There is an intriguing wellbeing twist in COVID-19’s multiple uncertainties. It seems bizarre that Japan, the world’s oldest and fastest-aging society, has so far recorded low rates of infection (13 confirmed cases per 100,000 people) and very low mortality rates (less than 1 per 100,000 people). By contrast and in relative terms, the US (a much younger society than Japan) and the UK fare poorly: respectively 370 and 293 confirmed cases with 22 and 44 deaths per 100,000 people.

The many possible explanations are difficult to disentangle, but an increasing number of public health specialists and economists posit that obesity levels may be significant. Simply put: Obesity is a major risk factor for COVID-19.

Japan may be old, but it has one of the lowest rates of obesity in the world, while the US has one of the highest (it is also high in the UK). When more progress is made in terms of understanding the Coronavirus, it could appear that those most at risk are not the elderly (provided they are old in a country with a highly effective health system like in Japan) but those who are overweight and obese, with related health issues such as hypertension and type 2 diabetes.

Obesity is also an economic condition in that it reflects the failure to address a growing divide between the wealthy and the poor. The academic literature is replete with studies and examples proving that low-income jobs and economic insecurity correlate with weakened immune systems, chronic stress, poor diet and physical inactivity.

The Air Pollution-Coronavirus Connection

There is a second wellbeing twist with COVID-19: air pollution. There is now increasing scientific evidence that air pollution worsens the impact of any particular Coronavirus (not only the current SARS-CoV- 2) on our health.

In the US, a recent medical paper has concluded that those regions with more polluted air will experience higher risks of death from COVID-19, showing that in the US counties with higher pollution levels, there will be proportionately more hospitalizations and more deaths. A consensus has formed in the medical and public community that there is a synergistic effect between air pollution exposure and not only the likelihood of contracting COVID-19 but also a worse outcome when the virus does strike.

The research, still embryonic but expanding fast, hasn’t yet proved that a link of causation exists, but it exposes unambiguously a strong correlation between air pollution and the spread of the Coronavirus and its severity.

It seems that air pollution in general, and the concentration of particulate matter in particular, impair the airways—the lungs’ first line of defense—meaning that people (irrespective of their age) who live in highly polluted cities will face a greater risk of (1) catching COVID-19 and (2) dying from it. This may explain why people in Lombardy (one of Europe’s most polluted regions) who had contracted the virus were shown to be twice as likely to die from COVID-19 than almost anywhere else in Italy. A similar conclusion was reached in relation to heavily polluted areas in China during the SARS outbreak.


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