Change the Boogey
I was on call for my medical practice over the weekend. Loads of people have COVID.
Cough, sore throat, body aches, and fever are rampant. Another common symptom? Remorse. “I knew I shouldn’t have attended that wedding!” or “My husband should have known better than to visit his sister….” were common themes on the phone.
But as I reminded patients this weekend, getting COVID isn’t a moral failure. BA.5 is so contagious that it’s become increasingly difficult to avoid it.
The good news? The vaccines continue to work well against serious outcomes. Paxlovid can be helpful for high-risk and unvaccinated patients. The rapid tests continue to be excellent measures of contagiousness. Plus, getting COVID itself tops off our immunity, lining our nasal passages with front-line defenders called “IgA” antibodies to protect us when we’re next exposed. (My newsletter last week was all about BA.5.)
Some of us feel defeated when we get COVID. Others are loath to accept that COVID isn’t going away. Of course, all of these feelings are normal and okay. We’re entitled to our own risk tolerance. No one should tell us how to think, feel, or live.
It’s also important to remember that accepting reality is not the same as giving up. Adjusting our lives to reflect a set of fixed unpleasant facts is not about being reckless.
Rather, acceptance allows us to direct our energy and resources to the things we can change (like vaccination status, our underlying health conditions, how we manage stress, etc).
Acceptance can rescue us from disappointment. It can help us better manage expectations. It can free up some brain space to focus on things that give us agency.
Speaking of agency, today I present to you a slice of genius from my friend and ICU doctor, Kwadwo Kyeremanteng, MD.
Kwadwo wants to “Change the Boogey”—to start a contagion of healthy living. You can hear us talk on this week’s episode of Beyond the Prescription. We discuss our shared passion for caring for bodies and minds in tandem—and our advocacy work to benefit kids’ mental health during COVID.
You can also read his guest post below.
The TL;DR?
In caring for critically ill patients during COVID, Kwawdo quickly recognized that many of the underlying conditions that caused severe outcomes were treatable—if not reversible. So he poured his energy into helping people prevent the chances of them landing in the ICU. Kwadwo is living proof that change is healthy—and that anything is possible.
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Prevention over Prescription
by Kwadwo Kyeremanteng, MD
I am a critical care doctor. I have been caring for ICU patients for over 10 years, and I had an epiphany during Covid. In that first wave in early 2020, the ICU was filled with a disproportionate number of people with Covid who had underlying metabolic disease—namely obesity and associated cardiovascular problems.
This opened my eyes. Maybe in addition to treating people for Covid, we should focus on ways to prevent them from landing in the ICU in the first place.
Remember that patients who leave the ICU not only have to recover from whatever illness brought them there, they have to cope with associated PTSD, anxiety, and depression, not to mention the significant suffering for their caregivers and their families.
It was clear to me from the early days of the pandemic that we should be looking at ways to prevent these huge medical, social and emotional costs from happening.
What are the interventions to help prevent an ICU admission?
First, let’s acknowledge that the metabolic problems (like obesity and associated cardiovascular risks) that put people at high risk for serious Covid outcomes can be greatly improved and even reversed. This is not to say that losing weight, getting fit, or changing how we eat is easy. Making lifestyle changes is a lot harder than taking a Covid vaccine, for example (something I also believe in strongly). But if I can help someone avoid landing in my ICU by sticking to a low-carb, high-fiber diet, consuming whole foods, and engaging in routine exercise including resistance training, I feel I’ve done my job.
So during the pandemic I got serious about trying to help people this way. I used my podcast Solving Healthcare and my social media feeds to reach people about simple ways to get healthy. There was so much talk about isolation and hand washing—but what about caring for our bodies and minds? Yes, the vaccines are amazing at preventing hospitalization and death, but what about caring for our underlying conditions? To prevent serious Covid outcomes and help their overall health, I wanted to create that example for people to keep moving.
I started a conversation on Tiktok sharing how I approach wellness. I recorded a video every day because I saw people responding to my content as a doctor—specifically as a Black doctor and leader. I wanted people to know that how we treat our bodies every day has a compound impact on our health over time. And empower people to change. We can reverse a lot of what's hurting our health if we share the right information and access the right tools. It doesn’t have to be expensive or rigid. You just have to do it.
Improving metabolic health not only improves Covid outcomes but also reduces risk for cancer, cardiovascular and heart disease, and stroke, to name a few. These are all things I see in my ICU on a daily basis. So why don’t we invest in ways to let people have access to higher quality foods, non processed foods, make our cities more walkable, and promote healthy living? Why not make that the focus?
What if we take collective action and support discount rebates for gyms, particularly in the hardest-hit, racialized communities? What if we provide subsidized meals for high quality foods? Let’s think about ways that we can reach out, educate, and reach those that are at highest risk. This is where I think more of our energy and communication needs to lie. Honestly, investing in prevention has such huge compounding effects and could be generational.
Personally, I get inspired when I see the “contagiousness” effect of a loved one, for example, getting healthy. You can see a ripple-down effect. I see people in my neighborhood say, “Hey Charles, I hear you came off your diabetic meds. How did you do that?” Then Charles becomes a champion—a go-to for information—that only amplifies his success and helps the next person.
What else can we do?
We need to invest in mental health. Mental health is part of the human condition. It shouldn’t be considered a luxury to get help with it. And we all know how much people have suffered during the pandemic from social isolation, depression, anxiety, bullying, and eating disorders (to name a few). Kids in particular have suffered, and it’s time we help the kids recover from the last two-plus years and get them the resources and tools they need. Childhood is where we lay the foundation for health habits long term. (This is why Lucy and I have advocated so strongly together for meeting kids’ broad human needs beyond just not getting Covid.)
We also should be thinking about surging resources to marginalized, low socioeconomic and racialized communities where they are the hardest hit with metabolic disease and, of course, Covid. We know that there is a direct association with socioeconomics and health outcomes. We saw this amplified during the pandemic. We saw racialized communities hardest hit by hospitalizations and by the mitigation measures themselves—which is why balancing the harms of the virus and the harms of the mitigation measures themselves is so crucial.
Now is the time for innovative thinking. Increasing access to mental health services—in addition to outdoor public activities, gyms, and subsidized high quality foods—plus improved education on the fundamental importance of staying mentally and physically healthy is the path forward. Collectively we get healthier and reduce the demands of hospitalizations and ICU visits. To do this will take a shift in mindset and a shift in priorities but honestly, I think we could do this. These changes need to be intentional, and, in my opinion, the effects on our health and well-being could be dramatic.
Lucy and I talk about a lot of this on her podcast. Check it out. Let’s go!
I will see you next week. Until then, be well.