Indoor Air Cartoon Journal, May 2020, Volume 3, #106

What makes a pre-existing condition a concern during the COVID-19 pandemic? To provide insight into the answer to this question, an understanding of stress and impact on the immune system is essential. The price the human body and immune system pay when recalibrating to ensure survival in an environment or to the effect of stressor is called stress. The rate at which the recalibration occurs determines the extent to which the human immune system that controls defense cells wear out. The higher the rate of recalibration due to the stressor, the higher the extent to which the immune system will wear out.

Look at it like this, imagine you have a group of soldiers fighting new enemies (stressors) on many fronts, or fighting a powerful pre-existing enemy before a more powerful enemy come on board to attack your territory. Imagine a situation where you have pre-existing weak soldiers protecting your territory against enemies (stressors). The battle is a similitude to the recalibration human immune system has to undergo anytime it is faced with a stressor. A pre-existing condition generates stressor the human body has to deal with. This occurrence usually leads to a weakened state of the human immune system.

Poor living and working conditions, lack of or inadequate health care benefits, and social discrimination produce stressors that cause the human body’s immune system to recalibrate to produce defense cells needed to deal with the stressors. The recalibration is essential for the adaptability and survival of the exposed human body. These stressors and continuous recalibration wear out the immune system and weaken its ability to protect the body from experiencing discomfort, falling sick, or dying. What would happen when a coronavirus attack when the human body is dealing with the stressors generated by the social and economic pre-existing conditions?

The answer to this question is not farfetched. There are reported cases around the world in the media and scientific literature where minorities in the community with lesser social and economic privileges were more prone to being infected with coronavirus and dying from the infection, especially when they are not afforded adequate medical attention.

Physiological related pre-existing conditions can also wear out the immune system. Cancer, kidney, cardiovascular and respiratory-related diseases are examples of physiological related pre-existing conditions many people are dealing with before the occurrence of a powerful stressor called coronavirus. Examples of pre-existing physiological conditions reported in the literature include hypertension, cardiac injury, liver dysfunction, kidney injury, obesity, diabetes, asthma, etc. General sickness is also an example of this type of pre-existing condition.

Unfortunately, many people dealing with social and economic pre-existing conditions are also experiencing the physiological related pre-existing condition. In such cases, the body of these people has to deal with so many stressors. Winning the battle, including that of coronavirus, occurring on many fronts, is an uphill challenge. It is no surprise that the human immune system wears out with age. The body has fought so many battles (stressors). The high rate of COVID-19 mortality among the elderly signifies the inability of their weakened immune system with little energy and competency to fight against pre-existing stressors and a new and more powerful stressor like coronavirus.

The impaired psychological pre-existing condition has also been reported as a stressor that induces immune dysregulation, thus making the affected person prone to developing and suffering from health problems. Immune dysregulation is like having uncoordinated soldiers or soldiers that are not following orders from their superiors during an attack by the enemy. We all know what will happen to the army. They are bound to be destroyed, and the enemy will conquer their territory. The conquer of the territory can be likened to coronavirus taking over from the body.

While improvement efforts are to be made to improve or manage the human immune system medically or with nutrition and exercise, pre-existing conditions altering and weakening the structure and function of the immune system should be given due attention by policymakers.

It is important to note that if coronavirus does not get into the human body, there won’t be any need to call upon the immune system. Thus, effective risk assessment and management are needed to manage the source of coronavirus and media (air, surfaces, and human) carrying it to reduce human exposure in the environment, especially in the indoor environment where we spend majoritý of our time.

While it is essential to prevent exposure as much as possible, exposure those not necessarily mean coronavirus will get into our body. The reduction of the fraction of coronavirus that finds its way into the human body is essential. The use of masks (in public space) and regular washing of hands, suppling clean and treated air to the breathing zone, are examples of strategies that could help reduce the absorbed dose of coronavirus into the human body.

Non-adoption of mentioned strategies or the inability of our existing strategies to reduce the absorbed dose of coronavirus into our body is also a pre-existing condition that warrants improvement. Preventing and managing pre-existing conditions to reduce their associated stressor is a continuous improvement endeavour and should be treated as such.

Do you want to learn more about this topic? Read Godbout and Glaser (2006), Li et al. (2020), Muniyappa and Gubbi (2020), Yancy (2020), and Zhou et al. (2020) papers. You may also want to read a book titled “The impact of the human stress response…” written by Wingo (2016) to learn more about the concept of stress as discussed in this article.