Secondary health effects of pandemic20 April 2021
Thomas Rutledge, PhD :
The COVID-19 pandemic began to hit Americans broadly in March of 2020 as a result of health policies that encouraged or mandated the closure of some businesses, restricted certain activities, and reduced social interactions. At the time, many health experts recognized that these policies were necessary to reduce the spread of COVID-19 while fearing that they could harm our health in other ways. However, the precise secondary health effects were impossible to predict. Would prolonged activity restrictions increase mental health disorders? Substance use and abuse? Suicides? Weight gain and physical activity? Leading causes of death such as cardiovascular diseases and cancer through disruptions in accessing medical care? Some might argue that secondary harms were inevitable and easily foreseen. But with no recent social disruptions in our society on this scale against which to compare, and the buffering (or exacerbating) effects of social media and technology-based treatment alternatives, predicting what secondary health harms would occur and to what degree was more speculation than science. Only objective data can provide answers.
Finally, after a year of COVID-19 and social policies, we are gaining insight about the health impact of the pandemic on a wide scale. With many of these scientific reports emerging only in the past month, we know that there will be many more to follow. Even these initial reports, however, offer findings that some will find entirely predictable and others surprising.
1) Drug and alcohol use. Leading off the predictable category, the CDC reported this week that deaths from opioid-related overdoses crushed previous records, killing an estimated 87,000 in the U.S. last year. For context's sake, this is almost double the deaths as recently as 2015 when the opioid epidemic was considered among the most important health concerns in the U.S.
1a) The recent news about opioids runs parallel to what has been observed about alcohol use during the pandemic. A JAMA report from the fall of 2020, for example, reported a 10-19% increase in self-reported alcohol use overall and evidence of a larger increase in heavy alcohol use.
2) Weight gain & physical activity. A 2021 JAMA report from a group of UC San Francisco researchers described weight gain patterns among a large sample of FitBit users. The authors found an average weight gain of approximately 1.5 lbs per month in 2020.
2a). Most of the physical activity studies are severely limited by their reliance on self-report data. In one of the higher quality studies from 2020 that utilized objective activity data from accelerometers and worn activity trackers, the authors observed an average 27.3% decrease in daily steps (about .75 miles) by the end of the first 30 days of the pandemic restrictions.
3) Total and cause-specific mortality. While small increases in year-to-year mortality are normal due to the growing U.S. population, there was an approximate 17% increase in deaths in 2020 compared to 2019. About 70% of these increases were attributable to COVID-19 (about 345k death). However, there were more than 150k excess deaths from other causes as well. This included a 5% increase in the single leading cause of death in the U.S., heart disease (more than 30k more deaths from heart disease than in 2019), and 9,000-14,000 more deaths in 2020 from each of Alzheimer's disease, diabetes, and stroke, among others.
4) Mental health. In surveys conducted during 2019, about 11% of Americans reported experiencing a significant level of depression or anxiety. In comparison, >42% of Americans reported significant anxiety or depression in December of 2020 on the same surveys (6). Even if the pandemic and restrictions subside in 2021, previous stressful events such as 9-11 suggest that mental health effects will be long-term for many.
4a). Finally, in the category of positive surprises, the sharply higher rates of reported depression and anxiety DID NOT appear to translate into higher suicide rates in the US or other countries as described in The Lancet (6). Provisional U.S statistics even suggest a modest 2019-2020 reduction in suicides.
We have a lot more to learn about the short and long-term effects of the COVID-19 pandemic on mental health and secondary physical health outcomes. However, recent data suggest that the secondary health effects of the pandemic were broad and substantial.