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The huge burden of obesity and other chronic conditions among people in the U.S. puts most of us at direct risk.

Public health measures to slow the spread of Covid-19 have already taken a staggering toll on the economy, with the prospect of worse to come. The strategy at the heart of prevention, physical distancing, will continue to be tremendously disruptive to society.

With businesses facing bankruptcy, schools closed and sports events canceled, President Trump and others have now asked: Is the cure worse than the disease?

According to this way of thinking, we should refocus our efforts on those most at risk for complications from coronavirus, the elderly and people with chronic disease, so that others can soon return to a semblance of normal life.

But this strategy is dangerously misguided for one simple reason: The huge burden of obesity and other chronic conditions among Americans puts most of us at direct risk. In fact, with obesity rates in the United States much higher than affected countries like South Korea and China, our outcomes — economic- and health-wise — could be much worse.

Four features of Covid-19 combine to create a perfect pandemic storm: It's highly contagious (more so than the flu, but less so than measles). It's new, so few people have immunity. It causes infection without symptoms in some people, who can unknowingly infect others. And it can latch on to receptors in the lung, causing severe pneumonia much more frequently (perhaps 10 times more) than seasonal flu.

Despite common perceptions, it's not just the elderly and frail who are at significant risk of a life-threatening complication. Data from China suggest that many chronic health problems increase the likelihood of a bad outcome, including cardiovascular disease, which affects nearly half the adults in the United States in some form, and diabetes, which affects about 10 percent. In Italy, 99 percent of the fatalities were people with pre-existing medical problems, especially hypertension.

Moreover, in the United States, obesity-related metabolic conditions may put the public at exceptional risk. Today, more than two of three adults have high body weight, and 42 percent have obesity, among the highest rates in the world. Almost two in 10 children have obesity. Excessive weight, and the poor-quality diet that causes it, is strongly associated with insulin resistance, chronic inflammation and other abnormalities that may lower immunity to viral respiratory infection or predispose to complications.

In a California study of the 2009 influenza pandemic, people with obesity were twice as likely to be hospitalized compared with the state population. Among those who were hospitalized, the risk of dying was significantly increased for people with severe obesity. A small study conducted in 2013 of the Middle East Respiratory Syndrome (MERS), caused by another coronavirus, reported a similar relationship.

We don't know yet whether these preliminary findings will apply to Covid-19. However, the high prevalence of obesity-related chronic disease at all ages raises serious concern. Only 12 percent of Americans over age 20 are considered metabolically healthy — that is, with optimal measures for waist circumference, blood sugar, blood pressure and lipids, and not taking drugs to control these risk factors. Indeed, reports from the Centers for Disease Control and Prevention indicated that younger adults are being hospitalized for Covid-19 disease at alarming rates.

So with only a small minority of the population that can be confidently considered low risk, relaxing restrictions on them makes no sense. (Although the president's extension of physical distancing measures through April is welcome news, it may not be enough.) And even if these low-risk individuals could be identified and safely allowed to become infected, they would pose a threat to the majority.

Comment: They make a good point that the overall state of health in the US is truly abysmal, but arguing that this is a reason for extending quarantine measures, or worse, is clearly buying into the hysteria surrounding the actual threat. There is no "threat to the majority" beyond what the majority is exposed to on a regular basis, corona-hype aside. None of these measures were ever put into place regarding the flu, or any other infectious disease, despite the fact that American's poor state of health should make them more susceptible as compared to the average healthy person.

Most critically, an overwhelmed health care system places everyone at risk. This includes the child with appendicitis, the expectant mother with labor complications, the middle-aged man with chest pain and anyone who can't get treatment for cancer, kidney disease or other medical conditions.

In short, the economic costs of this collateral damage are incalculable.

So calls to relax restrictions offer a false choice. Letting the pandemic ravage the population won't save money — it simply risks even greater economic calamity.

Many uncertainties remain about how this pandemic will unfold. Warmer weather may slow the infection rate. Intensive research efforts may identify existing drugs with exceptional effectiveness to reduce disease severity. There's a reasonable hope for an effective vaccine by fall 2021.

But with Americans' unique vulnerability from chronic disease, we cannot make an irreversible public health decision based on these far-off hopes.

Barring major new developments, we must pursue intensive actions to flatten the curve and expand the capacity of the health care system. We must also minimize economic harms and set the stage for a rapid recovery, as others have advocated, with spending to ensure that no one goes hungry, homeless or without health care for financial reasons; prevent personal financial ruin because of loss of employment or medical expenses; and maintain business infrastructure, focused especially on small business with limited financial resources.

The costs of these measures would be great. But failure to contain the spread of Covid-19 could result in great economic costs as well as untold deaths from the infection and millions more from other causes that could strike anyone. That's too great a risk to take.

David S. Ludwig is a physician specializing in obesity at Boston Children's Hospital and professor of nutrition at the Harvard T.H. Chan School of Public Health. Richard Malley is a physician specializing in infectious diseases at Boston Children's Hospital and professor of pediatrics at Harvard Medical School.