Friendship, stress, and viral immunity



If you've read Malcolm Gladwell's Outliers, then you're familiar with the story of Stuart Wolf, a physician who, in the 1950s, stumbled upon the town of Roseto in Pennsylvania where he discovered that the death rate from all causes was thirty to thirty-five percent lower than the rest of the United States, and the death rate from heart disease alone in men over sixty-five was roughly half. The findings puzzled Wolf, so he began a series of studies to discover their cause. Was it diet or exercise? No, Rosetan's were not remarkable with respect to those factors. Was it genetics? Again, no, relatives living in other parts of the United States did not share the same impressive health profile. What health secret was hidden in Roseto?

It turns out, the secret was community. Rosetans were Italian immigrants that had settled in the steep, rocky hillsides of Pennsylvania's Lehigh Valley where they had managed to isolate themselves and preserve the strong social support structures of their homeland. They were connected by large, extended family clans, lived three generations per household, maintained numerous civic organizations, visited with neighbors regularly, and sat on each other's porches chatting. Friendship kept them healthy.

How do social support and friendship make us healthier? One way is by making it easier to cope with unpleasant life events and avoid stress. Since stress is a major precursor to disease, avoiding it is an effective way of preventing disease from ever occurring. If you've never read about how stress contributes to diabetes, heart disease, stroke, and cancer, you should. I'm not going to talk about those illnesses here (although surely I will another time). Here, I want to talk about viral infections. As we grind into year three of the COVID19 pandemic, it's a topic we should all be sufficiently familiar with. If I asked you what the latest COVID19 variant is up to and the best ways to avoid exposure, you could probably give me a ten-point plan with visual aids. Yet, if I reminded you that stress affects your body's ability to fight COVID19, could you tell me how and the best ways to avoid it? If not, that's a significant liability.

Our stress response (also known as our fight-or-flight response) evolved to help us. If you were to encounter a lion, a cocktail of stress hormones would be dumped into your bloodstream that would cause your heart to beat faster and harder, raise your blood pressure, and funnel blood into your skeletal muscles to increase your strength and swiftness. It would dilate the bronchial tubes in your lungs and the pupils in your eyes so that you could breath easier and see things more clearly. Good thing, because you're going to need to wrestle that lion or run.

But, as Marta Zaraska lays out in her new book, Growing Young, what mostly benefitted our ancestors on the African savanna, causes us major problems today. We're unlikely to encounter a lion on our way to work every day, but we do encounter numerous opportunities for stress - loan payments, traffic, bosses, overscheduling, news, etc. The big difference between the lion and these modern stressors, is that the threat of a lion, while intense, doesn't usually last very long. Either the lion attacks or it walks away. Within forty to sixty minutes, stress hormones released during that encounter diminish and the fight-or-flight response is quelled. Our modern stressors are different - less intense, but much longer lasting. They keep us exposed in a sustained way to stress hormones - chronically stressed - an exposure that has been linked to weight gain, diabetes, heart disease, cancer, and, notably for this article, inflammation and insufficient viral immunity.

Stress hormones can change our immune system by influencing our genes. During periods of sustained stress, genes that promote inflammation are turned on and genes that promote viral immunity are turned off. The opposite happens during periods of low stress - inflammation goes down and viral immunity goes up. "From the savanna perspective, it made sense," Zaraska writes. "Back then chronic stress meant being outside the camp - away from viruses usually carried by fellow tribe members - and at higher risk of wounds, which can get infected by bacteria... The immune system, like everything in nature, takes energy to run and compromises had to be made. So down went antiviral protection, and up went inflammation, which is great for fighting bacteria in an oozing wound."


Stress reduces viral immunity, we're all fraught with it, and there's a viral pandemic on. What does that have to do with community? There are two big warnings occurring right now in conversations about COVID19. The first is about prevention: Do what's necessary to avoid serious illness, hospitalization, and spread - vaccines, masking, testing, social distancing and quarantine. The second big warning is about isolation: Be aware of the ways that decreased social interaction and support during the pandemic could be negatively impacting our lives - increased worry, depression, suicide, and diminishing health outcomes. These warnings seem separate, but they're not. Isolation makes us more stressed, which significantly reduces our ability to fight COVID19.

As you head off to gather (or not) with family and friends for the holidays, take both warnings together. Vaccinate, mask, test. Do them so that you can get to work rebuilding the social support structures lost during the pandemic and resume the most effective stress reducing and disease preventing activity humankind has - friendship.

Kind regards,

Jonathan

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