200726-Quotidien du Médecin ENG

Would the Covid have killed this many people 50 years ago?

Authors:  Millet GY

Article originally published in French in Le Quotidien du Médecin

Let's be clear: the goal of this article is not to give morality lessons, and even less to make sick people feel guilty. It is to simply describe a reality: the Covid-19 does not kill everyone. Setting aside the case of the elderly who are naturally more fragile, the virus is dangerous mainly for people suffering from chronic diseases and co-morbidities such as hypertension, obesity and type II diabetes, i.e. contemporary pathologies. It is so true that one could wonder whether the lockdown would have been necessary 50 years ago? Or if the virus would have killed so many people, despite the modern equipment of the intensive care units?

Overweight and obesity have exploded in rich countries. What is most worrying is that it starts at a very young age. In France, the rate of overweight 5-19 year olds has doubled since 1975 and the curve is not flattening, leaving a bright future for Covid and other similar pandemics. In the United States, African-Americans are more affected (33% of Covid-related hospitalisations, although they represent only 13% of the population). Because of the more exposed jobs and greater precariousness but perhaps also the fact that they are more affected by obesity problems. These last two points being related to each other.  

Overweight and associated pathologies increase while the level of physical activity follows a diametrically opposite curve. The causes are known (passive transport & leisure, sedentary jobs). Again, this starts at a very young age. Fifty years ago, the vast majority of children used to go to school walking or even cross-country skiing! How many of them do so nowadays? We may do more sport than before, but we are much, much less active. As a result, physical performance drops dramatically. Comparing the performances of fathers (or mothers) with those of their sons (or daughters) at the same age is always in favour of the former, regardless of the physical quality. Maximum oxygen uptake (an index of sport performance but also an index of health) has fallen by almost 0.5% per year between 1980 and 2000. This is dramatic and there is no doubt that it continues to decrease. Here again overweight plays a role but it is not the only reason.

It is true that the human being continues to break sports records. But never before have we had such a large gap between this very small percentage of the population that does sport at an elite level (and whose performance continues to increase) and the 50% least active people whose physical level is getting lower every day. Doesn't that remind you of the growing gap between the extremes in terms of earnings?

During the lockdown, the French government has allowed the population to get outside one hour a day for physical activity. Yet this daily exercise may have not been enough to compensate for the teleworking/Netflix sedentary behavior (raise your hand if you were doing the famous 10,000 steps a day?). The resulting physical deconditioning is likely to put a strain on the health care system. And perhaps even accentuate the chronic fatigue of the population which will itself potentially lead to an increase in absenteeism and a drop in productivity. A kind of double penalty.

As I said in the introduction, this is not a matter of moralizing at an individual level. Nor to ask the children to go back to school on cross-country skis (well, there is no more snow anyway). It is a matter of vehemently proclaiming that a proactive policy (sports facilities, promotion of physical activity, funding of research programs in movement sciences, improving cyclability and walkability of cities, sport at school, support for associations and companies) must be put in place to increase the level of physical activity of the population, at all ages. Of course the priority is to stop the dismantling of the health system, but combating sedentary lifestyles and inactivity certainly remains one of the best ways to reduce the number of people visiting hospitals every day.