The Power of Place in COVID-19 and Beyond

How Businesses and Buildings Can Make us Stronger By Supporting Healthy Habits

Americans are more than a year into the COVID-19 pandemic and health & safety are still top of mind. Public awareness campaigns featuring Lady Gaga, Jennifer Lopez, Michael Jordan, Robert DeNiro, Venus Williams and more are bringing visibility to WELL, a healthy building rating standard. Mental health resources have surged in popularity, due to the unprecedented impact on our national stress. And yet, when I take a step back and look at the bigger picture, the sad realization is that this could (and will likely) happen again in our lifetime.

This piece is intended to share my perspective on how buildings and businesses have the power (and the responsibility) to boost collective resilience by facilitating healthy habits for individuals. So we can pull ourselves out of this current pandemic faster, and better fare in the next one.

At the end of the piece, I offer up some clear examples of steps landlords, business owners, teams, and individuals can take to support our collective health and resilience.

Disclaimers include: (1) I am not a doctor and this is not medical advice, and (2) I am the founder of Zest, a workplace wellness company.

COVID-19 HURTS HARDER WITH UNDERLYING CONDITIONS

We’ve seen the data published everywhere from China to New York and everywhere in between. Most hospitalizations and deaths arising from COVID-19 have been correlated with co-morbidities. Specifically, hypertension, obesity, and diabetes. The research shows that for those with metabolic dysfunction, it’s harder for the body to fight infection.

In other words, if you have underlying conditions and get COVID-19, you will likely get hit harder. The term doctors use for “hit harder” is “acuity” and typically refers to hospitalization and death. Johns Hopkins cardiologist David Kass has noted that obesity is “a notable risk factor for COVID-19 — and often the primary risk factor for younger patients.”

Yes, anything can happen. There are healthy people that have been hard hit by COVID. But most people that have died from COVID had underlying conditions.

So the question is, how can we manage, prevent, or reverse these underlying conditions, in order to improve resilience? What can we do now to give ourselves the best possible chance to fight illness?

MANY UNDERLYING CONDITIONS CAN BE PREVENTED WITH HEALTHY HABITS

Medical research overwhelmingly supports some ways we can help our bodies improve resilience. The answer is categorized as “healthy habits” or “lifestyle changes”, and specifically includes regular exercise, healthy eating, and stress management.

It sounds too obvious. When you look at the data, it is obvious. But, it’s easier said than done. Let’s take a look:

REGULAR EXERCISE

On average, Americans take 5,117 steps a day. A person is considered sedentary if they take less than 5,000 steps per day. “Physical inactivity puts people at greater risk for complications from chronic conditions” according to the CDC (and every other medical professional I’ve ever met). Harvard Medical School even put exercise at the foundation of their food pyramid. It’s the largest part. The foundation upon which all food is metabolized.

The benefits of routine exercise are well documented. According to the CDC, it helps gain muscle, lower cholesterol, sharpen focus, improve mental health, manage weight, and strengthen the heart. The Journal of Sport and Health Science, summarizes that as moderate exercise increases, your illness risk goes down and that exercise “improves defense activity and metabolic health.” To top it off, research from Yale and Oxford suggests that exercise is more important for your mental health than money.

For COVID-19 specifically, researchers from Syracuse University and the University of Seoul conclude that “from a public health perspective, the importance of not conflating shelter-in-place with staying-in-place needs to be reinforced.” They illustrate how exercise is, at a enzymatic level, a possible “therapeutic strategy to bolster resilience against COVID-19.”

NUTRITIOUS FOOD

Research is validating that whole, plant-based foods can combat illness and boost immune function. Physician and Chief Medical Officer of metabolic health company Levels, Casey Means MD, says “The risk of becoming seriously ill with COVID-19 is likely to be lower if diabetes is well controlled, & glucose levels are rapidly modifiable with dietary & lifestyle changes.” Dr. Means expands on this concept in her opinion piece entitled “Healthy food: The unexpected medicine for COVID-19 and national security.”

STRESS MANAGEMENT

Initial research from the first few weeks of COVID-19 pandemic in the US, showed that prescriptions for antidepressant, anti-anxiety and anti-insomnia medications increased 21%. Chronic stress can negatively impact your health in a myriad of ways, like high blood pressure and heart disease. It also can lower the immune system, making you more susceptible to infection, according to Harvard Medical School. “Though stress is inevitable, you can help control your body’s response to it. Exercise, meditation, and mindfulness are great stress busters.”

Of course, many chronic illnesses are not so easily controlled with healthy habits and I don’t claim these are a panacea. Nonetheless, the research shows that exercising regularly, eating well, and managing your stress is great pandemic protection.

Dr. Means summarizes it well: “Americans must build personal immunity defenses through radical changes in diet and exercise, or risk getting sick and dying.”

HEALTHY HABITS ARE LARGELY INFLUENCED BY WHERE WE LIVE/WORK

“Habits play an important role in our health,” says Dr. Nora Volkow, director at NIH. And we all know that changing habits is hard. Countless books are written about this subject and people still struggle every year with resolutions.

In the interest of brevity, I will focus on creating habits around exercise and mindfulness. The research indicates that people gravitate towards the exercise behaviors of those around them. So it makes sense that the people you work and live with strongly impact your habits. That implies that if your co-workers are active during lunch, or half of your neighbors in your apartment building join the run club, or your team all participates in a group meditation class… you might be more inclined to join.

Another compelling tidbit is that people who exercise with others enjoy it more. And they push themselves harder. There’s a reason why group fitness classes have been popular throughout the decades — in the 80s we had jazzercise and step aerobics, followed by zumba and body sculpting, CrossFit and Spinning, then Soul Cycle and Barry’s Bootcamp. People find accountability, community, and results when exercising in groups.

