The scientific program of the recent IMCAS Asia 2021 included 30-minute Talk Show episodes in between the sessions. Each episode focused on an important yet controversial topics that shook 2021, with top experts from around the world discussing and debating on the subject to present new and refreshing perspectives.

One such episode was on the Covid-19, which began with an intriguing stance from Dr Patrizia D’Alessio on how the virus turned into a full-fledge pandemic.

1. On IMCAS Academy, you are a key reference for the topic of “body awareness” and the impacts of stress on health. What does “body awareness” mean?

Body awareness is simply the sense that we have of our own body. This capacity is important to maintain self-awareness about our internal body states.

This specific sense first develops when we are babies, testing movements that allow us to cope with gravity. In adult life, body awareness is constantly tested, but especially during “emotional challenges”.

According to James Oschman, any kind of response to an emotional stress “immediately precipitates the contraction of the flexors and movement away from its structural balance.”

As a consequence, “gravity pulls the body downwards, making it shorter”, inducing important modifications in posture and creating a default in body awareness. In the long run, this can determine chronic diseases, that have revealed of crucial importance in the development of Covid-19, I will expand on that in my presentation.

Specifically for aesthetics, posture changes account for the aging process as the body becoming shorter implicates the generation of a constant tension among all its parts.

Also, a corresponding functional inactivity due to the fact that the reduced volumes created by the flexors shortening, will be replaced by fat, reducing movement possibilities and impacting aesthetics quite heavily.

2. How did you come to be interested in this field of work?

As an expert in inflammation, chronic diseases and biomolecular mechanisms of cell senescence, aging in a word, it is nearly impossible to escape the problematic of the consequences of stressful experiences for the body.

On the opposite, interest raises also to the endogenous devices we possess, to restore the body balance in case of prolonged challenge. The most important endogenous anti-inflammatory tool we possess is driven by the vagus nerve.

Also by somatosensory pathways within the skin as skin touch is included within the enteroceptive processing system. Cardiovascular enteroception is measured by directing attention towards the sensation of the heartbeat during various tasks.

Finally enteroception includes signs that we perceive from the “silent” gut. It also refers to other tissue states such as muscle tension alerting the brain about the current state of the body.

In fact, through relaxation you can significantly lower inflammation in the body.

3. Your topic for the Talk Show episode during IMCAS Asia 2021 was about the Covid-19 “syndemia”. What does it entail?

During the recent SARS-CoV-2 pandemic, the main cause of death has been considered an overreaction of the immune system (“cytokine storm” associated to disseminated intravascular coagulation DIVC). But Covid-19 could be more than just a pandemic.

As Richard Horton, the brilliant editor in chief of “the Lancet”, puts it, “syndemics are characterised by biological and social interactions …that increase a person’s susceptibility to harm or worsen their health outcomes.”

In fact, two categories of diseases are interacting within specific populations:
1. infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and
2. an array of non-communicable diseases (NCDs), considered co-morbidities, but in fact are CCD, Common Chronic Diseases.

As shown by increasing chronic diseases in rich but also poor nations, the aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies.

Therefore, the idea is that this pandemic could in reality be a syndemic “meaning that a more nuanced approach is needed to protect the health of our communities.”

My idea here is that there must have been an underlying issue of high stress experienced by the population in general, corresponding to an enhanced inflammatory status. According to Jamie Garfield of Temple University Hospital, “the real morbidity and mortality of this disease is probably driven by this out-of-proportion inflammatory response to the virus…”

If the basis of immune overreaction could be due to an underlying stress, certainly the burden of the many measures (lock-down, mask-wearing, remote work…) limiting social relationships, has introduced additional stress, since social contact is crucial for health, highlighting the importance of social interaction.

4. Learning and studying remotely is definitely convenient, but we do hear about cases of demotivation or loneliness. What would you say to inspire physicians and practitioners who are in this state of mind?

I think that health starts at home.

Certainly, the management of the “syndemic” has challenged liberties in companies, hospitals, universities. At least at home you have a relative freedom to shape your own rules.

You have the possibility to limit screen access or engage in physical training to maintain balance. Not to forget about a more appropriate way to feed yourself.

It also, allows a critical evaluation of your global condition. Eventually becoming available for discussions (with family, friends, patients) normally shortcut because of lack of time running to a meeting, to an airport, fetching a bus, a plane, etc.

On the other hand, we all have read reports about the increase of domestic violence towards partners and children translating in a dramatic increase in hospitalization in psychiatry wards because of suicide attempts, sometimes of kids age 8-10 years. In Japan the suicide rate of women in 2020 has increased by 70%.

The numerous testimonies on social media, reveal both an increase in loneliness and depressive states, and some positive thinking about getting on with life in a peaceful way.

These two types of consequences of the unanticipated societal changes brought by the pandemic / syndemic bring us back to the importance of managing the balance of body awareness.

Altogether, I would say that the remote condition should be monitored not to develop an increased stress or on the other hand, a “nest syndrome”.

As far as possible, we should do everything we can to make an opportunity of it. This spared time could allow us some unforeseen free time for thinking, reading, reflecting, that we often so cruelly have missed. Also, to stay in closer contact with our more fundamental values that we might have forgotten, somehow caught by the rush of a non-stop flow of information, events, and challenges.

References
1. Butterworth & Heinemann. Energy Medicine in Therapeutics and Human Performance, pp 160-161
2. Horton, R. Covid-19 is not a pandemic. The Lancet. 2020;396:10255:P874.
3. Califf, RM. Avoiding the Coming Tsunami of Common Chronic Diseases. Circulation. 2021;143:1831-1834.