Why obesity and psychological stress matter in recovery of post-acute sequelae of SARS-CoV-2

Abstract

Numerous elements of the COVID‐19 pandemic have proven challenging to overcome. We now recognize a perplexing characteristic of SARS‐CoV‐2 features mixed, unresolving symptoms that can last 4 weeks or longer after initial diagnosis, termed post‐acute sequelae of SARS‐CoV‐2 (PASC). Full recovery can thus become a protracted ordeal as conservative estimates indicate 20% of SARS‐CoV‐2 cases will develop PASC, with women at increased risk. Emerging evidence suggests latent virus reactivation including cytomegalovirus, Epstein‐Barr virus, and/or varicella zoster virus may perpetuate the burden of PASC. This is problematic because immune dysfunction is linked to obesity and psychological stress, both of which disproportionately affect socioeconomically disadvantaged people and racial/ethnic minorities. Applying a patient‐centered approach in which the principal factors guiding decision‐making are based on the needs and abilities of the individual is essential. Still, the independent and combined influence of obesity and psychological stress on immune function necessitates due consideration in the context of PASC recovery.