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COVID-19: Does Muscle Health Matter?

Unless you are a Geologist based at a Research Station in Antarctica or a penguin that lives nearby, your life, your family and your medical practice have probably been massively disrupted due to the terrifying infectious disease, COVID-19, caused by SARS-CoV-2. As the father of two daughters, the son of elderly parents that live alone in Southeast Texas and a Biochemist that has dedicated the last seven years of his life t

o Musculoskeletal Research, SARS-CoV-2 and COVID-19 have dominated almost all of my thoughts during every waking hour of every day for the last two weeks.

In my memo to you, I discuss some of the most exciting research that is being made to address COVID-19. Physicians such as yourselves along with Infectious Disease Researchers have become my heroes.

Finally, I leave with you with a question to ponder: does muscle health matter when it comes to battling COVID-19?

Exciting Research Underway: SARS-CoV-2 and COVID-19:

As terrifying as COVID-19 may be, I feel tremendous hope everyday when I read about the exciting progress that is being made everyday by Scientists and Physicians all around the world. Due to progress that has been made in next-generation genome sequencing (NGS) technology, Scientists in China were able to rapidly sequence the SARS-CoV-2 genome and share their results with Researchers around the world [1]. Using Cryo-Electron Microscopy (Cryo-EM), Researchers at University of Texas, Austin and NIAID/NIH managed to solve the structure of the spike glycoprotein on the surface of the virus which is vital for drug discovery research [2]. The Coalition for Epidemics Preparedness Initiatives (CEPI) based in Oslo, Norway has funded several vaccine programs targeting COVID-19.

Moderna, Inc. (, CureVac AG ( and BioNTech SE ( are focused on addressing COVID-19 with mRNA-based vaccine technology while NovaVax ( has taken a vaccine development approach that utilizes recombinant protein nanoparticle technology. Because of the massive “cytokine storm” that is unleashed by the SARS-CoV-2 virus [3], Regeneron ( and Sanofi ( recently announced the initiation of a clinical trial on the monoclonal antibody, sarilumab that blocks that receptor of the inflammatory cytokine, IL-6. Researchers at the German Primate Center recently reported that the serine protease inhibitor, Camostat Mesilate that blocks the action of the serine protease, TMPRSS2 may have the potential to arrest the activity of SARS-CoV-2 [4]. The great news is that Camostat Mesilate is a drug that has already been approved in Japan for pancreatitis.

Does Muscle Health Matter When It Comes to COVID-19?

No one in the world knows the answer to this question including us as there is no data available.

However, my hypothesis is that people with greater muscle mass and muscular strength may have greater odds of successfully fighting COVID-19 if unfortunately, they become infected with SARS-CoV-2.

I explain the reasoning behind my hypothesis below.

COVID-19 Is Most Detrimental to the Elderly Population:

One of the most comprehensive epidemiological studies on COVID-19 was based on data collected from the Chinese Center for Disease Control and Prevention based in Beijing and reported in the Journal of the American Medical Association [5]. Researchers in China reported that 1,023 death out of 44,672 confirmed cases of COVID-19, giving rise to an overall case-fatality rate (CFR) of 2.3%. However, the CFR was 8.0% for patients between 70 to 79 years of age and 14.8% for patients aged 80 years and older. This increased CFR is probably related to the fact that many older patients have many other pre-existing conditions such as Type 2 Diabetes and High Blood Pressure.

COVID-19 is clearly much more serious than the seasonal flu; unfortunately, there are no vaccines at the current time that can prevent COVID-19. When we examine data on the burden of the flu in the United States as reported by the CDC (Table 1), we find that adults over the age of 65 years disproportionately bear the burden of the flu [6]. During the 2018-2019 Flu Season in the United States, it was estimated that there were 490,561 hospitalizations and 34,157 deaths. Adults over the age of 65 years accounted for 279,384/490,561 hospitalizations or 57.0% and 25,555/34,157 deaths or 74.8%.

Age-Related Muscle Loss Impacts Longevity and Quality of Life:

Age-related muscle loss or sarcopenia primarily impacts adults over the age of 65 years [7]. Researchers have reported that sarcopenia is associated with an increased risk for developing Type 2 Diabetes [8] which is not very surprising given the central role that muscle tissue plays in glucose metabolism. Given the crucial role that muscle plays in maintaining balance, it likely does not come as a surprise that sarcopenia increases the odds of suffering a fall [9]; as most of you are all too familiar, falls can be devastating if they result in a bone fracture.

