The COVID-19 pandemic began just over five years ago, and though it is largely over, it underscored two conditions that currently remain among the most serious threats to the public health: obesity and loneliness.
While both contributed to the morbidity and mortality of COVID-19, new pharmacologic and technologic advances may now address these complications, and they might have been lifesaving for many during the pandemic. Specifically, will the revolutionary weight loss drugs known as GLP-1 receptor agonists, including Ozempic, Wegovy and Zepbound, reverse some of the long-term residual effects of COVID-19? And can artificial intelligence be used to counter America’s loneliness epidemic?
Obesity was a risk factor both for the incidence and severity of COVID. States with higher rates of obesity tended to have comparatively higher numbers of per capita COVID-19 cases and, along with that, higher per capita death rates. The overall U.S. level of obesity was one reason the country had such a high total number of COVID-19 cases compared with the totals in other countries. It’s also a reason why the U.S. has suffered so many COVID-19 deaths.
In terms of individual patients, many of our intensive care physician colleagues noted that obese patients tended to experience more severe COVID-19 pneumonia.
The obesity link to COVID-19 outcomes continues today. Three percent to five percent of patients who contracted COVID-19 have lingering neurologic symptoms of fatigue and “brain fog” — so-called long COVID. While the exact cause of long COVID is unknown, current research suggests that obese patients have a greater chance of developing that syndrome and have more severe symptoms if they do. This raises an important research question: In obese patients, will these neurologic symptoms respond to the new weight loss drugs?
Another pathology highlighted by COVID-19 was loneliness, in part related to the social isolation associated with the pandemic. The effects of loneliness during COVID-19 were demonstrated by the unprecedented numbers of drug overdose deaths as well as increases in alcohol and substance abuse. The overall rate of death by suicide in the U.S. remained basically unchanged during the pandemic, but suicidal ideation and suicide attempts were more prevalent compared with the pre-pandemic period.
Lockdowns during the pandemic resulted in a sense of isolation that continues for many people to this day. In 2023, the World Health Organization declared loneliness a “pressing health threat,” responsible for nearly a million deaths worldwide annually. Dr. Vivek Murthy, the surgeon general under President Joe Biden, said the health risks of loneliness are as bad as smoking 15 cigarettes a day, increasing the risk of premature death by 30%.
Reports suggest that in 2024, a high percentage of adults reported loneliness. Now comes AI as a potential means of addressing the loneliness epidemic. The strengths and limitations of AI in many areas of modern society remain poorly understood, but it presents undeniable approaches to help people who are lonely by means of AI “direct synthetic companionship,” in which humans can engage with and enter into discussions and relationships with easy-to-access AI chatbots or robots. These can provide nonjudgmental emotional validation, recreational game distraction and a sympathetic ear.
AI can also function as a bridge to real-world connection by providing encouragement to contact friends or family or detecting unhealthy ideation so that health care providers can be alerted about the need for interventions.
A recent New Yorker article described studies of people who were tasked with interacting with either a human or a chatbot and then rating the experience. The experiments found that in blind comparisons, the “AI often comes out ahead,” and health care professionals preferred the AI’s answers, judging them to be “more empathic.”
With the new treatments and developments in today’s health care environment, what a difference even a few years can make. Imagine how many lives might have been saved or improved if the transformative weight loss drugs and AI had been widely introduced less than a decade ago, before the pandemic began in 2020.
As poet John Greenleaf Whittier observed, “For of all sad words of tongue or pen, the saddest are these: ‘It might have been!’”
Dr. Cory Franklin is a retired intensive care physician and the author of “The COVID Diaries 2020-2024: Anatomy of a Contagion as It Happened.” Dr. Robert Weinstein is an infectious disease specialist at Rush University Medical Center.
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