Overweight/obesity as the potentially most important lifestyle factor associated with signs of pneumonia in COVID-19.

OBJECTIVE: The occurrence of pneumonia separates severe cases of COVID-19 from the majority of cases with mild disease. However, the factors determining whether or not pneumonia develops remain to be fully uncovered. We therefore explored the associations of several lifestyle factors with signs of pneumonia in COVID-19. METHODS: Between May and July 2020, we conducted an online survey of 201 adults in Germany who had recently gone through COVID-19, predominantly as outpatients. Of these, 165 had a PCR-based diagnosis and 36 had a retrospective diagnosis by antibody testing. The survey covered demographic information, eight lifestyle factors, comorbidities and medication use. We defined the main outcome as the presence vs. the absence of signs of pneumonia, represented by dyspnea, the requirement for oxygen therapy or intubation. RESULTS: Signs of pneumonia occurred in 39 of the 165 individuals with a PCR-based diagnosis of COVID-19 (23.6%). Among the lifestyle factors examined, only overweight/obesity was associated with signs of pneumonia (odds ratio 2.68 (1.29-5.59) p = 0.008). The observed association remained significant after multivariate adjustment, with BMI as a metric variable, and also after including the antibody-positive individuals into the analysis. CONCLUSIONS: This exploratory study finds an association of overweight/obesity with signs of pneumonia in COVID-19. This finding suggests that a signal proportional to body fat mass, such as the hormone leptin, impairs the body's ability to clear SARS-CoV-2 before pneumonia develops. This hypothesis concurs with previous work and should be investigated further to possibly reduce the proportion of severe cases of COVID-19.

Frontline Employees’ Display of Fake Smiles and Angry Faces: When and Why They Influence Service Performance

Service firms invest much to ensure authentic and positive emotion displays from frontline employees. And yet, inauthentic positive displays (fake smiles) remain common, and at times, employees even show authentic negative displays (e.g., anger), thereby compromising service performance. Customer reactions to such unwanted emotion displays are heterogeneous, so managers need to know when possible negative effects on service performance are more or less strong. The literature on customer reactions to inauthentic displays is inconclusive and focuses on the moment of service delivery. We shine light on how predelivery choice confidence shapes customer reactions to inauthentic positive displays and demonstrate that customers? high confidence in their service provider choice mitigates the negative effects of display inauthenticity. We present evidence in terms of tipping in a field study and replicate this interaction effect in three experiments. A serial mediation by cognitive dissonance and decision regret explains the conditional effect of inauthenticity. We also contrast inauthentic positive displays with authentic negative displays. The latter yield the worst service performance, unmitigated by choice confidence. We provide recommendations on how to ensure authentic positive displays (e.g., recruitment, resources, and rewards), taking into account circumstances that affect choice confidence and market shocks (e.g., the COVID-19 pandemic).