Two thousand and five hundred years ago, in 430 BC, the earliest ever pandemic on record passed through Libya, Ethiopia and Egypt, before moving further into the Mediterranean, hitting mainland Greece, where it killed 30,000 Athenians, nearly a quarter of the population. 
There is never a good time for a disease that wipes out large sections of society, however in this case the plague wasn’t the biggest threat faced by the Greeks, this was in the middle of the Peloponnesian War, Sparta was growing in strength and winning battles against the Athenians, military general Pericles also caught the virus, which meant he couldn’t lead his soldiers in the defence, within the next few years Greece would lose its dominant position of Global power. 
The virus it later turned out, was most likely Typhus. Victims would get a severe headache, high fever, cough, rash, muscle pains and chills. It is still around today, and yet there is no vaccine available for it, however treatment with anti-biotics will prevent death. 
Throughout history pandemics have killed millions, however in the aftermath, millions more have also been affected as a consequence, these are known as secondary victims. 
In this article I mostly want to focus on secondary victims. Those who are not directly affected by the virus, but everything around it, the lockdown, a depressed economy, and changes to the way we communicate and live our day to day lives. 
It’s been an interesting few months, some people, the majority I expect, have lived through some great difficulties. Covid 19 has at the time of writing this cost the lives of forty five thousand and five hundred people in the UK. 
I do not intend this article as a critique of the government, health service or any other public body, these are merely my own observations, thoughts and proposed suggestions based on available evidence. 
When I first wrote about this (too late) in March, I noted that many people weren’t taking this seriously enough, we should all have seen what was coming based on the early reports coming out of China and the devastatingly quick way it spread around the World. If you had any shares at that point, you’d have been best selling them, or re-investing in hand soap, toilet paper and zoom. 
But alas hindsight is a great gift given too late. I’ve began to realize recently that the future threats we face are going to be dramatically different, they’ll perhaps be even more devastating, and instead of an incubation period of ten days before symptoms appear, it may take years or even decades to realize the full devastation of what’s coming. 
2020 might well be remembered as the year that fate decided to strap on the largest dildo it could find and give humanity a damn good seeing too without any lubrication, not only have we had Covid-19, but in recent months there have been reports of a new strain of Swine flu emerging,, oh is that not tough enough? Did I hear you say you can take more? Fine, how about a rare form of covid affecting children in London which is similar to Kawasaki disease? ,ooh, still resisting are you humanity? You naughty little bitches, OK then, how about the fucking bubonic plague 
We might now hope that fate has finally ejaculated after elbowing us all hard on the back whilst yelling don’t look round, and as it lies back to light up a cigarette we can attempt to rebuild our lives whilst sobbing quietly and trying to find our clothes, but don’t get too comfortable, because we’re all in for more of fates sadistic tendencies. 
To help prevent the deaths certain measures have been taken, it is estimated that these measures may well have prevented millions of deaths globally. But as always there is a life saved vs lives cost math that needs to be played out, and I would like to go over some of it here. 
In the excellent podcast Cautionary tales, Episode a tsunami of misery. The economist Tim Harford tells of the Japanese Nuclear disaster in 2011, a Tsunami wiped out 15,000 people in its first wave, and in the 2nd wave destroyed the Fukishima Power station, causing a Nuclear disaster. 
Authorities ordered an evacuation to save lives, many of the people ordered to move where fragile, some were near the end of their retirement, and had to watch as everything they had saved for was destroyed. Months later suicide rates increased, years later still they were at a high rate. These people where not immediate victims of the tsunami, so economist refer to them as “hidden deaths”. 
It is hard to predict right now what those hidden deaths might be and how covid-19 will re-shape the course of history. It seems likely there will be severe disruption in our economy, Global politics is on a fragile footing in times of crisis, and many pressures and disruptions might affect us in ways we cannot even begin to realize. 
I’ll try to focus on my own remit of health, and how we might expect this pandemic to impact us beyond the immediate casualties of the virus. 
My hope in writing this article is that it may help people think about future threats, but before moving forward with this let’s cover how being overweight will affect a person with covid-19. 
Carrying a few extra pounds is likely to increase the risk of severity of covid-19 symptoms. It was recently discovered that in France intensive care patients on coronavirus wards where 83% obese, whilst in the Netherlands this was 90%. 
In Britain (average BMI 27.3) about 64% of the population is overweight, which might possibly be why we’ve been hit so hard compared to countries such as Taiwan (average BMI 23.1) or South Korea (average BMI 23.9) Of course, this is only one crude measure which ignores factors such as how quickly they locked down, or the availability of testing etc. 
