How COVID-19 May Lead to a Wave of Chronic Illness Exacerbations

While COVID-19 is presently rebounding following its initial decline in the United States, other nations have experienced different curves, and even U.S. states and cities may face dramatically different scenarios at any given time. It is thus vital for clinicians to be aware of the challenges experienced in communities transitioning to post-peak phases of the pandemic. Providers must be prepared to handle the implications of delayed care of chronically ill patients, such as a likely volume surge of these patients as the COVID threat ebbs, in addition to more severe pathologies from initial delays seeking treatment. 

We anticipate a spike in chronic illness exacerbations in coming months because individuals have been avoiding medical care during COVID-19. Recent polls found 83% of Americans have significant or moderate concern about going to a healthcare facility during the pandemic.¹ This interruption in care will be especially concerning for vulnerable population with preexisting conditions. Estimates of when a post-peak surge in chronic illness care may present vary with communities’ public health circumstances, but the consequences of interruptions in such care should be further explored as medical professionals plan for future trends in patient illness presentations. 

The larger social and economic recovery that should mark the post-peak phase could present serious implications for chronically ill patients. We foresee a particular influx of cases for pediatric providers during this time frame. This warrants a call to action to educate medical providers to the alarming challenges anticipated in coming months.

COVID and the Chronically Ill

To prepare for an influx of chronic condition exacerbations, it is first necessary to detail why we foresee it.

COVID-19’s effects and the efforts against it span worldwide and deeply challenge the social and economic circumstances of millions of individuals. Nonetheless, there is a seemingly underemphasized host of problems facing patients with chronic illness that are also provoked by the pandemic. 

Continuity of care through follow-up visits, prescription refills, and in-person transfusions has all been impacted by the virus and its response. These missing parts of the care plan can derail the complex care of these patients if not upheld as consistently as before the pandemic. But viral barriers have led to decreased adherence to the tailored plans, and this has been further compounded by notable decreases in many providers’ typical clinic visits. Many such visits have been replaced by telehealth, but it’s not making up all the difference.

Instead the possibility of exposure to the virus at a healthcare facility seems to have caused patients to avoid care as a whole (follow-up requests like phone calls and e-mail communication have also decreased during the pandemic).

Lastly, the mental challenges and heightened stress impacting individuals poses an added challenge for those with chronic illness. It has been documented that the disease outcomes of chronically ill populations can be negatively impacted by medical setbacks caused by any of a myriad of physiological pandemic stressors.^2–4

These factors collectively suggest a coming post-peak care environment that warrants careful planning. The fear causing delayed treatment in these patients, added to the stress of the COVID-19 pandemic, creates a perfect storm for chronic illness cases in the months after the peak begins to wane. 

The authors would like to thank Ryan Brennesel, DO, for his mentorship and feedback in the development of this article.

References

1. Hanghøj S, Boisen KA. Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review. J Adolesc Health, 2014; 54: 121–38.

2. Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst, 2014; 8: 25.

3. Nakata A. Psychosocial Job Stress and Immunity: A Systematic Review. In: Yan Q, ed. Psychoneuroimmunology: Methods and Protocols. Totowa, N.J.: Human Press, 2012.

4. Salleh MR. Life Event, Stress and iIlness. Malays J Med Sci, 2008 Oct;15(4): 9–18.

Joe Caruso BS, EMT, is an emergency department technician at Cooper University Hospital in Camden, N.J. and a graduate of Clemson University. As a clinical research fellow at Lucile Packard Children’s Hospital Stanford, he has conducted research in pain management and anesthesiology.

Christopher Gaeta is a student at Swarthmore College. He has been published in several peer-reviewed journals in the field of emergency medicine and has garnered one of the largest LinkedIn networks among individuals his age, with approximately two million professionals following his posts and updates.