 and B12 and minerals like iron and zinc are important for the maintenance of immune function, all of which can be found in fruits and veggies. Proper intake of iron is also necessary to prevent anemia, a very common condition found among younger Americans. Third, sleep habits are integral to a healthy body. Sleeping at least 7 hours per night is a good way to make sure you are awake the next day, But more importantly, studies suggest that sleeping results in decreased levels of the stress hormone cortisol, which can suppress immune function, and increased amounts of signals that activate the immune system. In regards to drug usage and its effects on the immune system, most if not all drugs are harmful to your body and lead to a weaker immune system. Decreased liver and pancreas functioning caused by alcohol consumption can lead to immune system problems, for example.

There are several illnesses CDC considers as established or possible risk factors that impact the immune system and increase the incidence of developing certain infections and severe illness from infections. Some of these illnesses are preventable with a healthy lifestyle and education. 

Smoking: Cigarette smoking is responsible for approximately half a million deaths in the US annually and several million deaths all over the world. It increases risk of developing different infections like COVID-19, pneumonia, tuberculosis, flu. It also decreases life expectancy by causing cancer, heart disease, circulation problems, stroke, chronic obstructive pulmonary disease ( COPD) and scarring of lungs. Quitting smoking has great benefits and if one cannot completely quit, even reducing the number of cigarettes smoked per day helps improve the health status. Smoking cessation at any age and even after developing illnesses is beneficial and improves respiratory symptoms. Factors that make it difficult to quit smoking can sometimes be the withdrawal effects of nicotine because nicotine is addictive. There are several smoking cessation methods including medications, counseling, telephone quitlines. It might take several attempts to quit and people can have relapses after quitting. It is important to have a supportive environment from family, friends and your doctor. 

Obesity: Obesity is a global disease associated with high morbidity and mortality. It is associated with diabetes, high blood pressure, high cholesterol, heart disease, stroke, sleep apnea and cancer. During the recent Covid-19 pandemic, high BMI was associated directly with an increase in risk of covid 19 infection and delayed recovery. Incidence of obesity has been going up in all ages due to changes in our diet and decrease in activity, increase in sedentary lifestyle. It is important to see your doctor to get tests done to rule out secondary effects of obesity and also possible conditions that cause obesity. There are different kinds of diets like the Atkins diet, weight watchers diet, south beach diet to name a few but there is no proof one diet is better than others. Any low calorie diet and increasing the number of calories you burn with exercise will help lose weight. It is important to sustain these lifestyle changes lifelong. There are also medications and weight loss surgeries but these can have side effects and it is important to get doctor’s advice before one considers these options. 

Chronic obstructive pulmonary disease/Asthma: COPD is a common respiratory condition seen in smokers. It is one of the common causes of death and disability. Both COPD and asthma are caused by inflammation in small and large airways producing a lot of mucus, cough and shortness of breath. They predispose people to several infections. Covid 19 is considered as the third leading cause of death in the United States last year and COPD, asthma patients were shown to have a higher risk of not only developing covid- 19 but also prolonged and severe illness. COPD is a preventable illness and treatable with medication. Most important part of treatment is to stop smoking. There is a link to the number of pack-years smoked ( packs of cigarettes per day multiplied by number of years) and severity of the disease. Environmental factors like exposure to fumes, chemicals contribute to asthma and COPD. COPD can coexist with other smoking related illnesses like lung cancer. Quitting smoking and seeking appropriate treatment from a doctor can help with improving exercise capacity and quality of life.

Chronic kidney disease: Chronic kidney disease is caused by various conditions but most common causes are diabetes and high blood pressure. It can also be caused by certain infections like Covid- 19. Covid-19 not only affects patients with chronic kidney disease at higher numbers but also causes higher risk of severe disease. Certain ethnic groups like African Americans are disproportionately impacted by chronic kidney disease.  It is important to allocate enough resources to screen for early detection in this population so that end stage kidney disease requiring dialysis can be prevented. There was a higher incidence of COVID- 19 in this population as well. Although we cannot change our genetics, we can change the environmental factors that cause chronic illness. Kidney disease can be prevented by adequate control of diabetes and high blood pressure. Sometimes certain conditions causing kidney disease need treatment with immunosuppressive agents which increase the risk of infection. 

