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believed to have taken two million lives; in 1968, the Hong strong evidence that personal factors such as diet quality,
Kong flu killed one million people; and more recently, the exercise, sleep, microbiome composition, and stress
2009 H1N1 swine flu infected 61 million Americans and reduction can be significant in determining the course of
killed 12 500 people. With viruses, some are more HIV/AIDS in an individual who has become infected.
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infectious than others and some are more lethal than This concept has been advanced recently with the
others. recognition that an important way to approach the
In 2012, Anthony Fauci, MD, who is (and was then) treatment of a viral or bacterial infection beyond that of
the Director of the National Institute of Allergy and immunization and antimicrobial/antiviral medications is
Infectious Diseases, published an article in the New through activation of specific components of the immune
England Journal of Medicine with David M Morens, MD, system. In a March 28, 2020 article titled “Activating
titled “The Perpetual Challenge of Infectious Diseases.” Immunity to Fight a Foe—A New Path” that was published
They wrote: “Unlike many chronic and lifestyle-associated in the New England Journal of Medicine, Richard S
diseases resulting from multiple, interacting risk cofactors, Hotchkiss, MD and Steven M Opal, MD highlight their
most infectious diseases are caused by a single agent.” belief that both the pharmaceutical industry and leaders at
They continue: “Given their nature, infectious diseases are the National Institutes of Health need vision and courage
potentially preventable with personal protection, general to support trials that boost immunity in infectious
public health measures, or immunologic approaches such diseases.
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as vaccination.”
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Although the review article by Drs. Fauci and Morens COVID-19: Is Risk and Severity Modifiable through
is very informative as it relates to the origin of viral Personal Lifestyle Factors?
epidemics, I question the statement that infectious diseases From past pandemics we know that different viral
are caused by a single agent. My reasons stem from the infections influence differing percentages of people within
study of the history of global viral pandemics and their a population, but that the majority is generally not
pathogenicity and demographics. While there is no doubt infected. There are many reasons for this that are not fully
that specific organisms are seen as the infectious vectors understood. The biological factors I have outlined–
associated with specific pandemics, I believe history tells environmental exposures, diet, stress, medications, and
us that these viruses do not work alone. In fact, I believe a sleep—are becoming more well established as key factors
very different dynamic exists: these viruses work in that influence immune system integrity and defense
combination with other factors—both social and against viral infection. It is now recognized that more than
biological—and some may be modifiable. 20 million Americans are routinely taking various drugs
There is now evidence that certain lifestyle and that suppress the immune system and can change the way
environmental factors can serve as immunoadjuvants. the body responds to viral and bacterial infections. This
Once identified, these factors can lend themselves to means that other lifestyle and dietary factors that influence
specific personalized intervention that is focused on the integrity of the immune system have become even
renewal of immune system function, as well as increased more important in the age of globally transmitted viral
resilience. I break down the social and biological categories diseases.
mentioned in the preceding paragraph in the following In a study of lifestyle factors and the incidence of
way. Potentially modifiable social factors include things community-acquired pneumonia in men and women
related to structure and behavior, such as housing, living in the United States, it was found that smoking and
transportation, communication, health care systems, weight-gain, along with reduced physical activity, were
politics, and economics. What about biology? Here I associated with increased incidence. Additionally, there is
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would place potentially modifiable factors like stress, extensive research demonstrating that regular physical
environmental toxicity, diet and nutrition, physical activity improves immune response to viral infections. In
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activity, sleep, hydration, intestinal microbiome a March 2020 study published in the Journal of the
composition, and biological rhythms. It is generally American Medical Association titled “Association of Daily
recognized that social factors are challenging to modify, Step Count and Step Intensity with Mortality Among US
whereas biological factors are personal and therefore an Adults,” researchers found that a greater number of daily
individual has a greater focus of control. steps was significantly associated with lower all-cause
Hygiene, sanitation, and immunization are the three mortality. This was independent of step intensity.
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pillars of public health that are emphasized in the An overview of nutritional findings looks like this: a
prevention of pandemic viral infections. All are important study of people who followed an unprocessed diet plan
in reducing risk, but they do not adequately address the rich in plant foods, and also engaged in regular daily
biological modifiable factors that play a very important activity plus time spent outdoors in cooler temperatures,
and personal role in susceptibility to infection, as well as revealed that their immune system function and resistance
pathogenicity. I feel this observation has been validated by to infection was improved. It has also been reported that
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significant work done on HIV/AIDS pathology. There is the Mediterranean Diet improves immune function and

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