Multiple human clinical studies have also shown that sarcopenia impacts longevity. Clinical research has reported that people with reduced muscle mass are less likely to survive a very serious illness in comparison to people with strong muscle health. One of the most important clinical studies on the impact of muscle loss on longevity was done by Researchers at the Karolinska Institute (Sweden), The University of North Texas and The University of South Carolina [10] involving 8,762 men between 20 to 80 years old. The Researchers found that muscular strength was inversely associated with death from all causes including cancer and cardiovascular disease. In 2018, Researchers at the University of Michigan reported that older adults with muscle weakness as measured by reduced hand grip strength may be at greater risk for physical disability in later life [11].

COVID-19’s Less Serious Cousin, Influenza Can Have A Detrimental Impact on Muscle Health:

In 2019, Researchers at Northwestern University Feinberg School of Medicine published a study in which they elucidated the complex biochemical pathways that the Influenza A virus triggers, causing muscle wasting [12]. If an adult over the age of 65 years with reduced muscle mass manages to get the flu, unfortunately, they may lose even more muscle mass. When the body is trying to fight the flu, a massive inflammatory response known as a “cytokine storm” in unleashed. Yet, this “cytokine storm” can have a devastating impact on muscle health as highlighted by these Physicians and Scientists [12]. Researchers at the University of Connecticut, Farmington, CT [13] reported that aging further augments the damage to muscle and impairments to mobility that is caused by the Flu virus.

An Ounce of Prevention:

We are all familiar with the expression “an ounce of prevention is worth a pound of cure.” Building muscle mass will certainly not guard against COVID-19, influenza or any other serious infectious diseases! I am optimistic that talented Scientists at companies such as Moderna, Inc., NovaVax, CureVac AG and BioNTech SE will make the COVID-19 pandemic a thing of the past.

At the same time, it would be naïve to think that new viruses will never emerge or that we and/or our children will never face another pandemic again in our lifetime. We believe that an investment in muscle health is an excellent investment in guarding one’s overall health. What do you think are the downsides to improved muscle health?

Learn more at


1. Shen Z, Xiao Y, Kang L, Ma W, Shi L, Zhang L, Zhou Z, Yang J, Zhong J, Yang D, Guo L. Genomic diversity of SARS-CoV-2 in Coronavirus Disease 2019 patients. Clinical Infectious Diseases. 2020 Mar 4.

2. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, Graham BS, McLellan JS. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020 Mar 13;367(6483):1260-3.

3. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine. 2020 Mar 3:1-3.

4. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Müller MA. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Mar 5.

5. Wu, Zunyou, and Jennifer M. McGoogan. "Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention." Jama(2020).

6. Centers for Disease Control and Prevention, “Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2018–2019 influenza season (

7. Marzetti E, Calvani R, Tosato M, Cesari M, Di Bari M, Cherubini A, Collamati A, D’Angelo E, Pahor M, Bernabei R, Landi F. Sarcopenia: an overview. Aging clinical and experimental research. 2017 Feb 1;29(1):11-7.

8. Veronese, Nicola, et al. "Association between sarcopenia and diabetes: a systematic review and meta-analysis of observational studies." European Geriatric Medicine (2019): 1-12.

9. Yeung, Suey SY, et al. "Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta‐analysis." Journal of cachexia, sarcopenia and muscle 10.3 (2019): 485-500.

10. Ruiz, Jonatan R., et al. "Association between muscular strength and mortality in men: prospective cohort study." Bmj 337 (2008): a439.

11. Duchowny, Kate A., P. J. Clarke, and Mark D. Peterson. "Muscle weakness and physical disability in older Americans: longitudinal findings from the US Health and Retirement Study." The journal of nutrition, health & aging22.4 (2018): 501-507.

12. Radigan, Kathryn A., et al. "Influenza A Virus Infection Induces Muscle Wasting via IL-6 Regulation of the E3 Ubiquitin Ligase Atrogin-1." The Journal of Immunology 202.2 (2019): 484-493.

13. Bartley, Jenna M., et al. "Aging augments the impact of influenza respiratory tract infection on mobility impairments, muscle-localized inflammation, and muscle atrophy." Aging (Albany NY) 8.4 (2016): 620.

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