Meditation (sometimes thought to be a solitary activity) is regularly done in groups, and with huge effects. When done in community, mindfulness practices can have compounding positive effects.

WHERE WE LIVE/WORK CAN HELP (OR HURT) OUR FIGHT AGAINST COVID-19

Given 90% of our lives are spent indoors, these places are in a position to actively support (or detract from) our health.

Our homes, apartments, and offices themselves can make us literally sick (check out “sick building syndrome”). They also can (and should) minimize risk of sickness and disease transmission during times of viral explosion. The “Healthy Building” movement spearheaded by Harvard University School of Public Health has pushed the envelope on conversation here.

Professor Joseph Allen who has written a book on this has provocatively said, “the person who manages your building has a greater impact on your health than your doctor.” It’s bold, but I don’t think he’s incorrect.

Rachel Gutter, President of the International WELL Building Institute (IWBI) is a leading voice on this topic and took it even further. She has said that “buildings and those who tend to them — owners and developers, facilities managers and HR professionals — can be frontline caregivers.”

I agree. And I’ll take it one step further. These people can actually help prevent us from getting to the frontline in the first place.

Most people consider the immediate, short term approaches — improved sanitation, mask policies, air filtration/circulation, and social distancing to control the spread. They are important, no doubt.

In the long term, though, I believe the building’s ability to influence behavior change that will ultimately have an under-appreciated impact on our collective health. Simply because we spend so much time in these spaces, with other people. (Yes, even if it’s virtual).

HOW BUILDINGS, BUSINESSES & INDIVIDUALS CAN HELP

In commercial real estate, there are many individuals that have the power to make a difference — architects, interior designers, asset managers, property managers, facilities managers, tenant experience managers, and more.

Within corporations, those individuals include business owners, HR leaders, office managers, benefits managers, workplace experience managers, and more.

There are many good examples out there on how to “walk-the-talk” on wellness. Healthy building certification programs, like Fitwel and WELL Building Standard, have some great ideas on how the design, materials and management of buildings all inform occupant health.

Here are some of my favorite suggestions, as they directly relate to supporting healthy habits:

BUILDINGS

• If it’s easy to find the stairs and they look appealing, you are more likely to use them over the elevator.
• Covered bike racks make biking more accessible year-round.
• Walking paths, outdoor fitness equipment, and fitness centers are all great options, albeit a larger upfront investment is required
• It’s easier to eat healthy foods if the building participates in community sponsored agriculture (CSA) programs, offers healthy options (in cafeterias and vending machines), or has access to edible community gardens.
• Easy access to clean, filtered drinking water dispensers, makes you more likely to hydrate.

MANAGEMENT

• Stress management can be supported with onsite meditation classes, quiet areas, access to light and outdoors, indoor plants, building-sponsored or company-subsidized yoga, and more.
• Group fitness programming (interval training, bootcamps, barre, mat pilates, etc) are great low-overhead options. Scale up or down weekly class volume, depending on the number of tenants/employees. They can be held outdoors, onsite in wellness rooms with limited capacity, or live-streamed via Zoom to maintain social distancing.
• Nutrition-centric programming and cooking demos can be held at outdoor BBQs or in the common kitchen area or live-streaming. Like group fitness and meditation classes, these have the added benefit of also building community, which is proven to support mental health, especially during these more isolated times.

INDIVIDUALS

Every person has the power to advocate for their health in the places where they live and work. Hopefully this paints a bigger picture around what you can (and in some cases) should expect and empowers you to ask for the things that will empower you to lead a healthier life.

For individuals working in building or business management (facilities, HR, property management, office managers, etc) consider ways you can influence daily, healthy habits en masse. If you don’t have the time yourself, find someone on the team that does, hire someone, or outsource it to a wellness partner you trust.

Investing in wellness is only long-lasting and truly effective if it’s viewed as a strategic decision, and will have the most success if the whole team is enrolled. So make sure to get key stakeholders brought onboard early on to help move these initiatives forward.

SUMMARY

If your office offers short company-sponsored meditation classes to fit perfectly into your lunch break, you will be more likely to take that time for your mental wellbeing. If your apartment building runs top-notch yoga and fitness classes that all your neighbors and friends attend, you will be more likely to join and reap the benefits. (Even if those classes are live-streaming.)

And if these healthy behaviors are sustained over time, they have the potential to meaningfully decrease metabolic dysfunction and boost collective resilience — during this pandemic and ones that we will inevitably face in the future, per Dr Means.

Because offices and multi-family properties have high concentrations of people, they are uniquely positioned to help us adopt healthier habits and thereby impact public health at scale.

Let’s continue to think bigger and grow stronger, together.

Sources Referenced

• May 14 2020; NIH: Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis
• April 22 2020; JAMA: Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area
• Medicine & Science in Sports & Exercise: October 2010 — Volume 42 — Issue 10 — p 1819–1825
• CDC Benefits of Physical Activity
• Journal of Sport and Health Science, Volume 8, Issue 3, May 2019, Pages 201–217
• Healthy food: The unexpected medicine for COVID-19 and national security.”
• The Lancet: Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study
• Kevin Heffernan (Department of Exercise Science, Syracuse University) and Sae Young Jaeb (Department of Sports Sciences, University of Seoul) Science Direct: Exercise as medicine for COVID-19: An ACE in the hole?
• Forbes, “Warning For The U.S.: Diabetes And Coronavirus Cocktail Killing Young People In Mexico” by Andrew Wight
• Centers for Disease Control and Prevention. Physical Activity and Health: https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
• National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activityexter