Become COVID-19 Resilient
Why become COVID-19 Resilient?
Reason 1: To avoid death
Many people now consider COVID-19 to be a low-risk disease. However, the mortality rate for COVID-19 is highly variable and is determined by the presence or absence of a variety of risk factors 1.
Age is by far the greatest risk for COVID-19 mortality (Table 1) 1. For example, someone over 80 is approximately 20 times more likely to die from COVID-19 than someone aged between 50-59 years old (Table 1).
|Age||COVID-19 death HR (95% CI)|
Table 1. The relationship between age and the hazard ratio (HR) of COVID-19 death. Hazard ratio is the relative frequency of COVID-19 mortality. For example, people within the 60-69 year age bracket are estimated to be 2.4 times more likely to die from COVID-19 than people aged 50-59. Adapted from 1.
Additional risk factors included ethnicity, socio-economic status, diabetes, cancer, a history of smoking, sex (males are at higher risk than females), obesity and a range of other health conditions 1.
Reason 2: To avoid permanent disability
It is now clear that COVID-19 disease has the capacity to damage multiple organs within your body 2. This includes damage to your brain, heart, kidney and liver 2.
How the SARS-CoV-2 virus wreaks havoc across so many different organs is still not yet fully understood. It almost certainly includes a combination of direct infection of the cells within these different organs, destructive immune reactions, and blood vessel damage 2. Severe examples include stroke, heart, and kidney failure 2.
The prevalence and long-term consequences of multi-organ damage are currently unknown. However, amongst serious COVID-19 cases multi-organ damage is frequently observed 2. Worryingly, the incidence of out of hospital cardiac arrest increased by 60% during the COVID-19 peak in Italy earlier this year 2. This suggests that even people with less severe COVID-19 infections may experience serious damage to their heart and possibly other organs.
As a result, physicians world-wide are now preparing to deal with the long-term effects of multi-organ injury resulting from SARS-CoV-2 infection 2.
The Core Ideas Behind COVID-19 Resilience
The primary goal of the following interventions is to prime your immune system to optimally respond to the SARS-CoV-2 infection, thereby leading to rapid clearance of the virus and hopefully avoiding serious illness and permanent organ damage.
The role of chronic inflammation in severe COVID-19 disease
One significant risk factor for severe COVID-19 is the presence of chronic inflammation 2. Chronic inflammation is a low-level, constant activation of the immune system in the absence of infection. Importantly, chronic inflammation is more common in older adults, and is likely to be one of the reasons why people over 60 are at much greater risk of severe COVID-19 disease 2.
For this reason, the secondary goal of these interventions is to reduce your levels of chronic inflammation.
How to Become COVID-19 Resilient
1. Get an influenza vaccination
Influenza virus is most readily transmitted in winter and has the same route of transmission and similar symptoms to COVID-19 3. Importantly, it’s now known that patients can be infected with both SARS-CoV-2 and influenza virus at the same time 3. Fortunately, current evidence suggests that co-infection with influenza and SARS-CoV-2 does not necessarily worsen the clinical outcome in patients 4. However, co-infection does complicate COVID-19 treatment 3. In fact, patients presenting with influenza SARS-CoV-2 coinfection may require completely different treatment to standard COVID-19 patients 3.
If you do require hospitalisation due to COVID-19, the last thing you need is extra complications in your diagnosis and treatment. For this reason, the current recommendation is that you are up to date influenza vaccinations to reduce the risk of influenza SARS-CoV-2 coinfection . This will help ensure that you automatically receive the optimum medical support if you do present with severe COVID-19 symptoms 3.
2. Diagnose early and treat aggressively
Medical and support staff world-wide have performed a heroic job in improving the standard of care for COVID-19 patients. If you are infected, your best chance of avoiding serious disease and long-term health problems is to avail yourself to professional medical care as soon as is required.
To this end we have purchased an external thermometer and we regularly monitor ourselves for fever and other symptoms of infection. The rationale is that if we show symptoms, we will immediately get tested and rapidly diagnose whether the infection is caused by the SARS-CoV-2 virus. If we test positive, we can immediately self-isolate, rest and recuperate, and if required seek medical assistance if the COVID-19 symptoms are progressing towards a more severe disease state.
