By Daniel R. Gaita, MA, LMSW
4/27/20
For nearly the first time in our planet’s history, an entire species has sheltered in place and shut down the portals of economic activity in hopes of protecting primarily the elderly, obese and sick from a virus. Some from a science perspective cringe, knowing that Darwin is rolling over in his grave. Those from a religious perspective are watching a repeat of the ancient texts’ prophesies play out again. With studies coming in from all around the globe demonstrating those at highest risk of dying from COVID-19 are typically obese, unhealthy, unfit, have other underlying health conditions and are usually older. [12,13,14,15,16,17,18,19,22] Perhaps it is time we look at this and future pandemics through a more logical perspective and less emotional lens.
Background: Physical Activity and Health
July, 1996 the US Surgeon General, in a 300-page report, [1] sounded an alarm loud enough to awaken the US Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion and the President’s Council on Physical Fitness and Sports. In short, the Report of the Surgeon General articulated how lack of physical activity was detrimental to health. [1] Members and directors from each of the agencies chimed in to bolster the report and its implications on public health and the economy.
Secretary of Health and Human Services, then director, Donna Shalala articulated how the report should “catalyze a new physical activity and fitness movement in the United States”. Stating the report was “a work of real significance, on par with the Surgeon General’s historic first report on smoking and health published in 1964” [1]. She went on to state that schools and universities need to reintroduce daily, quality physical activity as a key component of a comprehensive education. Furthermore, directing the media and entertainment industries to “use their vast creative abilities to show all Americans that physical activity is healthful, fun, attractive, maybe even glamorous!”[1] She went on to promote worksite fitness and a review of community resources like parks, playgrounds, community centers and physical education.[1] Her comments were then bolstered by the report’s Forward.
In their Forward to the report, then acting CDC director David Satcher, M.D., Ph.D., Assistant Secretary for Health, Philip R. Lee, M.D., and the Co-Chairs for the President’s Council on Physical Fitness and Sports, Florence Joyner and Tim McMillen closed by stating “Increasing physical activity is a formidable public health challenge that we must hasten to meet. The stakes are high, and the potential rewards are momentous: preventing premature death, unnecessary illness, and disability; controlling health care costs; and maintaining a high quality of life into old age.” [1]
The report included data and research conducted by over 80 separate medical professionals, sixteen peer reviewers, eight senior reviewers, twenty-four contributing medical authors, an eleven-person planning board, thirteen-member editorial board, six editors, and nine acknowledgements by medical leaders. This report set the stage for America’s fitness comeback. So what happened?
Consideration for today: We’ve all been warned
The Surgeon General’s report laid out a historical background detailing the importance of physical exercise dating back to writings from Herodicus (ca. 480 B.C.), Hippocrates (ca. 460- ca 377 B.C.), and Galen (A.D. 1290 ca. 199). While most ancient religious texts warn of great torment and suffering from laziness and gluttony. Thus, it is fair to say, we were warned. That we’ve largely ignored the warnings, and in many cases reduced and or removed incentives for regular fitness and exercise.
Following the 1996 report, tax incentives were put into place that made gym memberships a deductible health care expense. Health insurance agencies began covering gym memberships as preventative medicine. Health and fitness centers were not required to charge tax for memberships and many corporations were then able to take advantage of the tax incentives to cover the cost of fitness club memberships for their employees. It was a win-win. Then Congress changed the laws and health and fitness club memberships became taxable and then non-deductible. States and local municipalities soon followed suit. Soon the health and fitness industry suffered low profit margins and sweeping bankruptcies. Exercise and fitness became a luxury expense. Also, a first expense to be cut out during economic crises.
