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The Immunologic Basis of Wellness in the COVID-19 Era

We indeed are living in interesting times and we all are seeking not to contract COVID-19 - this is logical. While our goal is to avoid infection, I think we all must agree that our aspirations must encompass more than disease avoidance. What we should be seeking now, as well, is more than absence of disease but rather a state of optimal wellness. 

Wellness has a variety of definitions but I like to think of it as a conscious and evolving state which is multidimensional and holistic where we attempt to optimize our physical, mental and spiritual well-being. Simply put, wellness is easy to recognize when our lives go well. Much has been said of wellness even before the COVID pandemic, but now it takes on new meaning.  

Every one of our patients hunger for some sort of affirmative action they can take to enhance their state of wellbeing and ‘strengthen’ their immune system. Given that there is no ex vivo definition of a strong immune system, this a tall task to achieve. Practically speaking, what they are saying to us is that they are searching for ways to ensure that their immune responses are well functioning and capable of defending them from contracting or alternatively overcoming COVID-19 and other dangers. This is eminently logical and I believe we are obliged to help. A bit of reflection leads us to recognize that these goals are not only important to the patient, but also to us as providers as well as our loved ones. 

Most of us have little time for such counseling, and even if we do, there is prevailing uncertainty as to what the content of such education should be.  Furthermore, we are all time strapped. Finally, and most disturbing to me, is the incredible amount of crap being spread about “immune boosting’ therapies, diets, techniques etc.  As an immunologist who has been thinking about this for over a decade, I am going to add my pebbles to the pile on this topic and share our practices and our resources with you for wellness education oriented to optimizing immune health.  

Above all, wellness education oriented to immune health must be:

  1. Evidence based
  2. Designed to complement our advanced therapies not compete with them
  3. Ot must be delivered in a way to empower the learner through knowledge that modifying our behavior can actually achieve these goals.

I will refer you now to a high impact publication from December 2019 in the form of a narrative review by David Furman and a group of internationally renowned immunologists (Chronic inflammation in the etiology of disease across the life span Nature Medicine volume 25, pages1822–1832;2019). In several presentations this year reviewing advances in immunology, I cited this as my number one pick.

The article describes mechanisms underlying chronic inflammation and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress and in addition suggests potential wellness-based strategies for countering this. I say that this publication in Nature Medicine has brought the field of immune health mainstream.

Read it please.

At each new clinic visit, I end by introducing the topic and ask my patient how they think they are doing in terms of the major domains of wellness behavior (i.e., eating, exercise, sleep and stress). I appraise how strongly their beliefs are that these are important. Then at the minimum I tell them that I am going to give them some homework on this topic for both them and their families. It is virtually always eagerly accepted. 

Please see, read, download and distribute our immune health manual entitled "How to Train and Maintain a Healthy Immune System" as you see fit.  My NP (world’s best) Betsy Kirchner and I have updated this many times over the past decade and it has been given to thousands of patients and thousands of providers attending my lectures.

(you can download this monograph here or from the "Daily Download" section of

Print and use as you see fit. We receive no financial benefits from it though we do highlight some our Cleveland Clinic Wellness resources (which are also evidence based and really good and accessible on line). It’s free. 

A trick I have learned is to emphasize that it is as much intended for their loved ones and give an extra copy to the accompanying partner. There are no secrets revealed in our monograph and is framed in an empowerment model of education. (“you have an immunologic condition or concern, your behaviors influence your integrated immune system, you have control over your behaviors”).  Then upon return visit, we take a minute or two each time to ask what they thought and what they have been trying. Not heavy handed but like an open door. We are rheumatologists and we are in this for the long run. 

Lastly, as I said, we believe what we present is evidence based and designed to complement our wonderful treatments. It is written for lay people but with some advanced education (high school) and it is not translated into any other language.  Let us know your thoughts on the monograph and enjoy.

When you enter the world of wellness, it’s a little scary in my opinion. If you are a skeptic like me be comforted by the words of the Buddha.  This quote proudly hangs on a tapestry on my wall (gift from Betsy many years ago) to keep us on the right (middle path).

 Buddha Image 


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The author has no conflicts of interest to disclose related to this subject