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“The vulnerability of African-Americans to the coronavirus is a national emergency.” The Economist, May 30, 2020

The COVID-19 pandemic, aided and abetted by racial disparities from the 50+ year chronic disease epidemic, has harmed blacks much more than whites.  Who is really surprised, crocodile tears aside, that blacks are dying at much higher rates than whites from the virus?   

As The Economist implies, African-American health has been worse than white health for centuries--but do whites really even care?  Major investments have been made in government programs, but the dismal outcomes remain.  

When it comes to public health, it’s not about what you say you care about, or what you try to do--it’s about the results. 

Exhibit A that it can be done: we reduced smoking by ⅔ in the course of more than five decades of hard policy and program work.  Smoking among black men declined even more than among white men--and by 2008 black teens smoked at half the rate of whites.

What will we do about our inactivity & unhealthy nutrition epidemic--which is much bigger, costlier & deadlier than the COVID…
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Chronic disease at core of Big Apple COVID-19 deaths

A recent summary of COVID-19-related deaths in New York City confirms the much higher mortality risks among those with underlying health conditions.  Among the >80% of fatalities for which underlying condition status was known, only 0.8% of those dying had no chronic disease. 
As we know from prior reports, obesity, diabetes, high blood pressure and heart disease are underlying conditions very frequently associated with novel coronavirus deaths. Furthermore, chronic diseases make up the vast majority of "underlying conditions" among those who die.  (See earlier blog post.) 
This pandemic has been another wake-up call on the continued dangers of failing to prevent the widespread inactivity & unhealthy nutrition leading to epidemic chronic disease.  Will we start making a serious effort to develop healthy habits, particularly K-12?  Or will we continue to hit the snooze button as health worsens?

Not ready, not set, not go (Sweden rant #2)

We need to consider American core values and competences, before we can judge whether the USA should follow Sweden’s example.  We highly value human life.  We are very good at figuring out how to “manage” diseases on a large scale—given enough time (and at very high cost). 

So we are trying desperately to postpone coronavirus spread until we can treat very high numbers of patients effectively.  “Proning” is one recent example, now remdesivir is another, of strategies that took us time to figure out, but which were worth waiting for.  And a recent study implies significant potential to re-purpose existing drugs and compounds quickly against COVID-19.

Of course, the ultimate solution is a vaccine--and both Dr. Fauci & Bill Gates, who are normally quite cautious, have recently expressed optimism on rapid availability.

Unfortunately, for decades we have grossly neglected to exercise our core competence in prevention, beyond tobacco.  We reduced US smoking by ⅔--but then did virtually …

Chronically Miscalculating with Pandemic Math: USA ≠ Sweden

There has been a lot of talk about using the “Swedish model” to more aggressively “re-open” the US economy.  We have to be realistic about what we can learn from a country as different as Sweden: it’s a bit like comparing a fast-food drive-thru to a smorgasbord.  

For example, only about 20% of Americans are active in sports compared to about half of Swedes--this has a huge impact on underlying health, but unfortunately we are a long way from closing that gap.
We have known for months--and was anyone really surprised?-- that underlying chronic disease appears to dramatically increase COVID-19 hospitalization & mortality.  Per OECD data, the USA has 2x worse diabetes prevalence than Sweden, and is 1.5x Sweden on overweight/obesity (undoubtedly even worse, when severity of obesity is considered). 

In addition, Sweden has greater public trust in government & therefore more voluntary policy compliance. 

Sweden has also had a 5x higher pandemic death rate than several of its Scandanav…

Pandemic + Child Obesity = Even Worse News for Young Adults

Widespread child obesity, i.e., continual inactivity & unhealthy nutrition in childhood, turns out to be even more dangerous than previously thought--now that we are in the midst of the COVID-19 pandemic.  
The New York Times recently described several studies showing the high risks facing obese young adultsfrom coronavirus infection.  
(This is in addition to the shocking news last year from Johns Hopkins, that obesity will soon replace smoking as the biggest preventable cause of cancer!)
Child health habits turn into lifelong destiny: the vast majority of children who are obese, remain so as adults. And it gets worse: for about half of children who are obese, child obesity turns into teen severe obesity. This dangerous trend continues later in life: by 2030, almost 1/3 lower-income adults are expected,"with high predictive accuracy," to be severely obese (>75 lbs. overweight).
If there is any good news from the pandemic...perhaps it will raise consciousness on just how …

Fatal connections: COVID-19 mortality, chronic diseases, & unhealthy habits

The relationship between death risk from the novel coronavirus & chronic disease is becoming clear.  At first, age was mentioned as a key risk. But the real culprit for high COVID-19 hospitalization & mortality seems to be "underlying health conditions"--i.e., chronic diseases, which typically worsen health as people age. 
The bottom line, even as we await more data in the coming months: a lot fewer people would be dying from COVID-19, if they had been more active, had healthier nutrition, not smoked, etc.--earlier in life.
Governments have had a very mixed record in responding to the pandemic.  But they can prepare us better for the next time--for future infectious and chronic diseases--by helping us develop healthier habits:
"Among the 105 patients who had died in Italy as of March 4, two-thirds had three or more preexisting conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus. These chronic illnesses can leave o…

Health Horror Shows--Sequels Even Worse!!

The recent health news double-feature was really scary: 1. 40% of Adults Obese 2. 1 in 5 Adolescents with Prediabetes
Then came the even-more-shocking news on the “sequels”: For adults: “Severe obesity is likely to become the most common BMI category among...low-income adults”-- close to 1 in 3 >75-100 pounds overweight by 2030--when about 50% of adults will be obese nationwide.For teens with prediabetes:  “However, compared with adults, decline in β-cell function seems to occur at an accelerated rate resulting in relative insulin deficiency and progression to overt type 2 diabetes with insulin treatment needed to control hyperglycemia within a few years after diagnosis.”Let us be clear what this means: High child obesity (~20% nationally now) is leading to very high adult obesity (40% now, going to 50%+) and severe obesity (1 in 12 adults now, going to 1 in 4 in 2030).Unlike typical adult-onset diabetes in the past, which is often treated wi…