by Jane S
Sometime in February, when it became clear that coronavirus wasn’t just going to be an outbreak limited to China and its neighbors, I got a lot more serious about going to the gym.
The logic was simple. I have cerebral palsy, a disability known to make pneumonia more dangerous by causing habitual shallow breathing, which reduces lung capacity. Less lung capacity means less reserve if you contract pneumonia. But this can be modified by exercise. As long as I was doing a lot of aerobic activity, my risk of severe illness should be about the same as that of a physiotypical 30-something.
Since avoiding the risk of infection entirely was impossible (even if I could have stayed home all the time, family members go out), it made sense to focus on harm reduction. Better a somewhat higher risk of an unpleasant illness than a lower risk of a dangerous one.
In March, my options for physical activity began to narrow. I stopped going to BJJ class because it didn’t seem like a good time to be getting into people’s faces. A week or two later, when students were sent home at my university, the rock wall was shut down. My main fun activities were gone — an unusually rainy March precluded outdoor cycling — but I could still exercise, maybe even train for a birthday challenge. Then, on March 15, my city ordered all gyms to close.
It’s an odd feeling when your main tool for staying healthy gets taken away in the name of public health. I felt a loss of control, combined with anger on behalf of others who would be harmed more than me. I could plunk down a hundred dollars on a mini-bike to use at home and set up Skype sessions with my trainer — not perfect but better than nothing. But that’s financially out of reach for many. Some people with disabilities need exercise equipment that costs thousands of dollars. Others can only swim. It wouldn’t have been too hard to set up designated fitness centers for such people, but no one thought of doing so. Even physical therapy offices closed.
The idea that an important aspect of pandemic preparedness is being overlooked is not just my intuition. Julie K. Silver, the Associate Chair of Physical Medicine at Harvard Medical School, writes in a BMJ opinion piece that it is crucial “to recognize that strategies that might help slow the spread of disease and perhaps reduce its overall incidence (i.e., social distancing and sheltering in place), could have the unintentional and harmful effect of decreased physical activity and contribute to cardiopulmonary deconditioning. In particular, the elderly, who are most vulnerable to pulmonary complications from coronavirus, may exhibit a decrease in their baseline cardiac and pulmonary fitness that could substantially impact their outcomes and increase morbidity and mortality.”
Some of the very people most at risk from COVID-19 — the elderly and those with heart disease and diabetes — are the ones most harmed by inactivity. And that doesn’t even begin to take into account questions of maintaining overall health and physical function. How many older people will become frail, possibly suffering fractures or losing the ability to do activities of daily living? How many will die from this?
There is still an opportunity to maintain vulnerable people’s health during this time. Some can take advantage of exercise videos or routines available on TV or online, or exercise outdoors while maintaining necessary distance. For others, cities and medical centers should try to provide individual or small-group telehealth sessions (hospitals may be overwhelmed, but the skills of physical therapists aren’t immediately relevant to treating COVID-19 patients) and set up in-person facilities for those for whom this is not enough. Getting through the pandemic with a minimum of harm to individuals and society will require a comprehensive approach that includes everyone.
Jane S. is an ecologist who teaches mathematical biology. She enjoys climbing, Brazilian jiu jitsu and any activity that involves thinking with your body. She also gets a kick out of using her powerchair to move heavy objects.