3. Supplement with essential micronutrients
Your body requires adequate amounts of vitamins A, D, C, E, B6, and B12, folate, zinc, iron, copper, and selenium to ensure the proper function of your immune system 5. Deficiencies in these essential micronutrients increases the risk of disease and death from viral infection 5.
Supplementation has the greatest beneficial effect in people who have a micronutrient deficiency. Importantly, there are a surprising number of people that are deficient in one or more micronutrients. For example, within the US population 45% of people are deficient in vitamin A, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc 6. Further, older adults are far more likely to be deficient in nutrients and vitamins essential for optimal immune function. This increases their risk of severe COVID-19 disease. Thus, supplementation is likely to have a positive effect in many people, most especially older adults.
The micronutrients with the strongest evidence for immune support are vitamin C, vitamin D and zinc 5. For this reason, we supplement with Vitamin D, Vitamin C, and zinc to ensure that these micronutrients are maintained above the levels required for an optimal immune function.
4. Eat healthy, eat clean
Macronutrients in the form of protein, fats and carbohydrates are also essential for proper immune function 4.
Eat high quality Protein
Protein deficiency increases your risk of infection 7. We consume protein of high biological value derived from healthy dietary choices, such as eggs, fish, and lean meat. Protein is consumed within the context of a balanced diet. Vegans and vegetarians are encouraged to seek out high-quality vegetable protein sources to ensure that they consume enough high-quality protein to support immune function.
Older adults require more protein than younger adults 8, and should therefore take extra care to ensure that they are consuming sufficient quality protein for optimal health.
Eat essential Fats
Fats and lipids also effect immune function. Polyunsaturated fatty acids, in particular omega-3 and omega-6, are associated with lower levels of chronic inflammation 4. Omega-3 and omega-6 fatty acids need to be consumed as part of a balanced diet, as your body cannot make these essential fats and you are dependent on dietary sources of these nutrients 4. These can be sourced through eating seafood or consumed as supplements.
Consume unprocessed complex Carbohydrate
Individuals who satisfy their carbohydrate requirements through the consumption of whole grains, vegetables and fruits have lower rates of inflammation 9. This has been attributed to their high fibre content, their high concentrations of essential vitamins and minerals, as well as the presence of protective phytochemicals abundant in plants.
Dietary fibre also increases the diversity of gut microbiota and promote health-associated bacteria 4,10, which in turn reduces chronic inflammation.
Eating clean means avoiding highly processed foods, most particularly processed carbohydrates, and sugars. Processed carbohydrates and sugars increase systemic inflammation 4. In contrast, the complex carbohydrates that are present in vegetables, nuts, seeds, and whole grains, do not trigger inflammation.
In conclusion, eating healthy and clean achieves two objectives. First, it provides you with all the nutrients, vitamins, and essential minerals that you need for optimal immune function. Second, eating clean is a safe and effective way to reduce chronic inflammation.
5. Get consistent, high quality sleep
Sleep quality has been convincingly linked to two important immune responses: vaccine response and infection 11.
Vaccine response is a useful measure of immune function. This is because vaccination mimics the infection process and generates an immune response that can be accurately followed over time 11. Strikingly, lack of quality sleep has consistently been shown to reduce the immune response in people vaccinated with influenza and hepatitis virus vaccines 11.
Sleep quality is also an important factor in determining the rate and severity of viral infection 11. Short sleep increases the probability of cold, flu and gastrointestinal infections as well as increases the chance of developing pneumonia 11. Experimental viral infection studies have shown that consistent, high-quality sleep protects people from cold and flu 12. In contrast, poor sleep increases the frequency and severity of cold and flu virus infections in these experiments 12.
During the pandemic, getting high quality sleep should become a high priority in your life.
6. Engage in moderate exercise
Physical inactivity increases the probability of getting cold and flu viruses 12. This is also true for COVID-19 13. Moderate exercise boosts your immune system and protects you from cold and flu infections 12. Evidence suggests that moderate exercise is similarly protective against COVID-19 13.
It is probably best to avoid gruelling exercise during the pandemic, as this may reduce your immunity and make you more vulnerable to infection 12.
7. Consume moderate amounts of alcohol
I am happy to report that there is good evidence to suggest that moderate drinking protects you against cold and flu infection 12. Importantly, this finding also seems to hold true for COVID-19 13.
