This is all fine as generic health advice, of course. But 38 million Americans have diabetes. More than 100 million have heart disease. More than 100 million are obese. Massively improve those numbers and there will still be tens of millions staring down a novel pathogen in ill health. And as a program of pandemic response? Like much of MAHA, it is magical thinking that has the secondary effect of laying responsibility for public health outcomes at the feet of the individual. Imagine sitting in the National Institutes of Health, contemplating the arrival of a disease like H.I.V./AIDS, which has killed 700,000 Americans, and advising the country that, as Bhattacharya and Memoli write, “the best pandemic preparedness playbook for the United States is making America healthy again.”
Or, for that matter, take Covid-19, which many contrarians will now tell you killed only the sick and vulnerable. The claim is flattering to survivors but otherwise deeply misleading: Poor health mattered for individuals and at the population level, but it was hardly determinative on its own. Age, which of course one cannot change, was the overwhelmingly dominant factor. Anything you might have done to improve your health before the pandemic arrived would have proved trivial compared with how old you were — and the fact that SARS-CoV-2 was a rapaciously infectious novel pathogen spreading through an immuno-naïve world.
The C.D.C. synthesizes research on this question this way: Obesity and diabetes with complications both increased the risk of death from Covid-19 by about 30 percent; chronic kidney disease, C.O.P.D. and bronchiectasis and neurocognitive disorders added 20 percent; heart disease added about 10 percent. These were the common conditions with the largest impact on individual mortality risk, and though each would make a meaningful difference in any individual case, the effect was only as large as a couple of years of age. You’d rather have been thin than obese in 2020, but you’d rather have been an obese 40-year-old than a fit 50-year-old. What does that tell you about the pandemic value of good health?
Future pandemics won’t likely resemble the last one, which is one reason it may be somewhat counterproductive to relitigate 2020 and 2021: Are we sure we want to resolve anything in particular about school policies without knowing the age skew of a future disease, for instance, or anything about social distancing before knowing how infectious it might be? Do we really want to give a second look to the old miasma theory or consider a variant called terrain theory, simply out of frustration with 2020 and 2021? One credible, though by no means definitive, account by Christopher Ruhm suggested that between the most and the least restrictive states, mitigation strategies could explain as many as 447,000 deaths in the first two years of the Covid pandemic. Are we really prepared to embrace a D.I.Y. public health libertarianism in the wake of a respiratory pandemic that taught us — or should have — that whenever we share air, we share disease?
To a distressing degree, the answer appears to be yes — not just in the fiercest MAHA circles but among the population at large, as a poll shows.
