By Dr. Jodi Leslie Matsuo and Dr. Leon Matsuo
Perspectives on COVID-19 have evolved rapidly since it was first introduced to the public’s mind a few months ago. Initially people were divided. At one end of the spectrum sat a small percentage who practiced caution immediately; at the other end were those who felt it was overhyped. As time went on, opinions about the disease changed rapidly, sometimes daily. However, there is now mutual agreement that COVID-19 is a serious disease that requires extreme caution and personal action in order to control its spread. Despite this realization, many people underestimate their own personal risk.
From the beginning of the COVID-19 spread, “older” adults appeared to be the only ones getting the disease (later defined as those aged 65 years or older). But as the number of COVID-19 cases continued to climb, it soon became apparent there was another large group of people also at high risk of severe illness, a group for which age did not matter: those with existing chronic medical conditions. These conditions include severe obesity, uncontrolled diabetes, those requiring dialysis, serious heart conditions, high blood pressure, chronic lung disease, asthma, liver cirrhosis, and weakened immune system.
This is one of the most frightening aspects of the disease: that it is inclusive of a far larger percentage of the population. For example, it is reported that while about 50% of deaths in New York were among those older than 75 years, approximately 80% of the deceased had an underlying medical condition. In Louisiana, about 97% of those dying from COVID-19 had a pre-existing medical condition. Of those who died, 40% had diabetes, 25% were obese, 23% had chronic kidney disease, and 21% had heart problems.
These medical conditions are not limited to those who are elderly. In Louisiana, about 27% of the people who are at higher risk of severe illness due to COVID-19 are under 65 years old. In Hawai‘i, about 20% of those at high risk are also younger than 65.
For Native Hawaiians, these findings are particularly concerning. If you ask any local person in Hawai‘i if they have any close relatives who have diabetes, heart problems, high blood pressure or who are severely obese, chances are most would say that they do have ‘ohana with these conditions. Compared to other major ethnic groups in Hawai‘i, Native Hawaiians have the highest prevalence of diabetes requiring insulin, heart attack, heart disease, asthma, kidney disease and the second highest prevalence of stroke and severe obesity, next to other Pacific Islanders. About 23% of Native Hawaiians have one of these chronic medical conditions; another 37% have two or more chronic conditions.
Keep in mind that many chronic diseases may be asymptomatic. Studies show that about a third of all people diagnosed with diabetes, and about 45% of those who had heart attacks, had no prior symptoms. In other words, you may not realize you are in a high-risk category until you get tested.
While sanitary practices and social distancing helps to reduce risk, because COVID-19 is airborne, we now know that is not enough. One of the best ways to reduce risk is to manage or reverse your chronic medical conditions. Here are some positive lifestyle changes you can make to help get you on track:
• Eat nutritious foods. You are what you eat. Eat healthy food and your body responds in a similar way. In Hawai‘i, “disaster” or “emergency” food often equates to ramen, spam, vienna sausage and white rice. Consider expanding your stockpile to include more nutritious versions of canned foods, such as tuna, salmon, sardines, vegetables, fruits and beans. Other shelf-stable items can include instant oatmeal or quick oats, dry cereals, brown rice (“hapa” rice is okay too), boxed tofu (non-refrigerated version), instant miso soup and other canned soups (high in sodium so reserve for occasional use). Stock up on frozen vegetables and fruits too; they are just as nutritious as fresh and less costly.
• Exercise regularly. Keeping active maintains proper body functioning (which includes maintaining a healthy immune system) and relieves stress and depression. Take a walk, go for a swim, or do all those household chores that you now have no excuse not to do, like cleaning your yard, the garage or that “miscellaneous” closet in your house.
• Stop smoking and drinking. Smoking is a risk factor for diabetes, heart disease and other chronic diseases. It also lowers your body’s immunity. Alcohol contributes to obesity and liver disease. We know that it is “easier said than done.” But think about the pros and cons of stopping versus continuing these habits. Consider the expense of such habits, especially in these economically trying times. We highly encourage you to seek professional help to get the support needed. With telemedicine now a widely available option, it is easier than ever to get medical support from the safety of your home.
• Get enough sleep. Lack of sleep is associated with lower immunity and can put unnecessary stress on the body, making it more vulnerable to disease. Aim for 7-9 hours daily. If you have difficulty sleeping, try developing a nightly routine to help “wind” your body down, such as reading, writing or listening to relaxing music.
• Minimize stress. Make conscious efforts to keep stress levels low to help you stay mentally and physically strong. Keep socially connected to family and friends via calling, texting or FaceTime. Start the beginning of each day counting ten blessings in your life. Sing out loud. Play an instrument. Watch a funny movie. Take a walk outdoors.
Practicing healthy lifestyle habits, in conjunction with other preventive measures, such as frequent handwashing, social distancing and wearing face masks, can potentially go a long way in giving you and your ‘ohana a fighting chance to not just survive, but thrive, despite these trying times. This is necessary for the health of our entire lāhui.
Dr. Jodi Leslie Matsuo is a Native Hawaiian Registered Dietitian and Certified Diabetes Educator, with training in Integrative and Functional Nutrition. Dr. Leon Matsuo is a Native Hawaiian physician specializing in Internal Medicine and Pediatrics. They currently work in private practice, promoting lifestyle medicine as a means of preventing, treating, and reversing chronic diseases. Being born and raised in Kona, Hawai‘i, their passion has always been serving Native Hawaiians and rural communities.