Health Care Cost: The Economic Cost Another major consequence from our collective lack of physical activity continues to be increasing health care costs. Health spending totaled $74.6 billion in 1970. By 2000, health expenditures had reached about $1.4 trillion, and in 2018 the amount spent on health had more than doubled to $3.6 trillion. [2]
Deaths: The Personal Costs Every death is a tragic loss. But also, the only guarantee at birth. We are all going to die. But we can impact, through regular physical exercise, how long we live and the quality of life we enjoy. Interestingly, of the top ten causes of death in America, seven are linked to a lack of regular physical activity and exercise. The number one cause of death is diseases of the heart, which takes 647,457 Americans annually.[3] Followed by Cancer, (599,108), lower respiratory disease, (160,201), Stroke (146,383), & Diabetes (83,564). [4]
Genetics: The Cards We’re Dealt While genetics certainly play a major role in our potential and probability of suffering from various health ailments, regular physical activity and exercise are also shown to reduce poor health outcomes [1] and sometimes result in epigenetic changes that can bolster good health and longevity that can be passed down to the next generation. (natural selection) [5]
National Security: Regardless of the pontifications surrounding the primary cause and origins of the pandemic i.e the “Chinese Virus”, “Wuhan Virus” etc, the COVID-19 pandemic has exposed a vulnerability in our national security. A vulnerability which goes hand in hand with lack of physical exercise and it’s resultant degradation of our armed forces readiness. Yet, this too is not new news.
A couple years back, Daniel B. Bornstein, PhD, a prominent professor in the Department of Health, Exercise, and Sport Science, at the Citadel Military College of South Carolina sounded the alarm when he and nine colleagues reported data which demonstrated the impact of how certain states, previously identified for their disproportionate public health burden, are also disproportionately burdensome for military readiness and national security. [20]
While our Joint Chiefs and intelligence agencies investigate whether or not COVID-19 is the result of biological weapons testing or just a natural occurring phenomenon, one observation is very clear. America is vulnerable. Moreover, Americans who don’t exercise and follow healthy nutritional habits are even more vulnerable. Currently, 2,995,456 COVID-19 cases and 207,583 deaths have been confirmed. Of all global cases, America has 968,203 with 54,938 deaths. [21]
Pondering if this was a weaponized bioterror attack deserves consideration as well as preparation. If China intentionally infected the globe, it created a virus that has killed nearly as many Americans as died in the entire Vietnam War. Doing so without ever firing a shot. Hitting us where we are most notably vulnerable. Our collective lack of physical fitness and sedentary nature. Adding yet another reason for Americans to focus on health and fitness.
Excuses: Justifications for Failure
Thanks to the concept of “optimistic bias” [6,7,8,9,10] many humans really don’t think that bad thing will happen to them. That if they smoke, they won’t get cancer. If they don’t exercise, they won’t get sick. Then when they do get sick, it’s too late. Excuses become the norm. As with the many excuses not to exercise, most have to do with either time or health-related issues that could actually be improved by exercise. For instance: The excuse of “I have severe asthma, so I can’t exercise” Yet science has shown for decades that regular moderate physical exercise is shown to reduce asthma severity. [11] Others will blame everything around them for their sickness and disease while never once looking into the mirror and asking if they could’ve eaten better or exercised more regularly. Some common reasons people use not to exercise and eat right:
Poverty: Turns out that while poverty poses a multitude of challenges to health and fitness, it also appears to have produced some of the greatest demonstrations of resilience, athletes and leaders in the world. How some ascend poverty and others do not is a multifaceted biopsychosocial equation with many variables. However, a common duplex of antidotes appears front and center among those greats that have escaped poverty: academics and athletics. It seems that even here amongst the impoverished segment of the human population, education and fitness are two key tools being used to attain personal as well as physical excellence. The mind/body connection.
Cost: Many will decry the cost of fitness and nutritional supplements. However, walking is free. So is running, push-ups, pull-ups, squats, lunges. A healthy salad is less expensive than a Whopper with fries. An apple or banana is less expensive than a can of soda. Those living in poverty, utilizing supplemental nutritional assistance (SNAP/Food Stamps) have access to all the healthier options at their grocery store. So, choosing to purchase a box of sugar filled ding-dongs instead of granola bars becomes a personal choice with well-known consequences.
