As the number of people infected with and dying from COVID-19 continues to climb, many Americans may be wondering what steps they can take to mitigate the potential for infection or, if infected, what modifications can keep them healthy and lower the likelihood of severe symptoms and worse while they wait to be vaccinated.

For those who do contract the disease, 99.5 percent will recover according to the CDC. Still, no one wants to get COVID, given that even those who recover from it may face lifelong debilitating problems, including cognitive decline and cardiovascular diseases.

Since the initial outbreak, physicians and scientists have learned that infections with SARS-COV-2, severe enough to require hospitalization, can elicit an over-activation of the immune system. The inflammation can become severe enough to cause extensive organ damage, but the degree of damage may not be known or recognized for weeks to months after recovery.

In an effort to mitigate the potential damage, some hospitals have employed strategies to intervene. Mitchell A. Miguel, MD, MHA, a hospitalist and frontline worker at TriHealth Hospital in Cincinnati, Ohio, told me that as a standard of care he provides, hospitalized COVID patients requiring oxygen, with dexamethasone, a steroid, and nutritional supplementation. Both interventions have the capability to decrease inflammation.

Given the increasing knowledge we have about prevention and treatment, those hoping to avoid or minimize the adverse effects of COVID-19 should they contract it, can make the following seven lifestyle modifications to increase resiliency and aid in co-morbidity prevention and improve health outcomes.

1. Diet. A healthy diet – Mediterranean, MIND, and DASH diets rank among the top diets according to the most recent U.S. World & News Report and have been associated with improved cardiovascular health, diabetic blood glucose control, brain health, and weight loss.

Further, researchers at Rush University Medical Center in Chicago have investigated the potential role of the anti-inflammatory and antioxidant properties of lifestyle modifications and several chronic disease outcomes.

My colleagues at Rush and I have specifically investigated the association of brain health and diet patterns, individual foods, food groups, nutrients, and bioactives. Consumption of berries, green leafy vegetables, other vegetables, fish, flavonols, anthocyanidins, omega fatty acids, and fat-soluble vitamins, are of particular importance as they all have anti-inflammatory properties. Additionally, reducing intake of high fat and processed foods like cheese, butter, red meat, fried foods, and pastries is equally important.

Given the antioxidant and anti-inflammatory properties of dietary components, specific food consumption and supplementation are being used in concert with standard medical treatments as an anti-inflammatory strategy for those suffering from COVID to prevent over-activation or sustained action of the immune system.

Through the properties contained in the nutrient and bioactive profiles of foods, diet has the potential to strengthen the immune system and perhaps dampen the experienced symptoms or even prevent symptoms of a COVID infection altogether. Further, for those that have been hospitalized, similar results could be experienced with the subsequent post-recovery inflammation-associated disease processes including stroke risk, heart disease, and cognitive impairment.

2. Physical activity. Doctors recommend 150 minutes of moderate to vigorous physical activity per week to improve COVID outcomes since physical activity can help decrease the underlying comorbidities, as it improves cardiovascular health, diabetic control, and weight loss.

Further, physical activity has been found to help reduce inflammatory cell production and improve neuro-inflammation. So, physical activity may help stave off or diminish inflammatory processes either during an infection or during the acute post-recovery phase.

Physical activity has also been associated with stress reduction and improved sleep, both of which have associations to decreased inflammation.

3. Weight loss. If overweight or obese, weight loss can improve health outcomes through inflammation reduction and reduced complications due to comorbidities.

4. Smoking cessation, including tobacco products and vaping. Smoking causes direct respiratory tract inflammation and endothelial damage that can further a pro-thrombotic (more clotting) state of patients infected with and recovering from COVID. Regarding hospitalized patients, smoking cessation could potentially reduce the likelihood of cytokine storm, and over-activation of your immune system. Additionally, smoking cessation can improve or reduce the potential sequelae during post-infection recovery.

5. Appropriate, consistent sleep of 7 to 9 hours a night
Inadequate sleep can lead to low-level chronic inflammation. Obtaining the appropriate quantity and quality of sleep can improve the potential for recovery and abatement of post-recovery disease processes.

6. Socialization/cognitive training or stimulation. Socialization with the proper precautions, like socially-distanced visits or virtual happy hours, and cognitive training and stimulation, including reading, learning a new hobby, or training to do everyday tasks with one’s non-dominant hand, like brushing teeth, can reinforce cognitive resilience and potentially prevent cognitive impairment or improve outcomes in the event impairment is noted post-recovery.

7. Stress reduction. It has been demonstrated that reducing stress and increasing mindfulness has the potential to lower levels of circulating inflammatory markers. While living through COVID is enormously stressful for everyone, taking steps to reduce stress is essential for those trying to recover, especially.

To be sure, following the guidelines set forth by the CDC and WHO, including wearing a mask and social distancing, are the best forms of primary prevention. But, these seven lifestyle modifications have the potential to bolster your immune system, improve your overall health, and help fight infections.

Thomas Holland is a physician scientist.

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