COVID-19 has raised the visibility of the importance of public health. It has also shone a glaring light on the racial health disparities since it has disproportionately impacted African Americans. Preliminary data from the Centers for Disease Control and Prevention, or CDC, suggests men may be experiencing disproportionate COVID-19 impacts as well. There are likely a number of other disparate populations, and a lack of good data will only continue to fuel this debate.
There are multiple secondary effects of the COVID-19 pandemic that could create a cascade of future public health crises and further health disparities once this pandemic is over. I have personally lost three family members in the past three weeks. The first died as a result of COVID-19. The second suffered at home for fear of contracting SARS-CoV-2, and by the time she went to the hospital — it was too late. The third, went to the hospital during the pandemic for a life-threatening condition and died alone in her hospital room. Each of these deaths in my personal life point to several problems that we as a nation must address as we fight this pandemic.
First, we must deal with health inequities, that is the systematic unfairness that prevents assurance of the condition of optimal health for all people. During COVID-19, that includes fair access to PPE, testing, health care, and treatment — despite race, age, gender, health status, incarceration status or whether someone has health insurance or a pre-existing health condition. The racial disparities in health that we have seen during this pandemic pre-date the introduction of the SARS-CoV-2 virus and merit our immediate and deliberate attention and mitigation — including after this pandemic is over.
Second, we must implement effective information dissemination strategies to the population at-large on how to manage non-COVID related illness in the midst of this crisis. The life-saving stroke medication, tPA (tissue plasminogen activator aka ‘clot buster’), is only an option if administered within the first several hours of the onset of a stroke. In the stroke community, they say ‘time is brain’; the longer people wait to go the hospital, the more neurons (brain cells) die. Researchers have documented a 39% decrease in hospital imaging for stroke in the first two months following the COVID-19 pandemic. Delays in the treatment of medical conditions like stroke and other chronic conditions due to fear of leaving the house or going to the hospital, will result in excess morbidity and mortality from these conditions.
Third, we must also promote the ongoing practice of primary and preventive care. As an example, children need to continue to receive well baby visits and vaccinations, which according to local hospital partners have decreased significantly in the past two months. If we lose sight of the need for these basic preventive and primary care services, we could see the outbreak of diseases like measles, which according to the CDC, spiked in 2019 in primarily underimmunized populations and threatened the eradication of the disease. We also need to continue routine screenings for diseases like breast cancer and colorectal cancer, which have the best prognosis when detected and treated early. The gaps in primary and preventive care will predictably have a greater impact on vulnerable populations that already have difficulty accessing preventive services and screening.
Lastly, we must address the ongoing psychological and mental trauma that people are facing due to job loss, living in fear, being socially isolated and witnessing death on an unparalleled scale during this pandemic. The mental health of our nation is as important as our physical health. Mental illness can be difficult to recognize and harder to treat than say a broken leg, but we have a system of care and good evidence that mental health is manageable and mental illness is treatable. It is safe to assume that the mental health needs of our nation have increased during this pandemic for a multitude of reasons and it is imperative that we expand our system of care to meet these increased needs.
As we keep our eye on the ball of COVID-19, we must not simultaneously lose sight of good public health practices, the need for primary and preventive care, and other emerging health needs. To do so will only further exacerbate non-COVID related health disparities and give way to avoidable future public health crises.