It’s still important to note however that a person with a BMI above 40, has almost double the risk of dying from covid-19 as someone with a healthy BMI according to John Wilding of the Obesity federation (as a point of reference, Boris Johnson’s BMI was reported to be 36 when he was hit hard with the virus) 
This might be because it is harder to ventilate an obese patient, however other obesity related factors may also be at play, including an already over stressed heart and circulatory system, poor blood sugar management, exaggerated immune response and exacerbated inflammation, however the most likely reason why obesity worsens outcomes with Covid is that being overweight will dramatically impair the respiratory system. 
Obese people often suffer with exertional dyspnea, in other words, things which should be quite easy, such as walking up a few stairs, will leave them breathing heavy and struggling for air. 
They’re also more likely to develop sleep apnea, a condition in which shortness of breath occurs frequently throughout the night causing heavy snoring, regularly waking up and a lack of adequate restful sleep. 
Obesity also increase the risk of or worsens COPD, asthma and other possibly life threatening respiratory conditions such as aspiration pneumonia (a condition in which the stomach contents moves up into the lungs, the stomach acid then burns the lungs resulting in severe pneumonia.). 
The increased risk of complications to obese people who contract covid-19 has put them on the moderate risk category according to NHS England, meaning they don’t need to shield, they should go to work if they can’t work from home, however where possible they should avoid going out unnecessarily. 
Future risk for Obesity 
A recent survey by Kings College London and Ipsos found that nearly half of all people during this lockdown have gained weight, I suspect the true number is much higher, there are a few obvious reasons for this. 
Stress and anxiety can cause people to consume more calories, there is a whole smorgasbord of stress for us to consume right now, job insecurity, fear of the virus killing/ hurting us or our family, a wider concern for society and our future, arguments with family members, lack of money etc etc. It’s very little wonder that under such enormous pressure people might seek extra comfort from food. 
Many people also eat more just out of sheer boredom, which can come about from being stuck inside. Even when busy working from home it can be all too easy to go grab some nibble in-between zoom calls. 
We’re also most likely burning less calories, as many people haven’t left their homes, or have ventured out far less, they have reduced their daily calorie expenditure from walking. Sure we could workout at home during lockdown, many people did in fact, but judging by the viewing figures on Joe Wicks Youtube channel audience participation has dramatically dropped off as the reality of hard work and getting out of breath set in past the initial novelty of a cheeky cockney doing star jumps. (on July 20th Joe posted a fun looking Spiderman workout, it has 8,851 views at the time of this writing, a video from 1st March has over a million views, most of his videos did around that time) 
In his attempt to keep people active and increase participation in exercise Joe Wicks has probably done more for this health crisis than many leading Government figures, there’s even talk of him getting a knighthood. 
As well as all the above issues, we can add to this the fact that there is often more food in the house, initial stockpiles bought early in the crisis soon dwindled down and peoples comfort stash disappeared. Whether your shopping online or queuing at a supermarket it makes sense to buy a large amount in one go, as it is just too much of a pain in the arse to keep nipping out to the shops. Buying large amounts might seem like a good way to save money, but usually it just means we end up eating more. 
Pre-epidemic, obesity was estimated to cause about 30,000 deaths per year (though this figure is likely to underestimate as obesity if often a contributing factor for many causes of death), it also increases the risk of developing type two diabetes fivefold, which puts a huge strain on the NHS (recent figures show a spend of £6.1 billion per year on obesity related illness, which is more than is spent on the police, fire service and judicial service combined) an overweight person will on average die about nine years before their healthier weight friends. 
For those who put on weight and struggle to lose it, there are miserable implications for their day to day existence and for the impact it will have on society in general. 
Aside from the impact on normal life (lower self-esteem, reduced quality of mental health, painful joints, lack of energy etc) just like everything else (Including covid) obesity impacts the poorest in our society hardest, children in the most deprived neighbourhoods of Britain are twice as likely to be obese as their posh distant counterparts in the top ten percent. 
Again, just like covid, obesity is more likely to occur in certain ethnic groups. 
So take a moment to consider this bleak picture before covid-19, it may turn out that what many people referred to as the Obesity epidemic may well be the light drizzle before the heavy downpour which sees the NHS yet further burdened, with yet more heart attacks, more diabetes, more lifestyle related diseases and yet more lives disproportionately lost in the lower income population, and in particular certain ethnic groups. 
This is just my bleak long-term outlook, imagine the impact if we really do have a 2nd spike in Winter which hits a population still struggling to lose their lockdown weight. 
Research also shows that generally speaking once people have put weight on, they struggle to lose it, a meta-analysis of twenty nine long term studies showed that after five years, 80% of those who had lost weight had regained most of it. This is especially true if they attempt ill-advised diets under the auspicious advice of emerging pseudoscience diet Guru’s. 
