Are you "training" for the next pandemic?

A new study found that a healthy pre-pandemic lifestyle protected against Long Covid symptoms.

Talk of pandemic preparation generally refers to work by public health professionals and governments. Will we have tests? Will we have treatments? Will we have enough hospital capacity? Will we have PPE? Will we have better ventilation?

In other words, to the average person, pandemic preparation is something someone else is doing.

That’s absolutely true. Mostly.

What can the average person really do, other than advocating that we take pandemic preparation seriously and supporting leaders/politicians who do as well?

Well, one answer is to get yourself ready for another pandemic.

A new study in JAMA Internal Medicine reported on post-Covid-19 symptoms (i.e., one definition of Long Covid) among women who had adhered to “healthy lifestyles” before the pandemic in comparison to those that had not. (The analysis leveraged an ongoing study of long-term health habits among people in the nursing profession.)

The researchers tracked 6 characteristics: weight, smoking, diet, alcohol consumption, exercise (moderate or vigorous), and sleep. They found that the more of these features a person had in the “good” column, the less likely they were to later experience symptoms of Long Covid. Participants who were “good” on 5 or 6 of these variables had around half the rate of Long Covid symptoms compared to those who had 0 checks in the "good” column. While this study could not establish causality, the analysis suggests that if having 5-6 “good” features had been causal, around 36% of all Long Covid cases could have been avoided if the entire cohort had adhered to the healthy lifestyle “syllabus” prior to the pandemic.

Many studies like this contain circular logic that negates the very findings people are interested in. For example, people who exercise 45-60 minutes daily have been found to have better health. But is that because exercise makes them healthier? Or is it because people with cancer or other serious health problems can’t exercise that much? It’s probably some of both. This study minimized that problem because it mostly followed features that are less intrinsic to health to begin with. For example, whether you sleep, smoke, eat well, drink alcohol, or have obesity are not exactly proxies for other underlying health conditions, per se (the exercise variable being the exception, as I mentioned). In fact, this study found that weight (being neither underweight or overweight) and adequate sleep (seven to nine hours per day) were the two factors most strongly associated with decreased rates of Long Covid symptoms down the road.

Every person reading this will face some kind of illness in the future, whether it is Covid-19, another dangerous pandemic virus, or even more mundane infections or common problems. What this research shows—and this matches my experience treating patients—is that once an illness hits, how a patient does is largely out of their hands. Either their bodies will be able to recover, the medical treatments will work, or not.

But how the patient enters a health challenge—that is, his or her condition at the moment the new problem is encountered—has a lot of influence on how they’ll do.

I don’t think that the particular features that put people at risk for Long Covid (nor one that protect from it) are likely to be unique to this one disease. If we have a flu pandemic, I’d wager that the same people who have been found to have higher risks of Long Covid will also have higher rates of medium and long-term effects of that infection.

A lot of people sign up for marathons because they want a goal that will help them achieve another goal—health and fitness. I think it’s time we realize that we’ve all signed up for a high likelihood of being exposed to another pandemic (let alone surviving this one). We should think of healthy lifestyle habits as though we are training our bodies to withstand the next pandemic because, with respect to outcomes, we truly are.