Adherence to Healthy Lifestyle Prior to Infection and Risk of Post–COVID-19 Condition

There is an old, old fallacy here. Sure: Healthy people survived Covid better but why was that? Was a healthy lifestyle the crucial factor? This article cannot tell us that. It could well be that people who adopted a heathier lifestyle were healthier to start with. And the converse -- that sickly people are unable to adopt many aspects of a healthy lifestyle (such as vigorous exercise) -- is undoubtedly true. So was it lifestyle that protected from Covid in the study below? Maybe, maybe not

It doesn't prove anything by itself but I have a very unhealthy lifestyle and Covid has not touched me at all -- and I am 79, in a high-risk group. So the report below will not influence anything I do

Siwen Wang et al.

Question Is a healthy lifestyle (healthy body mass index, never smoking, high-quality diet, moderate alcohol intake, regular exercise, and adequate sleep) prior to SARS-CoV-2 infection protective of post–COVID-19 condition (PCC)?

Findings In this prospective cohort study of 1981 women who reported a positive SARS-CoV-2 test from April 2020 to November 2021, adherence to a healthy lifestyle prior to infection was inversely associated with risk of PCC in a dose-dependent manner. Compared with those who did not have any healthy lifestyle factors, those with 5 or 6 had half the risk of PCC.

Meaning Preinfection healthy lifestyle was associated with a substantially decreased risk of PCC.

Abstract

Importance Few modifiable risk factors for post–COVID-19 condition (PCC) have been identified.

Objective To investigate the association between healthy lifestyle factors prior to SARS-CoV-2 infection and risk of PCC.

Design, Setting, and Participants In this prospective cohort study, 32 249 women in the Nurses’ Health Study II cohort reported preinfection lifestyle habits in 2015 and 2017. Healthy lifestyle factors included healthy body mass index (BMI, 18.5-24.9; calculated as weight in kilograms divided by height in meters squared), never smoking, at least 150 minutes per week of moderate to vigorous physical activity, moderate alcohol intake (5 to 15 g/d), high diet quality (upper 40% of Alternate Healthy Eating Index–2010 score), and adequate sleep (7 to 9 h/d).

Main Outcomes and Measures SARS-CoV-2 infection (confirmed by test) and PCC (at least 4 weeks of symptoms) were self-reported on 7 periodic surveys administered from April 2020 to November 2021. Among participants with SARS-CoV-2 infection, the relative risk (RR) of PCC in association with the number of healthy lifestyle factors (0 to 6) was estimated using Poisson regression and adjusting for demographic factors and comorbidities.

Results A total of 1981 women with a positive SARS-CoV-2 test over 19 months of follow-up were documented. Among those participants, mean age was 64.7 years (SD, 4.6; range, 55-75); 97.4% (n = 1929) were White; and 42.8% (n = 848) were active health care workers. Among these, 871 (44.0%) developed PCC. Healthy lifestyle was associated with lower risk of PCC in a dose-dependent manner. Compared with women without any healthy lifestyle factors, those with 5 to 6 had 49% lower risk (RR, 0.51; 95% CI, 0.33-0.78) of PCC. In a model mutually adjusted for all lifestyle factors, BMI and sleep were independently associated with risk of PCC (BMI, 18.5-24.9 vs others, RR, 0.85; 95% CI, 0.73-1.00, P = .046; sleep, 7-9 h/d vs others, RR, 0.83; 95% CI, 0.72-0.95, P = .008). If these associations were causal, 36.0% of PCC cases would have been prevented if all participants had 5 to 6 healthy lifestyle factors (population attributable risk percentage, 36.0%; 95% CI, 14.1%-52.7%). Results were comparable when PCC was defined as symptoms of at least 2-month duration or having ongoing symptoms at the time of PCC assessment.

Conclusions and Relevance In this prospective cohort study, pre-infection healthy lifestyle was associated with a substantially lower risk of PCC. Future research should investigate whether lifestyle interventions may reduce risk of developing PCC or mitigate symptoms among individuals with PCC or possibly other postinfection syndromes.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2800885

************************************************

Do mask mandates work?

