The New Normal

by Jennifer Ashton, M. D.

  The thing about risk factors such as age, gender, and race is that you can’t change any of them. But knowing you’re more vulnerable can help you better assess your risk tolerance for certain social activities, which we’ll talk about in chapters 9 and 10. If you have a number of high-risk factors—if you’re a black or brown man over age sixty-five, for example—I would encourage you to take every precaution possible, like always wearing a mask, keeping at least six feet away from others, washing your hands, and avoiding high-risk activities like eating indoors in restaurants and attending in-person religious services.

  What You Can Change

  After obesity, the second biggest modifiable risk factor for severe illness with COVID-19 is diabetes. Also known as hyperglycemia, the condition is cause for concern on its own. But when paired with COVID-19, diabetes can be deadly. People with type 2 diabetes are four times more likely to succumb to the coronavirus than those who don’t have hyperglycemia, according to research.5

  Type 2 diabetes, which often occurs in adults who gain weight, aren’t active, and/or eat a standard American diet, affects more than 34 million people in the United States. The really scary part: One in four people with the disease don’t know they have it. Similarly, one-third of all Americans have prediabetes—a precursor to type 2—yet 84 percent have no idea.

  Why is the combo of diabetes and COVID-19 so deadly? In basic terms, pathogens need glucose to survive—it’s why bacteria and viruses grow so well in sugar-rich environments. The more glucose surging through your cells, the more a virus can replicate, spread, and cause trouble. In addition, people with diabetes tend to have a higher level of inflammation that can exacerbate COVID-19 infections, which also produce inflammation in the body. When you’re diabetic and have coronavirus, it’s like a kid in a toy store before Christmas: COVID-19 goes crazy.

  If you know you have diabetes, now is the time to do everything possible to reverse or control the condition using a three-pronged approach of low-sugar nutrition, more exercise, and sustained weight loss. Those who have diabetes and don’t know it may be at greater risk, since many are not taking the necessary precautions recommended to those most vulnerable to the virus. That’s why I recommend anyone who is overweight, inactive, and/or following a standard American diet consider making an appointment for an annual physical, especially if you haven’t been to the doctor in more than a year (see page 29 for more information).

  Diabetes isn’t the only hidden ailment for severe COVID-19 complications. High blood pressure, called the “silent killer” since it’s often missed by both patients and doctors, can double your risk of dying from coronavirus.6 If you have high blood pressure and aren’t taking medication—either because you don’t know you have it or aren’t following proper treatment protocol—your risk of dying from COVID-19 is even greater, according to research.7

  These stats are particularly troubling because nearly half of all Americans have high blood pressure.8 That means approximately 50 percent of the U.S. population is in jeopardy of severe COVID-19 complications. What’s more, half of those with high blood pressure—about one-quarter of the country’s total population—aren’t taking medication to control the condition.

  Similar to the stats on diabetes and prediabetes, many people with high blood pressure don’t even know they have it. High blood pressure is often asymptomatic and easily missed by doctors, especially those who don’t follow the American Heart Association’s testing recommendations.9 (Learn the one thing to ask for when getting a blood pressure test here.)

  Why does high blood pressure increase one’s risk with COVID-19? One theory is that chronic hypertension weakens blood vessels, thereby allowing the virus to more easily dock in our bodies. High blood pressure also lowers the body’s immune system response.10 Contrary to early reports, though, taking certain blood pressure medications like ACE inhibitors does not appear to increase the risk of severe illness with coronavirus.11

  How do you know if you have high blood pressure? Or how can you ensure the condition is being treated properly? All the more reason to consider getting an annual physical, which we cover in depth starting here.

  Other risk factors for severe COVID-19 complications include cancer; serious heart conditions; heart, lung, or kidney disease; sickle cell disease; chronic obstructive pulmonary disease (COPD); and immunocompromised conditions like HIV. Other conditions like pregnancy, moderate to severe asthma, cystic fibrosis, and neurological conditions like dementia may also increase the risk of severe illness from COVID-19, but more research is needed.

  The New Normal Self-Assessment

  No matter what risk factors you have and whether they’re modifiable, you can’t improve what you can’t measure. If you want to train your body for an Olympic event, for example, you first need to figure out where and how to start by taking a hard look at your current and past training. If you haven’t run in years, have bad knees, and don’t own running shoes, your training plan will look a lot different from someone who has been working out several days a week, suffers from weak calves, and has a whole closet of high-performance sneakers.

  For this reason, I recommend that everyone consider taking the time to do a serious self-assessment of his or her physical and mental health right now. Given the pandemic—and the potential of another one in the future—it’s really important to know what you’re doing right, what you may be doing wrong, and perhaps most important, what you might be overlooking about your health that could endanger your life in our new normal.

  The goal of a self-assessment is not to unearth all your flaws or make you the healthiest human on the planet. Just as with weight loss, the goal of a pandemic self-assessment is specific to our new normal. You don’t have to identify every unhealthy habit you have, but focus on finding those that may increase your risk of COVID-19 and other infectious illnesses.

