What Do We Know About the Impact of the COVID-19 Pandemic Thus Far?

^{By: Yvette C. Terrie, BS Pharm, RPh, Consultant Pharmacist}

Since the emergence of the pandemic in March 2020 in the US, health experts have learned some things about the novel COVID-19 virus, but there is still great uncertainty about the unprecedented challenges of this pandemic. Moreover, there is still much uncertainty regarding the overall impact that this pandemic has had on the health care system especially with regard to the delays bought about in the diagnosis and treatment of other disease states. While COVID-19 can affect anyone and vary from patient to patient, the CDC has indicated that individuals of any age with certain preexisting medical conditions such as chronic kidney disease, COPD, compromised immune systems, CVD, T2DM and obesity are at increased risk for severe illness from COVID-19. A full list from the CDC can be found at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. 

In a recent publication in JAMA, researchers revealed that the most common comorbidities found in 5,700 patients hospitalized with COVID-19 in the New York City area included hypertension, obesity, and diabetes.¹ Various publications have also indicated the association between obesity and the severity of COVID-19. In another recent publication in The Lancet, the authors indicated that a higher body mass index is linked with more severe cases of COVID-19 and points to obesity as a substantial pre-existing condition especially in younger patients.² The authors indicated that this finding is particularly critical since the prevalence of obesity in the U.S. is around 40%.² A larger study of over 4,000 patients with COVID-19 in New York City found that severe obesity was a major risk factor for hospitalization, second only to age.³ Moreover in Seattle, a study of critically ill COVID-19 patients revealed comparable findings. This evaluation found that 85% of patients with obesity required mechanical ventilation, compared to 64% of patients without the condition.^3,4 Moreover, 62% of the patients with obesity died of COVID-19, compared with 36% of those without obesity.^3,4 The researchers indicated that it is vital to note that this particular study included only 24 patients, all of whom were critically ill, making it difficult to draw far-reaching conclusions from the data.^3,4 The final study included in the analysis involved 124 patients in Lille, France, and also discovered that patients with obesity were more likely to require invasive mechanical ventilation.³

In addition, the ongoing pandemic has also affected the emotional wellbeing of everyone to some degree. For example individuals have experienced furloughs and layoffs, social isolation, limited access to certain health care procedures for routine health care, patients fighting COVID-19 and other illnesses in the hospitals and at home without family members, loss of loved ones, financial uncertainty, disruptions in daily routines for those in school and working, additional stresses and burnout in those working on the front lines including health care workers and essential personnel and the lack of access to some everyday goods including food items, medications and cleaning supplies. In a study conducted in late May, which assessed a wide range of specific emotional effects related to the pandemic, researchers found that certain stressors affected a large majority of the population.⁵ Findings from the recent nationwide survey assessing the effects of the COVID-19 pandemic on the emotional wellbeing of U.S. adults indicate that 90 % of survey respondents reported experiencing emotional distress related to the pandemic.⁵ The survey also revealed that nearly 80% of respondents were frustrated on some level with not being able to do what they normally enjoy doing.⁵ A comparable number of respondents also reported that they were worried about their own health, and nearly 90% of those surveyed were more worried about the health of loved ones than before the COVID-19 pandemic. ⁵ Finally, women and men reported comparable levels of emotional impact due to COVID-19, although women with children under the age of 18 were more likely to report clinical levels of anxiety compared to women without children.⁵ Men with children under the age of 18 were more likely to report signs of depression than men without young children.⁵ The survey also revealed that adults younger than 50 were much more likely to report emotional impact of the pandemic compared to older adults.⁵

As a health care professional, I have been asked many questions about the virus itself, preventative measures and about dealing with other health issues during this challenging health crisis. The most important things that I try to relay to others are to stay informed with information about the virus from reliable health care resources, take time to destress and relax, consult health care providers if having any health issues and to continue to take medication as prescribed. Reinforcing patient education and being proactive about one’s health can improve clinical outcomes. Indeed, these are trying times filled with uncertainty, anxiety and fear, but the promising news is that vaccines and potential therapies are being investigated and health care experts continue to explore measures to decrease and potentially eradicate this virus. Every day as health experts learn more and more about COVID-19 and its impact on other comorbidities, the emotional well-being of the population should also be identified and addressed. As states across the country reopen in various phases, we as health care professionals should encourage patients to take an active role in their health. Health care providers should encourage patients to maintain routine checkups, eat balanced diets, get adequate sleep and exercise when possible. We should also seize every opportunity to engage our patients in conversation to assess their overall emotional well-being because the only way we are going to get through this pandemic and be prepared should another wave come in the fall during cold and influenza season is TOGETHER. The COVID-19 pandemic has created many challenges and has had some degree of impact on every facet of our lives whether physically, socially, economically or psychologically. The true impact of this unprecedented health crisis in our lives remains to be seen, but it is my hope that we as a society emerge from this healthier, more resilient, wiser, and more grateful than ever for the gift of life and that we all work together to make the world a better place for us all.

Yvette C. Terrie, Consultant Pharmacist, Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com/).

References:

1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052–2059. doi:10.1001/jama.2020.6775
2. Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020;395(10236):1544-1545. doi:10.1016/S0140-6736(20)31024-2.
3. Latest evidence on obesity and COVID-19. Medical News Today website. https://www.medicalnewstoday.com/articles/latest-evidence-on-obesity-and-covid-19. Accessed July 7, 2020.
4. Stefan, N., Birkenfeld, A.L., Schulze, M.B. et al. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol 16, 341–342 (2020). https://doi.org/10.1038/s41574-020-0364-6
5. O'Neill M. Findings Released: Nationwide Survey Assessing Emotional Wellbeing During COVID-19 Pandemic. SciTechDaily website. https://scitechdaily.com/findings-released-nationwide-survey-assessing-emotional-wellbeing-during-covid-19-pandemic/ . Published June 29, 2020. Accessed July 6, 2020.