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Metropolitan Museum of Art. , Stevepb, Tomasz Sienicki
New data from the Centers for Disease Control and Prevention confirm that people with lung disease, heart disease, hypertension, or diabetes who contract COVID-19 have a much poorer clinical course, compared with people without these conditions. Figures as of March 28 showed that the risk of an ICU admission was 2.2 percent to 2.4 percent in those without underlying conditions and 13.3 percent to 14.5 percent in those with such conditions. Of those who died, 94 percent had one or more underlying health problems.
So far, government advisories have been silent on steps to address these underlying conditions, focusing instead on avoiding the virus, rather than strengthening the host. But when this strategy fails, as it often does, and infection takes hold, these neglected conditions lay a path to a grim outcome.
If we have imagined that the oncoming locomotive of COVID-19 has left us no time to bring these underlying conditions under better control, it is time to think again. According to the Institute for Health Metrics and Evaluation at the University of Washington, the COVID-19 epidemic will not taper off until mid- to late June. This means that, over the next eight weeks or so, many people will acquire the virus. A lot can be done in eight weeks. Moreover, virologists are already predicting a recurrence in the fall. Now is the time for action. So what can be done?
First, we can quit smoking. Influenza infections occur five times more often in smokers than nonsmokers, and there is no reason to believe that COVID-19 is any more benign to smokers. Smoking cessation improves lung function and reduces sputum neutrophil (white blood cell) counts within six weeks.
Second, we can optimize medications. Roughly half of individuals with hypertension or diabetes are undertreated. Restoring lapsed prescriptions and treating to target can be done in a matter of weeks.
Third, we can implement diet changes. The Dietary Approaches to Stop Hypertension (DASH) study showed that diet changes alone can reduce blood pressure in eight weeks. Within a similar timeframe, low-fat plant-based diets reduce body weight and improve blood sugar control and blood cholesterol concentrations. Limited evidence suggests that diet changes, especially avoiding dairy products, may also rapidly improve lung function in individuals with asthma.
This is precisely why Brooklyn has enacted policy initiatives to help community members adopt healthier diets rich in fruits, vegetables, and grains. Whether it’s Meatless Mondays for schoolchildren, the plant-based lifestyle medicine clinic at NYC Health+Hospitals/Bellevue, or veg-curious meet-ups, Brooklyn is encouraging its constituents to protect their health through their food choices. Those who have done so may now have a better chance of fighting COVID-19, and we encourage communities throughout the U.S. to optimize their diet as soon as possible. Once we’ve emerged on the other side of this pandemic, nutrition initiatives need to stay central to the conversation around health.
Faced with a novel threat for which we have no treatment, we may take a lesson from a curious observation during the H1N1 pandemic of 1918. At a Minnesota seminary, 90 of the 120 students and faculty developed influenza symptoms. However, in sharp contrast to the devastating statistics elsewhere, none of these individuals progressed to pneumonia and none died. What differentiated the seminarians from the general population was that they were nonsmoking, teetotaling individuals fed a diet of grains, fruits, nuts, and vegetables—precisely the sort of plant-based regimen that modern randomized trials have shown to be effective for treating diabetes, hypertension, and lipid disorders.
Quitting smoking, optimizing our medication doses, and making diet changes to shore up our heart and lungs will not shield us from contagion; that is what handwashing, hygiene, and social distancing are for. But they will ameliorate the underlying conditions, and that may determine who lives and who dies. We have time—barely. Let us not waste it.
Eric Leroy Adams is the Borough President of Brooklyn. Neal Barnard, MD, is president of the nonprofit Physicians Committee for Responsible Medicine.