For the past year, we have been inundated with statistics about the impact of COVID-19 on our lives. Reports of daily case rates, hospitalizations, and deaths are so pervasive that they have become routine fodder for “water cooler” and dinner table conversations. Several early studies, looking at the pandemic’s secondary health implications, give us an inkling of just how broad and deep its impact has been.
Perhaps the most visible secondary health effects of COVID-19 have been in mental health. A recent Kaiser Family Foundation survey showed an almost four-fold increase in depression and anxiety in the adult population, from 11% in 2019 to over 41% by 2021. An earlier survey from June of 2020 revealed that 13% of adults reported new or increased substance use due to pandemic-related stress, and 11% reported suicidal thoughts in the past 30 days. This increase in mental health issues is particularly problematic. In addition to the direct increase in suffering and death and co-morbid conditions, mental illness and substance use disorders exacerbate other medical conditions.
Cancer diagnosis and treatment
The pandemic has also had a major impact on the diagnosis and treatment of cancers. An excellent study published in the Lancet in January revealed a 92% decrease in colonoscopies done in England in April of 2020. While this number gradually returned to “normal” by October, it left an estimated 3,500 people with colon cancer undiagnosed. We have yet to see the human and financial tolls of these delayed diagnoses.
Another study published in the Lancet earlier this month demonstrated a global impact on childhood cancer. In a survey of 213 pediatric oncology institutions across 79 countries last summer, the authors revealed compromises in the care of children with cancer, particularly in poorer countries. Despite very low rates of COVID-19 in these institutions, the indirect impacts of the pandemic were clear. Nearly 45% of institutions reported a decrease in new diagnoses of cancers, and 34% reported an increase in care abandonment. Reductions in surgical care, shortages of blood products, modifications to chemotherapy, and interruptions in radiotherapy were all commonly reported. The challenges with chemotherapy, radiotherapy, and treatment abandonment were particularly evident in low and middle-income countries.
Yet another area of impact from the pandemic has been demonstrated in cardiovascular disease. A recently published study in ECS Heart Failure examined a random sample of heart failure (HF) patients during a lockdown. In general, patients reported more stress, more screen time, more smoking, more salt intake, and less activity. Over 27% experienced weight gain, and almost 22% had worsening of their HF symptoms.
Similarly, concerning results came from a study on strokes in the Pittsburgh area. The authors compared March 2020 data to the prior three years and were able to show a dramatic decrease in emergency room visits for transient ischemic attack (TIA)/stroke. The authors conclude that this is most likely avoidance of care among those with TIA/stroke symptoms rather than an actual decrease in the number of people experiencing those events. Interestingly, there was no decrease in the number of people undergoing endovascular thrombectomies, suggesting that those with severe strokes were still making it to the hospital. The longer-term implications of this decreased attention to milder strokes and TIAs have yet to be determined.
Influenza: a silver lining
On a brighter note, one positive impact of the pandemic has been the absence of a flu season this year. With increased vaccination and the ongoing measures to reduce the spread of coronavirus, the entire U.S. has experienced the mildest flu season on record. In the prior seven years, the peak week of influenza in the U.S. saw an average of 764 deaths, while the worst week of this season was at the end of December with just 44. Even though this reduction in deaths from the flu makes only a small dent in the damage from COVID-19, it’s still a bit of good news.
While sobering to absorb, assessing the indirect impact of the pandemic on other conditions can help us improve services for our vulnerable populations going forward. It will likely take years to measure and understand the true breadth and depth of the pandemic’s damage. Hopefully, that understanding will lead to a better-prepared world for the health challenges that lie ahead.
Martin Lustick is a physician and senior vice-president and principal, NextGen Healthcare.
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