  Consider this self-assessment to be a judgment-free zone—you just want to find possible issues so you can be aware of and fix them before they become catastrophic problems. And while everyone should strive for optimal health, your top priority now is to make sure your body can survive a health crisis—whether it’s coronavirus, a bad strain of the flu, or an unknown pathogen that triggers the world’s next global outbreak.

  To do an honest self-assessment, you need to get your mind in the right place, too. Like most things in life, it’s all about attitude and the realization that things are different now. While maybe you were able to get away with poor health habits or preexisting conditions so far, we live in a new world now. Poor health habits or preexisting conditions can mean the difference between a slight fever and cough with the coronavirus—or a ventilator and an ICU room.

  So clear your schedule for one hour this week, grab a pen and paper, and keep your cell phone nearby. Here’s how to do a physical self-assessment in pandemic times:

  1. Ask yourself how you’re feeling. Whenever I see patients, the first thing I always ask is how they are feeling. It sounds simple, but the answer to this question is super informative. If you can honestly say you feel great, that’s wonderful. But if you feel at all achy, tired, burned out, or bummed out—or have been dealing with dizziness, pain, muscle weakness, gastrointestinal problems, or a number of other ailments—that’s a sign that something might be wrong. Use your pen and paper to write down exactly how you feel, physically and mentally. Be as honest, accurate, and thorough as you can.

  2. Take a hard look at your daily habits. If you were a new patient of mine, I would try to get as much information as I could about your daily habits before I pulled out a blood pressure cuff or did a physical exam. How active are you on a regular basis? How many hours do you sleep on average? How much alcohol do you drink? Do you smoke or vape? Do you eat a lot of sugar, takeout meals, and/or mostly processed food? Or is your diet made up primarily of whole foods, with plenty of protein, fat, and green vegetables? Are you super stressed all the time or do you have a handle (mostly) on your mental health? Think about o
ther habits you may have that could be affecting your physical or mental health.

  Now grab your pen and paper and make two columns—one for your healthy habits and the other for the not-so-healthy ones—and write each of your daily habits in one column or the other. Don’t judge yourself—we all have issues (me included), but if we don’t identify them, we can’t address them. If you can’t decide whether a habit is good or bad, create a third column with a question mark so you have it on hand.

  3. List any known health conditions and medications. Are you overweight or obese? Do you know if you have high blood pressure or high cholesterol? Were you diagnosed with hypothyroidism years ago and haven’t been tested since? Write it all down. Be sure to include any mental-health issues you may have been diagnosed with or believe you might have.

  Next, open up your medicine cabinet and write down any medications you take, with dose information and prescribing doctor. Nearly two-thirds of all Americans take at least one prescription drug,12 but many don’t know the drug’s name, the dosage, or the reason they take it in the first place. Many patients also don’t take their medication properly. Now is the time to find out what you’re on, why you’re on it, if you’re taking the therapy properly, and whether you still need to be using the drug.

  4. Find out your medical family tree. Pick up your cell and call Mom, Dad, Granny, Sis, Aunt Helen, Great-Uncle Jack, or anyone else who may be able to help you ascertain the health conditions that run in your family. Don’t stop at the obvious ailments like cancer and heart disease. But if there is cancer, find out what kind of cancer, if and at what age your relative contracted the condition, his or her risk factors, how it was treated, and any other illnesses—physical and mental—that might have a congenital link.

  5. Review your past health experiences. Have you had mostly positive or negative experiences with healthcare providers? Have you usually left a doctor’s office feeling good about your visit? Or have you felt frustrated, overwhelmed, fearful, or distrustful?

  This exercise may seem random, but it’s essential in pandemic times. Since past history informs future predictions, if you’ve had mostly negative medical experiences, you may be tempted to avoid the doctor altogether or not heed a physician’s advice if and when you go. Recognizing you may have mental resistance when it comes to healthcare can help you overcome your limitations if and when you need to seek out or maintain medical treatment.

  If you discover you have had mostly negative medical experiences, I’d suggest revisiting my earlier advice: It’s all about attitude and the realization that things are different now. Unfortunately, now is not the time to put off a trip to the doctor because you’re fearful or frustrated, or have had poor experiences in the past. If you don’t like your primary-care doctor or whomever you’ve seen in the past, I would encourage you to find a new physician.

  6. Add up your coronavirus risk factors. If you’re older than sixty-five, male, and a person of color, your risk factors and the consequential precautions or actions you may need to take to survive and thrive in our new normal are different from those of a thirty-year-old white woman who is at her ideal/normal body weight. Make a list and include any preexisting conditions you know you have, including diabetes; high blood pressure; cancer, heart, lung, or kidney disease; COPD; sickle cell; or immunosuppressant conditions like HIV.

  Vaping and Viruses

  We know that a history of smoking traditional cigarettes can double the risk of severe illness from COVID-19.13 But what about e-cigarettes, often (and erroneously) viewed as safer than smoking tobacco cigarettes?