Time: Perhaps the most relied upon excuse of them all. “I don’t have time to exercise.” Well, that is a personal decision. If you make the decision to have a lifestyle and career that affords you no time for exercise, you will have chosen a path most likely to result in early sickness and disease. Thirty to sixty minutes most days of the week is not a lot of time. Especially when it is your life at stake. You choose how you invest your lifetime. Choices have consequences.
Disability: In many cases, people have serious injuries that make physical activity harder than for others. Thankfully, the great availability and variation of exercise options to improve physical health are nearly limitless. (Walk, Run, Bike, Swim, Bands, Weights) As inspiration, we find all kinds of amazing athletes who, without legs and arms still manage to attain physical excellence through continue exercise despite physical injuries and limitations. In that, it is vital that we look at disability not as an inability, but rather an alternate opportunity at life.
Social Sensitivity: Your Feelings Really Don’t Matter
Viruses don’t care about your feelings. Neither does cancer, asthma, heart disease, or any of the other factors impacting human mortality. It is up to you to care about yourself. To choose to develop healthy habits that incorporate regular physical exercise and healthier nutritional habits. Stop pointing the finger at the world and take some personal inventory. Be honest with yourself. Are you part of the human population driving up health care cost by making poor health decisions or are you staying healthy and active? Are you part of the population that the world has sheltered in place to protect, or are you part of the population that is has been either unaffected or testing positive, showing no symptoms and developing antibodies against the virus and those to follow?
“Undesirables” & Natural Selection: Nope! This pandemic is not an opportunity to separate the strong from the weak or the sick, lame and lazy from the overachievers. But it is an opportunity to look at how our lifestyle decisions impact not only our personal health, but the global economy and the entire human population as well. This is a collective human calling. A moment of nearly entire planetary awareness. An epiphany whereby we realize how our daily personal decisions impact the survival of the self and the entire human species. We were warned. Some of us have headed the warnings, others have chosen not to, and some are unfortunate victims of complex circumstances and unfortunate genetic predispositions.
Regardless, we will all die. That is the only guarantee at birth. But the choices we make while alive have universal impact, far beyond the self.
Lessons Learned: Future Alternatives Based on Current Observations.
It is reasonable to argue that humanity will not last much longer if it chooses to paralyze the capability of the strong in order to quarantine and protect the vulnerable who may get sick and die. Perhaps a few points of guidance can help shape future policy considerations:
1. Only Quarantine/Shelter in place the most vulnerable: Protect our grandparent’s and sick or vulnerable loved ones by protecting them from exposure through distancing, wearing a mask and use of technology for socialization.
2. Institute National Fitness & Nutrition Standards: Americans need to move more and sit less! Standardized national protocols could be created that offer financial incentives for physical fitness based on probable reduction in individual health care cost throughout the lifecycle. Standardized mechanisms like Resting Heart Rate, Blood Pressure, BMI, and Body Fat percentages could be universal tools for such a program as they currently occur within the general primary care environment.
3. Maintain Social Distancing: If it works, keep it up. But let’s not stop kids from playing sports and athletes from competing and parks, pools and beaches from being opened.
4. Stress Hygiene: Reinforce general hygiene standards of washing hands and cleanliness.
5. “Stay-At-Home” Orders: Should perhaps apply mostly to the most vulnerable populations based on current epidemiology and not the entire population due to the cascading and destructive impact on local, state, federal and global economies as we’ve witnessed from COVID-19.
References
1. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. Retrieved from: https://www.cdc.gov/nccdphp/sgr/pdf/sgrfull.pdf
2. Kamal, R., McDermott, D., & Cox, C. (2019) How Has U.S. Spending on Healthcare Changed Over Time?Peterson-KFF Health System Tracker. Retrieved from: https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-start
3. U.S. Department of Health and Human Services. (2019) National Vital Statistics Reports. Deaths: Final Data for 2017. 2019; 68:9. Retrieved from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
4. Centers for Disease Control & National Center for Health Statistics (2019) Deaths and Mortality. Retrieved from: https://www.cdc.gov/nchs/fastats/deaths.htm
5. Gildenhuys, Peter, "Natural Selection", The Stanford Encyclopedia of Philosophy (Winter 2019 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/win2019/entries/natural-selection/>.
