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Whilst the subject of viral disease is by virtue of the time span since Jan 2020 somewhat overcovered in musings as well as science reviews, each month brings new clarity on the intersecting health and economic risks of a global pandemic.

The SARS-Cov-2 virus is a recognised threat to billions of people around the world, with the risk being compounded for people who live in overcrowded homes, who don’t have access to safe drinking water or nutritious food and are obese. Other risk factors are also relevant but being overweight, according to one of the largest UK studies on the Covid-19 mortality rate to date from Glasgow University, found that as a patient’s Body Mass Index (BMI) increases, so does their risk of having a severe case of the virus. Obesity is a chronic inflammatory disease and it starts with an inflammation in adipose tissue, or body fat. Researchers have proposed there may be a link between this inflammation and an immune system response in Covid-19 patients ultimately manifesting in the terminal induction of the “cytokine storm”.

Background

For the past 70 years or so, our food systems have focused on reducing the costs of producing and distributing calories, but not the costs of nutrients. This combination of poor-quality food, consumed in vast amounts, has fuelled an obesity and metabolic dysfunction epidemic. On the way, we have weakened the health of an increasingly large proportion of the population and put them at risk for infectious and chronic ill health generation. Also included is the development of the nutrient gap, where large numbers of the population are deficient in one or more essential nutrients, and the associated decline in immune competence.

Financially disadvantaged populations are even more prone to higher rates of obesity due to a lack of access to healthy food and food education. To put that further into a somewhat alarming context, the obesity rate in two of the world’s richest countries, the UK is 28.7% and in the USA, it is an outstanding 39.6%.

These western societies, with their reliance and penchant for high-sugar and high-fat foods, are particularly vulnerable to associated nutrition depletion related health outcomes. Even when you think you have purchased and consumed healthy, nutrient dense foods it’s still somewhat of a guessing game about what nutrients were actually present – in the USA, one company is approaching this challenge from a big data perspective to help you understand the food you choose by nutrition density rather than visual quality alone  – something we may see find a place in the UK also.

Impact

When faced with a novel virus like SARS-CoV-2 rapidly emerging in the human population, there is a limited knowledge base to work with, leaving us at a significant disadvantage. To create safe interventions, efforts are pooled to understand the origin, genetic variation and epidemiological characteristics of the new virus. This includes knowledge on mode of transmission, incubation period, window of transmission, and reproductive number, to ensure an effective public health response and to put in place appropriate infection control measures.

Yet this reorientation of focus has impacts across other existing medical needs. The impact of Covid-19 is being felt in the area of non-communicable diseases (NCDs). According to a recent WHO survey of 155 countries, more than half of the nations reported that services for NCDs have been partially or completely disrupted. This means people with conditions such as cancer, diabetes and cardiovascular diseases have not received adequate care during this crisis.

On a larger scale still, increasing weather variability due to a warmer atmosphere, coupled with Covid-19 supply chain disruptions and trade restrictions, are driving up food prices and increasing food insecurity in 2020. Many countries that traditionally depend on food imports are now facing shortages of key staples as trade and transport restrictions compromise domestic food supplies, triggered by Covid-19 responses, which may further exacerbate political and economic instability.

The Governments of all countries hold the power to determine the public response to this, and related challenges, and to date we have witnessed a wide range of outcomes. It’s clear that democracy does not guarantee good government, even in its original heartlands. Neither does the individual choice that citizens of democracies periodically exercise – whether in referendums or elections – confer political (or indeed scientific) wisdom on the chosen. It might even delude them, as some populist leaders confirm, into deranged notions of omnipotence.

However, after the most radical upheaval of our times, screeching ideological U-turns have recently taken place in the UK and USA. Adopting a German-style wage-subsidy scheme, and channelling FDR rather than Churchill, Boris Johnson now claims that ‘there is such a thing as society’ and promises a ‘New Deal’ for Britain. Biden, abandoning his Obama-lite centrism, has it appears rushed to plagiarise Bernie Sanders’s manifesto.

Underlying these political dalliances with ideological variation, is a slow recognition that the current extraction-based economies cannot continue in the same plane. Some form of restitution is needed. From our perspective, if part of this focusses on the generation and management of health, with as much enthusiasm as there is being thrown at treatment, then maybe the next societal challenge will be met with a better prepared population, as well as a better prepared central response?

Whilst the current acute viral pandemic dominates the media and research, NCDs are the greatest problem by far. These are in the main, preventable by appropriate behavioural changes and central government support, such as economic security for a safe and healthy food supply,  enhancing educational appreciation of food preparation and consumption and restoring and protecting green space and emotional health. Clearly this is not an exhaustive list, but as we have seen, the health status of a nation is as important as economic status – at present they are not aligned!

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