  In the weeks before COVID-19 hit the United States, vaping was on the national news 24/7. Every day, there was a different headline on e-cigarettes: an uptick in vaping-related deaths and lung injuries; the CDC’s investigation into e-cigarettes; the national ban of some flavored vapes, which went into effect February 2020.

  While these headlines may have fallen off the news cycle, none of these concerns about e-cigarettes has gone away. Today, vapers have something new to worry about: Research out of Stanford University shows that teens and young adults who vape are five times more likely to be diagnosed with COVID-19.14 Why? Researchers say vaping damages the lungs, while those who use e-cigarettes are more likely to touch their face and share devices.

  Another reason to drop the pen: In April 2020, at the initial height of the pandemic, the CDC found that vaping-related lung injuries were still occurring at an alarming rate, but were manifesting very similarly to COVID-19 infections, with symptoms like shortness of breath, fever, and chills.15

  The Pandemic Physical: What You Need to Know

  There is no national recommendation being made by a major health organization that everyone needs to get a physical now. And the term pandemic physical is my own. But the concept conveys my point: I think nearly everyone should strongly consider getting a comprehensive medical checkup now, especially if you haven’t been to the doctor in the past year. An annual checkup with a qualified healthcare practitioner, regardless of what you want to call it, is the best way to make sure your health is in order and you have no sneaky chronic conditions that could increase your risk of serious illness or death.

  Take this consideration seriously: No matter who you are or how you feel, preexisting conditions are far more common than you think. Sixty percent of all Americans have at least one chronic health condition.16 Two-thirds of all Americans are overweight or obese. One in three American adults has prediabetes. Nearly half of all adults have high blood pressure. And the list goes on.

  One of the biggest benefits of a pandemic physical is that it can help unearth a risky chronic condition that you didn’t know you have. I see prediabetes, high cholesterol, and mental illness in my patients all the time—every single week. And the overwhelming majority of them tell me they had no clue or never even fathomed that they had the condition.

  None of this is meant to frighten you, but to encourage you to make an appointment with your doctor or healthcare provider. Remember, this is a judgment-free zone: If you haven’t been to the doctor in years, don’t beat yourself up or be intimidated to “find out the truth.” I’m a doctor and even I fall short sometimes on my annual mammogram or skin-cancer screening. But now is the time to act and correct the problem. Here’s how to get a comprehensive pandemic physical:

  1. Make the appointment already. The best place to start is with your primary-care doctor, but if you don’t have one, an OB-GYN, internist, family medicine doc, nurse practitioner, or physician’s assistant can also perform a comprehensive checkup. Don’t be afraid to find a new doctor if you’re not comfortable with your current practitioner. Think of it this way: If you didn’t like a certain food as a kid, would you give up on all food altogether? No, you’d just avoid that specific food and find ones you like better. It’s the same with physicians and just as important for your overall well-being.

  2. Discuss your self-assessment. Don’t assume every doctor will ask you every question that he or she should. Some doctors are better than others, while many simply don’t have the time or bandwidth to be as thorough as they should be, unfortunately. That’s why it’s up to you to bring up important topics like your family history, medication regimen, “not so healthy” habits, symptoms that might indicate a preexisting condition, and other concerns that you discovered during your self-assessment. Be sure to include any mental-health concerns, too—these are just as critical to your overall health as any physical issues.

  3. Look for problems, not praise. The point of having a pandemic physical isn’t to get a glowing review from your doctor, but to find possible problems so you can do something to fix them. This was the attitude I had when I went to parent-teacher conferences when my children were young. Don’t just tell me that my kid is amazing—tell me what they need to work on so we can all benefit and grow.

  4. Ask your doc about your weight. Most physicians don’t discuss body weight with patients, despite the fact that this measurement is o
ne of the biggest risk factors for most diseases—and the single biggest chronic risk factor for COVID-19. Don’t be afraid to ask your doctor if he or she thinks your weight, BMI, or body-fat composition (if your physician can take this measurement) is unhealthy. If so, ask if he or she would recommend medication or surgery.

  5. Have your blood pressure checked in both arms. This is a pet peeve of mine. Most practitioners check blood pressure in only one arm, which doesn’t give an accurate snapshot of a patient’s hypertension risk. Ask your practitioner to check both arms, with an appropriate size blood pressure cuff, which is what’s recommended by the American Heart Association.

  6. Get poked. Almost every annual physical, especially one performed in pandemic times, should include bloodwork to rule out the possibility of diabetes, infection, and other disorders or diseases. You don’t need to be fasting or have twenty different panels performed. Just be sure that your bloodwork includes a:

  Hemoglobin A1C test, which shows how much glucose your red blood cells have been exposed to in the last thirty days

  Basic metabolic panel, which checks for kidney and liver function

  Complete blood count, or CBC, which helps assess your overall health and inflammation levels

  Lipid panel, to check both bad and good cholesterol (LDL and HDL, respectively) and your triglycerides. You don’t need to be fasting to check LDL/HDL, but your triglycerides could be affected if you are not fasting.