New Haven Register (New Haven, CT)
One pandemic can help draw attention to another
One could be forgiven for thinking that however bad it is to be in the middle of one pandemic, it would be worse to be in the middle of two at the same time. In fact, though, we are very much in the middle of two — and at least through one pertinent lens, two pandemics are better than one.
One pandemic is, obviously, COVID19. The other is the massive, global burden of chronic diseases that have been siphoning years from lives and life from years for the past half century and more, and will be doing so long after COVID19 is archived in history books.
Why are two concomitant pandemics good news, rather than bad? Well, if the toll of SARS-CoV-2 pertained to the virus and nothing else, there would be little we could do about it other than shelter from exposure by various means; scramble for a vaccine with unprecedented alacrity; and hope for the best. If COVID19 were an equal opportunity menace, we would all be comparably at risk, and that risk would derive from the virus itself. The “fault,” as it were, would lie with SARS (only), not with ourselves, our culture, and such benighted misadventures as the routine acceptance of “junk” as a food group.
The bottom line is that if a viral contagion were preying upon people with a baseline health that could not be improved — then the pandemic toll would be the toll, for thee, and me, and everyone else – and our one and only choice would be to pay it. If, however, the contagion preys preferentially on the frail, like those predators we’ve all come to know watching nature shows, and some of that frailty is remediable — then there is an opportunity in the crisis of COVID19.
And so it is. The relevant frailty is in large measure age-related, and that — we cannot fix. We cannot undo old age. But we can also accept that every kind of mortality risk is concentrated among the elderly for the simple reason that we are all mortal. Eventually, we will all die, and most of us will do it old, and because we are old.
That in no way obviates the grieving and mourning for the pandemic losses of elderly loved ones so many of us have experienced. My condolences extend to all of us so affected. Elderly people are, though, more prone to die, pandemic or no, and nothing less fundamental than our mortality requires us all to come to terms with that.
The relevant frailty is also, in its other large measure, modifiable; it is a consequence of prior chronic disease. Cardiovascular diseases, type 2 diabetes, hypertension, and obesity are all effectively “pandemic,” or at best hyperendemic throughout the modernized and modernizing countries of the world. These in turn are ill effects of adverse lifestyle practices, especially, although not only, poor diet quality and lack of routine physical activity. We have known the salience of these, and the other root causes of chronic morbidity and premature mortality for more than a quarter century at least; we have known how to eliminate 80 percent or more of this burden for as long.
Why haven’t we? There are many reasons, of course, but among them is this: chronic disease is chronic, at least until it becomes acute (e.g., as when heart disease advancing slowly for years or decades suddenly precipitates a massive heart attack, or sudden cardiac death). The chronic is a slow-motion menace that quite simply does not capture our attention, concentrate our anxiety, stoke our desperation for remedies, or activate our fight-orflight response. COVID, however, in its acute assault on our communities, in its onslaught of breaking news…does all of that.
The horizons within our skin suffice to remind us all that a crisis is a dangerous opportunity. By imposing an acuity of danger that has fixed our anxious attention, COVID-19 provides an opportunity to confront the clear, omnipresent, longestablished, and muchneglected ravages of chronic disease related to lifestyle.
Two pandemics are, paradoxically, better than one, when each evinces an opportunity to slash the human costs of the other.