Covid’s Four Horsemen

In the discussion of Covid treatment, vaccination, and social measures, such as masking, social distancing, etc. almost nothing is said about our unique susceptibility in the US to something like Covid. With Covid, it seems the chickens have come home to roost and we are now paying for more than a generation of unhealthy habits.

The primacy of co-morbidities clearly belongs to obesity. It is epidemic in the US, with more than one third of adults today meeting the definition of obese- a body mass index (BMI) over 30. For men and women, this would be someone who is 5 foot, 7 inches tall and weighs 200 lb or more. A few years back, it appeared that the rate of obesity was flattening, but that hope was dashed as it continues to rise. Closely tied to obesity is Type II diabetes, which is also epidemic in the US and has risen in perfect concert with obesity; you can almost superimpose the two curves. Today, one in ten people in the US has Type II diabetes. The causes of obesity are multifactorial and include inactivity; cheap, plentiful food; high consumption of processed and fast foods high in fat, sugar, and salt; and poor dietary choices. These medical issues are more common in lower income individuals, especially blacks and Hispanics and it is no coincidence that Covid seems to strike this demographic harder as well. This is not just a US problem. Worldwide, obesity is a bigger problem than starvation and is the leading cause of death and disability. Obesity also is a causal agent in hypertension, which accelerates heart disease and leads to heart attacks, the number one direct cause of death in the US.  

It is now clear that these conditions present a clear and present danger to anyone who is exposed to the Covid virus. It is too late to address this susceptibility for this pandemic; that ship has sailed. All appearances are that Covid will likely be with us from now on. Over reliance on vaccination, given the unknows of the current crop of vaccines and the inconsistent effectiveness of seasonal flu vaccine, as the ultimate answer to this pandemic seems to be putting all of our eggs in one basket, universally regarded as an unwise thing to do. Unless we direct our public health and other resources to seriously address the epidemic of obesity and its related conditions we will, as a country, remain at the mercy of the virus and all that follow it, as will inevitably happen. If we have to institute the same draconian measures in the future that we have instituted for this pandemic to protect us from our own bad lifestyle choices, our future is bleak.

Richard T. Bosshardt, MD

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