Developmental origins unravel the root causes

While COVID-19 has reached pandemic proportions, it is not the only pandemic we are facing. 

In the U.S., the severity of COVID-19 is associated with preexisting, chronic conditions. In addition to age, the CDC lists cancer, kidney disease, lung disease, weakened immune system, obesity, serious heart conditions and type 2 diabetes among the most common underlying conditions that portend a severe infection. This list of chronic conditions is important for several reasons.

First, it alerts people with these conditions to take extra precautions to protect themselves during the COVID-19 pandemic.

Second, it explains the disparity in severe illness and death from COVID-19 among different racial and ethnic groups. American Indian, Alaska Native, Black, Pacific Islander, Hispanic and Latino communities all have hospitalization rates that are roughly four times higher than in whites. Death rates are double or more among Pacific Islanders, Indigenous, Black and Hispanic or Latino Americans. Why? Because these groups have much higher rates of the underlying chronic conditions listed by the CDC.

Third, though perhaps the least well known, the underlying chronic conditions that predispose individuals to severe COVID-19 cases are known to have their roots in early life development due to poor nutrition and exposure to chronic stress.

Research now shows that poor nutrition at critical periods of development alters the structure and function of the body’s organs and systems, increasing the vulnerability for adult disease. Poor nutrition also results in epigenetic changes – essentially silencing health promoting genes, or turning up health harming genes. The result is an adult with an increased chance of developing chronic disease.

Nationally, the prevalence of type 2 diabetes has increased some 10-fold in the past 50 years. In Oregon, type 2 diabetes has more than tripled over the last three decades. The same is true of other chronic diseases like obesity and heart disease. Rates of chronic disease may have risen slowly by comparison to the usual standards of an influenza epidemic, but rapidly if viewed across human history. Chronic disease prevalence must now be placed in the epidemic category and associated with words like “crisis” and “urgent.”

Compared to the COVID-19 crisis, chronic disease rates are less alarming to news media, government officials and most medical organizations. Perhaps because there is no biological organism to blame and strategies for reversing these diseases are complex.

So why care what term we use for the problem? The word matters because an epidemic or a pandemic, whether of a harmful virus, opioid use or vaping, captures the national attention. Once identified as such, experts get called to testify, resources are set aside to combat its spread, programs are established, and no one is happy until the culprit is vanquished.

Vaccines will likely slow the COVID-19 pandemic in the next 12 months. However, we need to address the underlying chronic diseases, or they will keep unnecessarily killing people.

We need a multi-pronged approach to halt the chronic disease epidemic that we now face. We must continue to invest heavily in understanding the biological origins of disease so that specific remedies can be applied to slow the disease process or stop it altogether. However, we must also challenge the systems that encourage diets high in calories, but low in nutrients and we must improve access to nutrition in every community, with a focus on those where chronic disease rates are highest.