COVID-19 –What part of “underlying” do we not understand?

Schools are opening all over the country. Sure enough there are immediately cases of COVID-19 in students and staff. It was inevitable. Its a virus for Pete’s sake.

The flu is a virus that spreads like wild fire. Lots of people (maybe all) are exposed and don’t even notice. Our immune systems provide protection from all sorts of infections. Folks who “don’t even notice” have first stage innate immune response that wipes out the virus before it becomes a problem.

I wrote about the immune system recently in the post entitled The Immune System in a Nutshell. You can read that article at this link.

When we get sick

Of course the innate immune response doesn’t always work for everybody. Just like a cold, there may be minor symptoms to be endured before the adaptive immune system clears out the virus. Some could be really miserable before the immune system accomplishes the fix.

And then there will be a few, including an occasional child, who will become dreadfully ill and may die. This has always been true of the flu. And as we have seen, this is also true of COVID-19.

Understandably we would all like to know the absolute fail safe truth. Children are or are not susceptible? All old people will or will not die if they get COVID-19? Diabetes or heart disease is or is not a death sentence? Will it rain on Thursday? Bad new my friends, there are no such absolute truths.

There are significant differences between the flu and COVID-19 but one thing they have in common is the susceptibility of individuals with underlying health conditions. How we acquired those underlying conditions is less important right now because there are no quick fixes. What matters is that they exist right now.

Underlying conditions

So what are conditions? Typically a doctor diagnoses them with a name and records it on a patient’s medical record along with medication prescribed. They are chronic diseases and there are always medications. If you haven’t been diagnosed then you apparently don’t have it.

But one condition that isn’t considered an illness but typically exists alongside every single diagnosable chronic illness is overweight/obesity. About half of Americans are overweight/obese and prediabetic/diabetic. (BTW, pastors seem to be the worst.) A third to half of teachers are overweight or obese. Obesity is not an “illness” but you know it by looking. Prediabetes/diabetes are often not individually diagnosed but exist none the less.

Sad stories

I have watched reports on TV of people who have suffered and died from COVID-19. I dug around on the internet for the stories of teachers who died with COVID-19. I’ve seen such sad stories of children orphaned when both parents died. Without exception every single story I saw reflected a significantly overweight person.

I have seen hundreds of studies and articles on the particular implications of obesity with COVID-19.

So school starts, kids and teachers show up, and the virus gets spread around despite every effort to maintain distancing. The virus gets delivered to the school by the people who show up there. What matters is the susceptibility of the people in the school.

Why do some die?

I listened this morning to a fast-talking, almost panicky reporter telling about two teens who went to school, were infected, and died. You know why they died? Because both had multiple extreme underlying conditions and their immune systems simply weren’t prepared to deal with the virus.

Kids and teachers (people) don’t die just because schools are opened. People die because their immune systems aren’t prepared to respond to an infection. And the mark of an immune system in trouble is chronic diseases, those much mentioned underlying conditions.

Can we make the risk go away?

The flu and COVID-19 aren’t going away. And, as we know, not everyone will get the vaccine when it becomes available. There is no populated place in the world with absolute protection.

And remember, sooner or later a new virus is going to show up and there could well be another pandemic. In fact COVID-19 may well rear its ugly head regularly just like the flu. That means waiting a year or two years for school to open doesn’t make risk go away.

What would I do now?

If I were a concerned teacher with underlying conditions I would be wearing, at minimum, a full face plastic shield through which my face could be seen along with a mask.

If I were teaching in front of a classroom, distanced from the students, I would remove the mask so that my smile could be seen. I would wear that shield and mask anytime I was within six feet of anyone, including other teachers or staff. Otherwise I would wear the shield all day long.

If I were a parent whose child had serious underlying health conditions he/she would be wearing the same shield and mask or I would just keep my kid at home. And, as a parent, I would be prepared for home schooling should my child be sent home to quarantine/isolate for two weeks. Because that is very likely to happen to some kid(s) sooner or later. The school will likely provide me with home schooling options.

What comes after now?

That is what I would do NOW. I am not a teacher and (thankfully) have no school age children but still I employ this strategy every day. The question is, what comes after now?

Obviously, it seems to me, we need to make those underlying conditions go away. So next week this column will transition to the primary root cause of all those conditions (no, it isn’t obesity) and what to do about them.

Sooner or later a new virus is going to show up and there could well be another pandemic. (I think I said that before.) It would be nice to be personally prepared.

Pat Smith is the author of “It’s All about the Food,” a book that guides nutritious food choices as the way to avoid illness and maintain a healthy weight. Proceeds from her book benefit the Montgomery County Food Pantry. Her website is She can be contacted at, 870-490-1836. Her Facebook page is