This week there was an update to a Cochrane review, which studies the way physical interventions can interrupt or reduce the spread of respiratory viruses. The review, which Tom Jefferson is the lead author of, looks at evidence from 78 randomised trials with over 610,000 participants. In other words, this review is exactly the sort of higher-quality evidence you want when making healthcare decisions.

The review’s fifth update looked at handwashing, antiseptic use, social distancing and barriers such as masks, gloves, gowns and visors.

Given past controversies, it’s worth looking at what the review says about the effects medical or surgical masks have on the way respiratory diseases spread.

Interestingly, 12 trials in the review, ten in the community and two among healthcare workers, found that wearing masks in the community probably makes little or no difference to influenza-like or Covid-19-like illness transmission. Equally, the review found that masks had no effect on laboratory-confirmed influenza or SARS-CoV-2 outcomes. Five other trials showed no difference between one type of mask over another.

This is the second update of the review since the start of the pandemic. The first update was delayed by seven months due to unexplained editorial decisions. It was too late when it came out in November 2020 to make a difference to national Covid policy; by then, activism, low-quality observational evidence and government policy had set the agenda for mask mandates, and the damage had been done.

Often these government policies relied on observational studies on mask usage and the spread of Covid. But there are lots of flaws in observational evidence. For example, in the absence of a study protocol setting out methods before the study is done, it is possible to shift the dates of an observational analysis to suit the rise and fall in infections. So if you time your analysis near the peak of infections, the results will favour mask interventions as the infection rate quickly decreases.

But when we pointed out in November 2020 the troubling lack of robust evidence on face masks and the problems with observational studies, we were shouted down, removed from Facebook and put on the government’s secret watchlist.

What many also failed to notice at the time was that studies that look at individuals – as opposed to populations – can lead to erroneous policy decisions. Studies which involve individuals frequently track people who have specifically chosen to wear a mask. But policies on mandatory masks are very different – they involve lots of people who don’t like wearing masks every day, and many people who won’t wear one at all. A study which only looks at keen mask-wearers will not reflect how people comply on a population level.

The Cochrane review findings report relatively low adherence to mask-wearing, which is similar to what happens in the real world. With better adherence and higher quality masks (and if you are careful when you step out the door), you might reduce your risk in specific settings by a small amount. However, when you scale up any potential small benefits to those who step out the door regularly, the effect doesn’t stack up as a population-based intervention.

Mandates that affected the whole population never made sense. Moreover, even in high adherence populations such as Japan, they have not stemmed an inevitable rise in infections. Part of the problem may be that during the pandemic the government had to be seen to be doing something. Interventions like handwashing and vaccines are invisible, but masks acted as a visible sign of compliance.

What we have witnessed in this pandemic are strong beliefs about what works and what doesn’t. At times, it’s been more like a football match, with cheerleaders on either side goading the opposition. Several policies such as mask mandates, restrictions, and unproven interventions now seem absurd in hindsight. And as the culture of fear has lifted, the population has become all too aware of their detrimental effects.

We failed to follow an evidence-based approach during the pandemic. We are now left with the human, social and economic aftermath of evidence-free policies.

https://www.spectator.com.au/2023/02/do-mask-mandates-work/

*************************************************

Also see my other blogs. Main ones below:

http://edwatch.blogspot.com (EDUCATION WATCH)

http://antigreen.blogspot.com (GREENIE WATCH)

http://pcwatch.blogspot.com (POLITICAL CORRECTNESS WATCH) Also here

http://australian-politics.blogspot.com (AUSTRALIAN POLITICS)

http://snorphty.blogspot.com (TONGUE-TIED)

https://immigwatch.blogspot.com (IMMIGRATION WATCH) Also here

https://awesternheart.blogspot.com (THE PSYCHOLOGIST)

http://jonjayray.com/blogall.html More blogs

**************************************************