Shelter from the cytokine storm: Healthy living is a vital preventative strategy in the COVID-19 era

Abstract

Coronavirus disease 2019 (COVID-19) continues to have a devastating effect on a global scale. COVID-19 variants continue to arise and counteract vaccination efficacy. As such, preventative health measures, such as social distancing and stay at home mandates, will continue for the foreseeable future. Evidence on those at greatest risk for poor outcomes if infected with COVID-19 has rapidly come to light. It has become clear that those with unhealthy lifestyle characteristics, chronic disease risk factors and/or a confirmed diagnosis of one or more chronic conditions are at greatest risk for hospitalization, intensive care unit admission, mechanical ventilation, and death if infected with COVID-19. The cytokine storm is a phenomenon that has been posited as a pathophysiologic response to COVID-19 infection that leads to poor outcomes. The current graphical review illustrates the association between unhealthy lifestyle characteristics and increased vulnerability to the cytokine storm as well as the physiologic mechanisms healthy living behaviors elicit and decrease risk for the cytokine storm. Through this graphical review, we will demonstrate unhealthy lifestyle characteristics, chronic disease risk factors and diagnoses, and COVID-19 outcomes are intricately linked, creating a new global syndemic. It is also clear that a primary way to uncouple this syndemic is through increasing healthy living behaviors, as illustrated in this graphical review. Moving forward, healthy living medicine should be practiced with renewed vigor to improve human resiliency to health threats posed by both chronic disease and viral infections.

Why are COVID-19 effects less severe in Sub-Saharan Africa? Moving more and sitting less may be a primary reason

“… 1 , 4 , 5 In this context, decades of unhealthy lifestyle behaviors, both independently and through the association with chronic disease risk factors, primed the pump for poor COVID-19 outcomes. 1 , 6. , 7.…”

“… 33 Numerous health benefits directly relevant to infectious diseases are associated with being physically active, one of which is lower levels of systemic inflammation. 34 , 35 Poor outcomes with SARS-CoV-2 have been associated with a cytokine storm, 6 and elevated systemic inflammation prior to infection may foretell an increased risk for this storm and an untoward clinical course. 36 There is some evidence to indicate systemic inflammation levels are lower in the sub-Saharan African population.…”

Post pandemic research priorities: A consensus statement from the HL-PIVOT

“…Rationale: COVID-19 has a direct impact upon the cardio-respiratory systems and its sequelae have broad implications for exercise intolerance and healthy lifestyle behaviours. 5 , 41 The incidence of PH may increase post-pandemic. 42 Therefore, it is important to understand the factors that contribute to chronic exercise intolerance among those infected by the virus.…”

“…, 4. , 5. related chronic diseases and co-morbidities, which can increase disease severity if infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19.…”

The impact of the COVID-19 pandemic on cardiovascular health behaviors and risk factors: A new troubling normal that may be here to stay

“… 12 , 15 Findings from a recently published comparative risk assessment study found that nearly 64% of the >900,000 COVID-19 hospitalizations occurring in the US through November 2020 were attributable primarily to obesity (30.2%), hypertension (26.2%), and T2D(20.5%), suggesting that the majority of hospitalizations could have been prevented if these conditions were not present. 8 Individuals with obesity were found to have increased risk of COVID-19 hospitalization and severe illness similarly across the lifespan in adults 2 , 8 as well as in children and adolescents 16 — an observation that is not surprising given the role of obesity in inciting inflammation, 17 and impairing the immune response as evidenced in prior disease-related pandemics (e.g., 2009 H1N1 Influenza A Virus). 18 Of grave concern were the well documented higher cases of COVID-19 19 among racially and ethnically minorized communities with whom already had unequal burden due to the higher prevalence of cardiometabolic comorbidities 20 and are more likely to suffer worse outcomes, 21.…”