This lockdown could end up in the long term killing far more people who developed obesity than it ever saved from covid. 
I had wanted to focus on other long-term health consequences that we should now consider, however I’m already two thousand words into this article and I have to prepare for my gym opening again next week. 
For example it’s quite likely there’ll also be an increase in alcohol reliance, this isn’t what we typically think of as an alcoholic (not a helpful word), many of us don’t start the day with a bottle of whisky on cornflakes, that would be an obvious issue, but gleefully cheering its wine o clock every evening can normalize a negative health behaviour and lead to lasting damage. 
Mental health is also likely be poorer because of all the necessary measures taken, we can expect increased anxiety, higher depressions, poor cognitive function and agrophobic behaviours from people at low risk who believe it isn’t yet ‘safe’ to resume any semblance of normality. 
We might also expect a rise in undiagnosed cancers from people who couldn’t get to their GP in lockdown, and who might now believe it isn’t safe to do so. Those currently living with cancer might have worse outcomes due to lapses in treatment and disruption to normal therapies. 
Even as we get nearer to finding a vaccine that can give us some protection against covid, there was a global reduction in vaccinations, meaning that measles or diphtheria could become a serious threat again. 
It seems improper to mention any potential benefits that may occur as a result of all this, but I’ll briefly mention that many lives might be saved by a reduction in atmospheric pollution, a lack of cars, planes and shutdown of businesses resulted in cleaner air, as I alluded to in my last article air polloution is responsible for up to 40,000 deaths per year in the UK. 
It might also be the case that a larger scale emphasis on public health and especially prevention might help change us all for the better, people might even start to pay more than just lip service to climate change. Already a four-million-pound trial scheme of “green prescribing” (outdoor activities such as walking clubs, exercise classes etc) is underway to help tackle the issues I’ve highlighted in this article. 
As I prepare to welcome back customers, I’m looking forward to helping more people with lockdown lard loss and engage with the joy of exercise, if you’d like to be one of them please get in touch, I have implemented various procedures to ensure safety for all clients and myself, including a one way system in and out of the gym, anti- bacterial handwash on the way in and way out, and more time between clients to ensure a thorough clean and wipe down with antibacterial spray and wipes. 
For those who aren’t able to attend my holy gym shrine, I’d like to leave you with a few pointers of advice I hope may help you to tackle any issues in your own health. 
1. Calories management 
To be a healthy weight you need to eat less. How much of a disruption to your diet will depend on your current level of motivation, how much weight you want to lose and how quickly you want to lose it (there will be an emotional cost to this) 
Counting calories might be a useful strategy for some, but it takes time and effort, for most people simple straight forward calorie reduction changes will be enough to make a difference. 
So try planning your meals in advance, aim for healthy meals, lots of veg. When you shop, only buy the things you need, avoid being tempted by special offers or interesting packaging. This tip alone will help you eat better and save you money and as I covered in my last article, will be much better for the environment (a huge dietary environmental impact is food waste) 
Fill up on veg, fruit, water, or low-calorie drinks, you probably don’t have to completely cut out sugary snacks or crisps, but you should be monitoring how often you have these things. 
Try to pay attention to why your eating, are you hungry? Bored? Stressed? Are there other things you could do other than eat that might help you feel better? 
Make high calorie super tempting foods hard to get too, place them in the back of the cupboard where it’s easier to avoid seeing them and being tempted, make it an effort to get them out and try to monitor how often your eating them. 
2. Movement 
Physical exertion is good for your mental health, joints, heart, lungs and it helps you live longer and feel better. It shouldn’t really be a hard sell, but it is. Because exercise can be painful, not only can it hurt whilst your doing it but it can hurt for days afterwards. It can make you feel inadequate, like your doing it wrong, you look silly, your just too out of shape. 
I hear these things often, it’s a common theme especially amongst those who haven’t exercised for a while. Because exercise can be hard on the body, it’s best to take it easy at first. Just a few reps, one or two sets, mostly body-weight. Progressively try to increase the amount you do, a few more reps, a few more sets, add weight, take less rest time. It’s a process, don’t rush it. You’ll never feel super motivated to do it, I never do either and I workout most days. But you’ll always be glad you did. 
Remember also the value in daily steps, calories are burnt not just in the gym, but whilst cleaning, mowing the lawn, keeping busy and on your feet as often as you can. It all adds up and it can lead to more calories burnt than a gym session. 
3. Joy, fun, play
Have fun, when ever and wherever you possibly can, dance, laugh and make the most of the time you have left on this Earth. Have child like energy by being childish, be fascinated by every day things you wouldn’t normally even notice, be kind to animals, take time to plant food. These actions may or may not help you live longer, but for sure they will help you live more fully. 
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