Novel Physical Therapist Lens on Developing a SARS-CoV-2 Vaccine: “Healthy Lifestyle Practices” Are Safe and Cost-Effective

Abstract

Once the SARS-CoV-2 virus hit the planet in the fall of 2019 and an understanding of its infectiousness and severity quickly became apparent, the starting gun in the race for a vaccine sounded. The trajectory for vaccine development follows a typical path: the identification of a specific pathogen, deconstruction of its structural characteristics, construction of a vaccine to counter it, and years of phased clinical trials to establish its safety, efficacy, and eventual effectiveness when administered to humans. Correspondingly, as the race for a vaccine escalated, research emerged examining susceptibility and risk factors for poor outcomes of COVID-19, the disease caused by SARS-CoV-2. Based on the concurrence of findings from multiple studies that were being published at a feverish rate, a pattern arose. Multimorbidity including obesity, hypertension, diabetes, cancer, heart disease, chronic lung disease, and renal failure; aging; and frailty emerged as key predictors of susceptibility and poor outcomes of COVID-19 includingmortality. Between 96% and 99% of individuals who die from SARS-CoV-2 infection have at least one underlying chronicmorbidity or risk factor. This proportion cannot be overlooked. Not only are physical therapists well qualified to prevent as well as manage these morbidities and risk factors, but the cardiopulmonary physical therapy community has a primary responsible to lead the way. Vaccines not only take years to formulate and test before becoming widely available and distributed, but typically have variable rates of effectiveness. This is particularly true of viruses that adapt and mutate quickly. The earliest predictions for the development of a safe and reasonably effective vaccine may be several years. But, what if we shifted our lens on conceptualizing and developing a safe and effective vaccine?What if we focused on the immune status, general health status, and lifestyle practices of those who are uninfected by SARS-CoV-2; those who are infected but experience few, if any, symptoms; and those who are infected and have severe symptoms and recover? What if we stratified these 3 cohorts and compared them with respect to their immune status, their general health status, and lifestyle practices? Based on the extant literature, such an analysis leads one to reasonably hypothesize whether the reach of SARS-CoV-2 would have resulted in being a mere blip on the global health radar screen rather than a full-blown pandemic, had unhealthy lifestyle practices, that largely underlie the prevalence of lifestyle-related noncommunicable diseases, been minimal. One cannot deny that the food industry (perhaps better termed the “edible products” industry) in high-income countries and increasingly in middle-income and lowincome countries, contributes substantially to the unhealthy western diet that typically consists of excessive amounts of fat, sugar, salt, and consumable processed products and dangerously inadequate amounts of vegetables, fruit, legumes, and whole grains. A whole-food plant-based diet has been well documented to be both healthful and disease preventive. With globalization, the western diet has itself become pandemic along with other unhealthy practices such as prolonged sitting, inadequate physical activity, and smoking. Thus, it is not inconceivable that these practices increase susceptibility to infective viral load given they have beenwell established to be proinflammatory by exacerbating the inflammatory response. A viral load superimposed on such chronic lower-grade systemic inflammation warrants being a research priority particularly in light of COVID-19. Adopting and adhering to healthy lifestyle practices— known to be anti-inflammatory—is safe, effective, can be instituted immediately, and yields such positive effects as reduced blood pressure, blood sugar, and body weight relatively quickly and even show signs of reversing atherosclerosis within a year or so. To implement safe and effective protection against SARS-CoV-2 infection and help minimize its susceptibility, healthy lifestyle practices including wholefood plant-based nutrition and physical activity, we as the leading established noninvasive (i.e., nondrug and nonsurgical) health profession in the world, need not only to address the root of the problem and support responsible evidence-based practice in addressing it but also assume a