Time to clean up your habits.
Life has continued to move toward pre-pandemic norms, but the COVID risk remains. As a result, so does the risk of long COVID.
There's no consensus on the exact definition of long COVID. The TL;DR version? "Basically, people have not returned to their baseline state at least four weeks following infection with COVID-19," says Dr. Sritha Rajupet, MD, the director of the Stony Brook Medicine Post-COVID Clinic.
Getting sick isn't fun to begin with. But not feeling like yourself for weeks or months? It's safe to say most people wouldn't sign up for that. And a new study published online in JAMA Internal Medicine is shining light on lifestyle habits that could cut the risk of developing long COVID in half.
These habits are maintaining a healthy BMI, never smoking, limiting alcohol consumption, diet, exercise and sleep. The findings are in line with standard medical advice for a healthy lifestyle, but experts share it bears repeating as we live with COVID.
"It is estimated that around 1 in 5 people who were infected by SARS-COV-2 may develop long COVID," says Siwen Wang, MD, the study's lead author and a research fellow with the Harvard T.H. Chan School of Public Health. "Long COVID has a wide range of symptoms that can affect the heart, lungs, digestion, thinking and mood, which can impact daily functioning. With the ongoing waves of SARS-CoV-2 infection, long COVID has created a serious public health burden."
Below, Dr. Wang and other experts discuss the study and how to best protect yourself.
About the Study
The medical and scientific communities do not have an official consensus regarding the definition of long COVID. Dr. Wang says she and her team used the U.S. CDC's, which is: "Symptoms developing during or after COVID-19 infection that are present four or more weeks after infection, with no alternative diagnosis."
Researchers used a prospective cohort study design, which means they followed groups of people with many similarities—but some differences.
"From early in the pandemic (April 2020), we followed more than 32,000 people," Dr. Wang explains. "Over a year, more than 1,900 contracted COVID-19. We then asked them about their COVID symptoms and how long they lasted. Among those who were infected by COVID-19, we studied whether people who had more healthy lifestyles had a lower risk of long COVID."
Related: What Is Pneumonia?
How To Reduce Your Long COVID Risks
Long COVID has been a frustrating and confusing challenge for people, and Dr. Wang says it could have been largely avoided. "If these associations represent real causal effects, 36 percent of long COVID could have been avoided if everyone adhered to all six healthy lifestyle factors," Dr. Wang says.
Hindsight is 20/20, of course, but experts have shared ways to protect yourself moving forward.
Maintain a healthy BMI
In the study, researchers defined a healthy Body Mass Index (BMI) as 18.5-24.9.
"BMI is a convenient indicator of body fat," says Dr. Rajupet. "Fat cells are thought to play an inflammatory role in our immune system. As persistent inflammation has been indicated in post-COVID, having a healthy BMI may be protective in reducing the risk of long COVID.”
To get to a healthy BMI or maintain one, Dr. Rajupet suggests regular exercise, eating a diet of primarily plant-based and whole foods, and getting a good night's sleep.
Smoking is a risk factor for more severe COVID cases. It also ups your chances for long COVID, according to the new study.
"Tobacco smoke contains more than 7,000 chemicals, and about 70 of them can cause cancer," Dr. Rajupet says. "When we introduce toxins in our body, we make it harder for our body to fight off disease and make recovery times longer as well.”
If you don't smoke, consider this research another reason not to start. But what if you do?
"I frequently tell patients who are smoking that quitting will be, by far, the best thing they ever do for themselves," says Dr. Denise Pate, MD, a board-certified physician and medical director at Medical Offices of Manhattan. "There are a variety of resources including nicotine replacement with a patch, gum or lozenges...Some people benefit from acupuncture or hypnotherapy."
Moderate alcohol consumption
Research shows that alcohol consumption increased during the early days of the pandemic. But this new study indicates that limiting alcohol consumption can reduce your odds of developing long COVID.
The CDC guidelines suggest women limit themselves to one drink or fewer per day and men keep it to two drinks or less.
"Alcohol consumption significantly increases the risk of contracting bacterial and viral lung infections," Dr. Pate says.
You have options if you're struggling with alcohol consumption.
"If the consumption is mild to moderate, motivational counseling and peer-led groups are successful," says Dr. Pate. "The heavier drinker may benefit from a multi-pronged approach including individual therapy and peer-led groups as well as medications to treat addiction or inpatient detox."
A high-quality diet may also provide protection from long COVID. What does that mean?
“A high-quality diet is made up of whole—basically things that do not come out of wrappers," Dr. Rajupet explains. "They are high in antioxidants. They are anti-inflammatory. Healthy diets promote healing and can be regenerative, which can be helpful in decreasing long COVID risk.”
But Dr. Rajupet knows that it can be challenging to overhaul your diet. “It’s hard to make change all at once," she says. "Start small and incorporate healthy options into your diet for one meal per day and build from there."
Adding an apple to your breakfast is a good place to start.
The new study showed that getting at least 150 minutes of exercise per week was another habit that could cut low COVID odds. Dr. Pate says it provides a trifecta of benefits linked with COVID.
"It improves immune function, decreases inflammation and improves cardiovascular and respiratory capacity," she explains.
Dr. Pate suggests finding something you enjoy doing."This is the only way to keep the consistency that is necessary," she stresses.
If you're unsure where to start, try walking.“You don’t need any equipment for it," Dr. Rajupet says. "You can do it anywhere.”
Busy people can strive to break up 30 minutes of walking per day into smaller increments of 10. Get creative.
“Why sit at a desk and have a meeting?" Dr. Rajupet asks. "Maybe we can walk around the building and have a chat. There are lots of ways to make it easier.”
Related: Is It Bad to Sleep By Your Phone?
Finally, the research suggests people who get seven to nine hours are less likely to have long COVID. "Sleep is how we heal, and it is important for regenerative processes in our body," says Dr. Rajupet.
Good sleep hygiene is essential. Dr. Pate says good sleep hygiene consists of:
Sticking to a bedtime routine
Eliminating electronics from the bedroom
Limiting alcohol, caffeine and large meals before bedtime
Completing exercise four to six hours before bedtime
Dr. Rajupet suggests speaking with a doctor or considering cognitive-behavioral therapy if you are having issues sleeping or think you're struggling with insomnia.
Dr. Sritha Rajupet, the director of the Stony Brook Medicine Post-COVID Clinic.
Siwen Wang, MD, the study's lead author and a research fellow with the Harvard T.H. Chan School of Public Health
Dr. Denise Pate, MD, a board-certified physician and medical director at Medical Offices of Manhattan.