Psychosocial Vulnerabilities to Upper Respiratory Infectious Illness: Implications for Susceptibility to Coronavirus Disease 2019 (COVID-19)

Perspect Psychol Sci. 2021 Jan;16(1):161-174. doi: 10.1177/1745691620942516. Epub 2020 Jul 8.


For 35 years, our laboratory has been involved in identifying psychosocial factors that predict who becomes ill when they are exposed to a virus affecting the upper respiratory tract. To pursue this question, we used a unique viral-challenge design in which we assessed behavioral, social, and psychological factors in healthy adults. We subsequently exposed these adults to a cold or influenza virus and then monitored them in quarantine for 5 to 6 days for onset of respiratory illness. Factors we found to be associated with greater risk of respiratory illnesses after virus exposure included smoking, ingesting an inadequate level of vitamin C, and chronic psychological stress. Those associated with decreased risk included social integration, social support, physical activity, adequate and efficient sleep, and moderate alcohol intake. We cautiously suggest that our findings could have implications for identifying who becomes ill when exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19). This argument is based on evidence that the associations we report are replicable across multiple respiratory viruses and that the pathways found to link psychosocial factors to colds and influenza may play similar roles in COVID-19.

Keywords: COVID-19; common cold; health practices; influenza; psychological stress; social integration; social support.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Alcohol Drinking / epidemiology
  • Ascorbic Acid Deficiency / epidemiology
  • COVID-19 / epidemiology*
  • COVID-19 / psychology*
  • Comorbidity
  • Exercise
  • Female
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Pennsylvania / epidemiology
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / psychology*
  • Risk Factors
  • SARS-CoV-2
  • Sleep
  • Smoking / epidemiology
  • Social Support
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / psychology*
  • United Kingdom / epidemiology
  • Young Adult