Shelter from the cytokine storm: Healthy living is a vital preventative strategy in the COVID-19 era

Abstract

Coronavirus disease 2019 (COVID-19) continues to have a devastating effect on a global scale. COVID-19 variants continue to arise and counteract vaccination efficacy. As such, preventative health measures, such as social distancing and stay at home mandates, will continue for the foreseeable future. Evidence on those at greatest risk for poor outcomes if infected with COVID-19 has rapidly come to light. It has become clear that those with unhealthy lifestyle characteristics, chronic disease risk factors and/or a confirmed diagnosis of one or more chronic conditions are at greatest risk for hospitalization, intensive care unit admission, mechanical ventilation, and death if infected with COVID-19. The cytokine storm is a phenomenon that has been posited as a pathophysiologic response to COVID-19 infection that leads to poor outcomes. The current graphical review illustrates the association between unhealthy lifestyle characteristics and increased vulnerability to the cytokine storm as well as the physiologic mechanisms healthy living behaviors elicit and decrease risk for the cytokine storm. Through this graphical review, we will demonstrate unhealthy lifestyle characteristics, chronic disease risk factors and diagnoses, and COVID-19 outcomes are intricately linked, creating a new global syndemic. It is also clear that a primary way to uncouple this syndemic is through increasing healthy living behaviors, as illustrated in this graphical review. Moving forward, healthy living medicine should be practiced with renewed vigor to improve human resiliency to health threats posed by both chronic disease and viral infections.

Keywords: Diet; Immunity; Inflammation; Physical activity; Viral infection.

Fig. 1

The unhealthy phenotype – priming the pump for increased severity with COVID-19 infection. Legend: The following image features an overweight (not necessarily obese) figure, shown in sedentary position eating/nearby unhealthy foods late at night to indicate poor sleep habits. A zoomed-in callout of adipose tissue is shown releasing pro-inflammatory cytokines with a single white blood cell. From there, you can see an extremely schematic view of a TLR and a relationship between NLRP3 and IL-1.

Fig. 2

The cytokine storm and COVID-19. Legend: The Cytokine Storm and Compounding Impact of COVID-19. No human figure will be shown, as this story will focus on the cellular level. A large amount of pro-inflammatory cytokines will be shown, building onto similar imagery from graphic 1 and leading to the cytokine storm. Inflammation response leads to compounding effects from COVID-19 in the lungs.

Fig. 3

The healthy phenotype – protection for the cytokine storm. Legend: This figure is meant to juxtapose the first figure to emphasize the most important parts of the story. A healthy-weight figure is shown doing yoga during the day, with nearby healthy foods and water. Similarly, to Image 1, a zoom-in shows a lower amount of adipose tissue to prevent those pro-inflammatory cytokines from being released. We also see a larger amount of white blood cells and a lack of response at the TLR (as opposed to what is shown in Fig. 1).