6. Weinstein, N. D. (1980). Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39, 806-820.
7. Weinstein, N. D. (1983). Reducing unrealistic optimism about illness susceptibility. Health Psychology, 2, 11-20.
8. Weinstein, N. D. (1987). Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample. Journal of Behavioral Medicine, 10, 481-500.
9. Weinstein, N. D. (1988). The precaution adoption process. Health Psychology, 7, 355-386.
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11. American Lung Association. (2020) Benefits of Exercise When You Have Asthma. Retrieved from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/asthma-and-exercise
12. Auwaerter, Paul G. "Coronavirus COVID-19 (SARS-CoV-2)." Johns Hopkins ABX Guide, The Johns Hopkins University, 2020. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_.
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14. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775
15. Kolifarhood, G., Aghaali, M., Mozafar Saadati, H., Taherpour, N., Rahimi, S., Izadi, N., & Hashemi Nazari, S. S. (2020). Epidemiological and Clinical Aspects of COVID-19; a Narrative Review. Archives of academic emergency medicine, 8(1), e41.
16. Chow N et al. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020 Apr 3; 69:382. (https://doi.org/10.15585/mmwr.mm6913e2)
17. Franki, R. (2020) Comorbidities more common in hospitalized COVID-19 patients. The Hospitalist. Retrevied from: https://www.the-hospitalist.org/hospitalist/article/220109/coronavirus-updates/comorbidities-more-common-hospitalized-covid-19
18. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis
19. Wei-jie Guan, Wen-hua Liang, Yi Zhao, Heng-rui Liang, Zi-sheng Chen, Yi-min Li, Xiao-qing Liu, Ru-chongChen, Chun-li Tang, Tao Wang, Chun-quan Ou, Li Li, Ping-yan Chen, Ling Sang, Wei Wang, Jian-fu Li, Cai-chen Li, Li-min Ou, Bo Cheng, Shan Xiong, Zhengyi Ni, Jie Xiang, Yu Hu, Lei Liu, Hong Shan, Chun-liangLei, Yi-xiang Peng, Li Wei, Yong Liu, Ya-hua Hu, Peng Peng, Jian-ming Wang, Ji-yang Liu, Zhong Chen, Gang Li, Zhi-jian Zheng, Shao-qin Qiu, Jie Luo, Chang-jiang Ye, Shao-yong Zhu, Lin-ling Cheng, Feng Ye, Shi-yue Li, Jin-ping Zheng, Nuo-fu Zhang, Nan-shan Zhong, Jian-xing He. European Respiratory Journal Jan 2020, 2000547; DOI: 10.1183/13993003.00547-2020. Retreived from: https://erj.ersjournals.com/content/early/2020/03/17/13993003.00547-2020
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About the Author
Daniel R. Gaita, MA, LMSW, a United States Marine turned veterans' advocate. He is the Founder of Operation Vet Fit, a 501C (3), combat veteran advocacy agency recognized by the Department of Veterans Affairs Mental Health Services for his ground breaking research on veteran suicide causes and solutions. He is a South Carolina Licensed Social Worker specializing in Mental Health and Military Families; a volunteer research assistant at the Citadel, inducted into the Phi Alpha Honor Society while a graduate student at the University of Southern California, also a Presidential Management Fellowship Finalist; a participant in Military Clinical Skills Training and research conducted through the Center for Innovation and Research on Veterans and Military Families. Dan earned his Bachelors in Psychology from combined studies at the University of Connecticut and Western Connecticut State University, His first Masters degree in Organizational Leadership at Gonzaga University with a concentration in Servant Leadership. He later completed his second Masters degree in Clinical Social Work
from combined studies at Fordham University and the University of Southern California. Formally trained in EMDR, Dan also meets all HHS requirements for education in the protection of human research participants, while continuously publishing the findings of new research outcomes on veterans suicides and evidence based treatment for PTSD.
Contact: dan@operationvetfit.org