Diabetes: It is a well known fact that diabetics are more susceptible to developing infections compared to non diabetics. Diabetes also poses unique challenges as it can cause severe illness and higher death rate. This is the reason why it is extremely important  to spend resources on education to prevent developing this condition. Most recently, with COVID-19 pandemic, diabetics were impacted disproportionately reflecting in the deaths and prolonged recovery from complications of this illness. Studies show the risk of infection increases proportionately with higher blood sugars. Additionally, uncontrolled diabetic patients  have higher incidence of circulation problems, neuropathy making them more vulnerable to infections. The immune response in diabetics is impaired and so they cannot fight off the infections leading to permanent damage like amputations and prolonged recovery. Adult onset diabetes can be prevented to some extent with a healthy lifestyle and complications from diabetes can be prevented with careful attention to controlling sugars and cholesterol, complying with doctors visits and treatment. Covid also brought forth the health disparities

Heart disease: Heart disease is a broad term to describe different kinds of heart problems including congenital and acquired. The acquired heart disease is associated with smoking, diabetes, hypertension, alcohol, poor diet and lack of exercise. Additionally, infections can cause heart disease. Most recently a number of heart complications were noticed in  COVID -19 patients because of damage to heart muscle. People with preexisting heart failure had worse outcomes including longer hospitalizations and death. This pandemic brings forth the importance of  prevention and early diagnosis of conditions that contribute to heart problems and also heart disease itself. Education of people is important so that they understand the impact of lifestyle on a healthy heart and going to the doctor to get age appropriate screening tests for early diagnosis and treatment.

Cancer: The number of people with cancer has dramatically increased in the last 50 years. Some of the most common cancers are breast, lung, colon, bladder, melanoma and prostate. People with cancer are more susceptible to infections because their immune system is weakened not only from the illness but also the treatments. Some data indicate there is higher prevalence of Covid-19 in cancer patients. The pandemic caused challenges in delivering care because of cancelations and delays in surgeries, chemotherapy, making this population more vulnerable to not only getting covid-19 from their immunocompromised state but also severe illness from infection and cancer.

Some cancer can be prevented by following a healthy lifestyle including diet, exercise, not smoking and consuming alcohol, avoiding risky behavior. Eating plenty of fruits, vegetables, less processed meats are known to decrease risk of cancer. If one chooses to drink alcohol, it is best to drink in moderation because overuse of alcohol can cause liver disease and cancer. Skin cancer is preventable by wearing sunscreen and avoiding mid day sun exposure. Getting vaccinated against hepatitis B and HPV ( human papilloma virus that causes genital warts) protects from infections and cancer caused by these viruses. Safe sex prevents sexually transmitted diseases like HIV and Hepatitis, HPV which are assoicated with some types of cancer. Drug use can increase these infections as well by sharing needles.

Inherited conditions like Sickle cell disease, Cystic fibrosis, Thalassemia also make people suffering from these conditions more susceptible to infections. These are conditions that impact different parts of the body and decrease immune response making it difficult for the body to fight off infection. It is important they seek care from doctors and get vaccinated per guidelines which will help prevent infections from becoming serious illnesses. Sometimes they have to take medications that decrease immune response, also making them more vulnerable to COVID-19. By following CDC guidelines with masking and physical distancing, they can decrease exposure and get infected.

Liver disease: Liver disease can be caused by alcohol overuse and infection. Obesity can cause fatty liver and illegal intravenous drug use can cause liver infection with hepatitis viruses. All of these increase risk of developing COVID 19. Liver damage can be irreversible and so it is important to avoid alcohol, drugs and get screening tests for hepatitis virus. If treated early, hepatitis can be cured.

Age: Risk of infection increases with age, although some children with obesity, genetic disorders, autoimmune diseases, neurologic disorders, sickle cell anemia, asthma, lung diseases, congenital heart problems might be at increased risk of developing infection and severe illness. 

References:

https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html

https://covid.cdc.gov/covid-data-tracker/#county-view

https://coronavirus.jhu.edu/us-map

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html#:~:text=Help%20at%20Home-,The%20risk%20for%20severe%20illness%20with%20COVID%2D19%20increases%20with,than%20people%20in%20their%2050s

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