By moderate, I mean 1-2 drinks per day (preferably one drink!). Please keep in mind that abusing alcohol or binge drinking is bad for your immune system and is linked to severe cold and flu infections 12. Also, alcohol has a negative impact on sleep quality, so do not consume alcohol and then immediately go to bed.
8. Seek out joy
Chronic stress, anxiety and depression all make you more vulnerable to virus and flu infections 12. Try and cut out all negative influences and seek out the positive in life. Ditch the serial killer movie and watch the romantic comedy instead. Block all the toxic garbage from your social media streams and binge on dog and/or cat videos.
Basically, get your joy on any way you can.
9. Increase positive social engagement
Strong social integration and support helps you fight off infection 12. In contrast, social isolation is a known risk factor for more severe cold and flu symptoms 12. If possible, focus on getting involved in work, charity, or social/family projects. Reconnect with your family and friends.
An important caveat is that social engagement is both subjective and personal. People who are usually outgoing may require greater social integration and support compared to those who are naturally inclined towards solitude. For this reason, you should find the level of social interaction that is right for you.
It’s important to note that the lifestyle interventions outlined in this article are not a ‘magic bullet’ that provide 100% protection from COVID-19. Instead, they are directed towards supporting your immune system to help you avoid and recover from respiratory viral infections, including SARS-CoV-2.
We highly recommend that you continue to maintain established social isolation, hand washing and mask wearing practices. Please remember that COVID-19 is an important instance where ‘an ounce of prevention is worth a pound of cure’ 14.
Please download the free PDF version of this article by clicking the link below.
We are both thankful and humbled by the heroic efforts of the global health and scientific community in addressing the emerging threat of COVID-19.
References and Further Reading
1 Williamson, E. J. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature, doi:10.1038/s41586-020-2521-4 (2020).
2 Gupta, A. et al. Extrapulmonary manifestations of COVID-19. Nat Med 26, 1017-1032, doi:10.1038/s41591-020-0968-3 (2020).
3 Konala, V. M. et al. A Case Series of Patients Coinfected With Influenza and COVID-19. J Investig Med High Impact Case Rep 8, 2324709620934674, doi:10.1177/2324709620934674 (2020).
4 Zabetakis, I., Lordan, R., Norton, C. & Tsoupras, A. COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation. Nutrients 12, doi:10.3390/nu12051466 (2020).
5 Gombart, A. F., Pierre, A. & Maggini, S. A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients 12, doi:10.3390/nu12010236 (2020).
6 Reider, C. A., Chung, R. Y., Devarshi, P. P., Grant, R. W. & Hazels Mitmesser, S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients 12, doi:10.3390/nu12061735 (2020).
7 Woodward, B. Protein, calories, and immune defenses. Nutr Rev 56, S84-92, doi:10.1111/j.1753-4887.1998.tb01649.x (1998).
8 Deer, R. R. & Volpi, E. Protein intake and muscle function in older adults. Curr Opin Clin Nutr Metab Care 18, 248-253, doi:10.1097/mco.0000000000000162 (2015).
9 Hosseini, B. et al. Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis. Am J Clin Nutr 108, 136-155, doi:10.1093/ajcn/nqy082 (2018).
10 Kumar, J., Rani, K. & Datt, C. Molecular link between dietary fibre, gut microbiota and health. Mol Biol Rep, doi:10.1007/s11033-020-05611-3 (2020).
11 Besedovsky, L., Lange, T. & Haack, M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev 99, 1325-1380, doi:10.1152/physrev.00010.2018 (2019).
12 Cohen, S. Psychosocial Vulnerabilities to Upper Respiratory Infectious Illness: Implications for Susceptibility to Coronavirus Disease 2019 (COVID-19). Perspect Psychol Sci, 1745691620942516, doi:10.1177/1745691620942516 (2020).
13 Hamer, M., Kivimäki, M., Gale, C. R. & Batty, G. D. Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK. Brain Behav Immun 87, 184-187, doi:10.1016/j.bbi.2020.05.059 (2020).
14 Benjamin Franklin, 1736.
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Yoga Nidra for Better Sleep
Disrupted sleep increases anxiety and depression. Yoga Nidra is an effective method that has helped many people overcome insomnia.
Yoga Nidra for Better Sleep
Disrupted sleep increases anxiety and depression. Yoga Nidra is an effective method that has helped many people overcome insomnia.