Beyond COVID: A crisis of coalescing epidemics 

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On an average day, nearly 8,000 people die in the U.S., which is about 300 an hour, or 5 every minute. Many of these deaths can be traced to the multiple epidemics and crises we are battling beyond COVID, including cardiovascular disease, the mental health crisis, substance abuse, obesity, and lack of access to care. We must meet the challenge of managing these colliding health crises to avoid decades of hardship to come.

Today millions are suffering from multiple comorbidities while overwhelmed with social and economic stress. Despite being through the worst period, COVID was the second leading cause of death this January, behind heart disease. Many ailments elevated during the pandemic, like high blood pressure and smoking, remain key risk factors for heart disease.

 More alarming, data show that COVID aftershocks are leading to post-acute sequelae. Simply stated, for many, COVID was not a one-and-done. At the same time, we have entered a period where COVID is no longer the sole public health priority. Those suffering from heart disease, cancer, mental health illness also need attention and a path to care.

Our mental health crisis was mounting years before the coronavirus pandemic hit. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020), and two years of isolation, stress, and missed care has only magnified this crisis. The pandemic laid bare our nation’s continued failure to care for people with mental illness.

Emergency department visits for suicide attempts among teenage girls were up more than 50 percent from the start of the pandemic. Data shows roughly 6 percent of people diagnosed with COVID-19 go on to develop a new psychiatric disorder, while 13 percent of adults report abusing substances to cope with the stress of COVID.

The latest data from 2020 shows that nearly 92,000 people died from drug overdoses, representing the largest increase ever recorded in a calendar year, and reflecting a five-fold increase in the rate of overdose deaths since 1999. Experts have estimated the costs of opioid use disorders and overdose deaths in the U.S. exceeded $1 trillion in 2017.

During the pandemic, the national rate of obesity among kids increased to 22.4 percent, which means 1 out of every 6 kids are obese, which costs us $14 billion a year. Adult obesity prevalence at 42 percent is equally alarming, as it is associated with diabetes, heart disease, stroke, and some types of cancer. In fact, obese people were not only at higher risk of COVID mortality, but are up to 2.5 times more likely to die of heart disease than people with normal body mass indices (BMI).

The patient with long COVID (which is still unfolding) is equally worthy of care, as is the patient delaying surgery or suffering from mental illness. During the height of the pandemic, 41 percent of patients in one study forwent medical care due to a variety of reasons including fear, office closures, or financial stress. As routine care was halted during COVID, deaths among seniors with Alzheimer’s disease and dementia surged 26 percent in that same time period. There remains a pent-up demand for care that must work its way through a strained healthcare system, which is more difficult due to an ongoing healthcare labor shortage.

One healthy sign is there appears to be bipartisan support on some healthcare priorities, including extending access to programs like telehealth and virtual care. In late January, the U.S. House set a bipartisan record for Medicare Advantage, with 346 members signing on to a bipartisan letter supporting the program. In addition, there is bipartisan support to fund comprehensive student mental health promotion and suicide prevention efforts. Over the past two years, we have seen unprecedented funding and action during a public health emergency, but we must do more.

The policies have been favorable (reimbursement of telehealth, funding for virtual care), but we still need more. Now is the time to focus on the other epidemics and collateral crises, including preventive care, a worthy investment, as downstream morbidity is something we all pay for.

We have several health crises colliding that should not be viewed in competition, as this is not Epidemic Shark Tank. As a first world healthcare system spending $4 trillion a year, we must and can manage multiple priorities.

 

Meghan FitzGerald is an adjunct associate professor with the Columbia University Mailman School of Public Health and a private equity investor. She has decades of experience, ranging from frontline patient care to serving as an executive at Merck, Pfizer, and Cardinal Health.