The Forgotten Epidemics During COVID-19

The world’s attention is justifiably focused on battling the COVID-19 pandemic which continues to ravage indiscriminately across the globe. There are, however, three other epidemics that we were dealing with prior to COVID-19 that are at risk of being forgotten:

  1. The Opioid epidemic
  2. The Obesity epidemic
  3. The Physician Burnout/Mental Health epidemic

All three have been exacerbated by COVID-19 and if we aren’t careful, we will be back at ground zero if we don’t start to give a little bit of attention to what’s happening.

The Opioid Epidemic

On June 30th, the American Medical Association (AMA) updated their brief on the increase in opioid-related overdoses during the COVID pandemic. In it the AMA states that it is:

“greatly concerned by the increasing number of reports from national, state and local media suggesting increases in opioid-related mortality – particularly from illicitly manufactured fentanyl and fentanyl analogs. More than 30 states have reported increases in opioid-related mortality…”

Several factors are contributing to this increase:

  • The shuttering of safe injection sites due to the lock-down
  • A reduction in the capacity of opioid treatment centers that have remained open (due to a lack of PPE and now due to physical distancing requirements)
  • Disruption to the drug supply-chain forcing people to seek less trustworthy suppliers
  • An increase in the lethality of available opioids
  • More people are using alone due to restrictions on gatherings
  • More people feeling helpless during this pandemic due to isolation, job loss and financial pressure

What can be done? The AMA is calling on state governments to:

  • Adopt the new SAMHSA and DEA rules and guidance (which allows patients to obtina up to 28 days of take-home medication if they are stable) for the duration of the COVID-19 emergency—including flexibility for evaluation and prescribing requirements using telemedicine.
  • Remove prior authorization, step therapy and other administrative barriers for medications
  • Remove existing barriers for patients with pain to obtain necessary medications. This includes removing arbitrary dose, quantity and refill restrictions on controlled substances.
  • Enact, implement and support harm-reduction strategies, including removing barriers to sterile needle and syringe services programs.

The Obesity Epidemic

Prior to COVID-19, obesity was recognized by many as a national public health crisis. There was growing awareness of the harmful downstream impacts of obesity including: heart disease, diabetes, and cancer. A 2013 study showed that obesity “accounted for 18% of deaths among Black and White Americans between the ages of 40 and 85”.

As if that wasn’t dire enough, scientists have recently shown there is a link between obesity and patients with severe COVID-19 symptoms. The American Heart Association recently released a report that cited a French study that showed “the risk for invasive mechanical ventilation in patients with COVID-19 infection admitted to the intensive treatment unit was more than 7-fold higher for those with body mass index (BMI) >35 compared with BMI <25 kg/m2

The COVID0—19 pandemic, has made the obesity situation worse:

  • There are more families facing food insecurity due to job loss
  • With schools shuttered, many children are not getting proper nutrition and/or regular meals
  • Public transportation is viewed as risky and thus many have not been able to get to grocery stores, forcing more to eat at convenient fast food chains which are around the corner and affordable
  • Donations to food banks are down
  • With more time at home, unhealthy snacking is harder to resist
  • Many gyms remain closed

Like the opioid situation, there isn’t a single magic bullet that will address this. A combination of initiatives will be needed.

The Physician Burnout Epidemic

Pre-COVID, the headlines were dotted with stories about the growing frustration that clinicians had with electronic health records (EHRs) and reimbursement changes. This was on top of the increasing number of tragic stories of physician suicides and promising young talent leaving the industry.

A recent Forbes article had these sobering statistics,

“According to a 2018 study, 400 physicians die by suicide each year – double that of the general population. In addition, doctors have the highest suicide rate of any profession in the U.S including combat veterans. From an economic standpoint, studies estimate that physician burnout is costing the health care system approximately $4.6 billion per year.”

To this we have now added:

  • A lack of personal protective equipment (PPE)
  • Unclear communications
  • Overlapping and contradictory protocols
  • Personal risk of infection
  • Isolation from family and loved ones
  • Lack of sleep and long hours
  • Watching patients experience poor outcomes from a virus that does not have an effective treatment

Yet despite all of these pressures, clinicians around the world have responded selflessly during this pandemic. My worry is what will happen when this crisis is over. Will we have the will to make physician burnout a priority again?

HCLDR – Tuesday July 7th at 8:30pm ET

Join me the next HCLDR tweetchat happening on Tuesday July 7th at 8:30pm ET (for your local time click here) when we will be discussing the following questions:

  • T1 What pre-COVID epidemic are you concerned about the most (opioid, obesity, physician burnout, other) and why?
  • T2 Realistically, is there anything that can/should be done to address these issues during the pandemic?
  • T3 What role does healthcare leadership play in keeping these other healthcare issues and epidemics from being completely forgotten?
  • T4 What other healthcare issues and challenges do you want to ensure aren’t forgotten?

Resources

“Issue brief: Reports of increases in opioid related overdose and other concerns during COVID pandemic”, American Medical Association, 30 June 2020, https://www.ama-assn.org/system/files/2020-07/issue-brief-increases-in-opioid-related-overdose.pdf, accessed 6 July 2020.

Satter, Naveed et al. “Obesity Is a Risk Factor for Severe COVID-19 Infection”, Circulation, 7 July 2020, https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047659, accessed 7 July 2020

Roy, Lipi MD, MPH. “Doctor, Heal Thyself: Physician Burnout In The Wake Of Covid-19”, Forbes, 17 May 2020, https://www.forbes.com/sites/lipiroy/2020/05/17/doctor-heal-thyself-physician-burnout-in-the-wake-of-covid-19/#5d7044f2213c, accessed 6 July 2020

Marcelina, Jasmine Silva; and Zakary, Kelly. “The Escalation of the Opioid Epidemic Due to COVID-19 and Resulting Lessons About Treatment Alternatives”, The American Journal of Managed Care, 1 June 2020, https://www.ajmc.com/journals/issue/2020/2020-vol26-n7/the-escalation-of-the-opioid-epidemic-due-to-covid19-and-resulting-lessons-about-treatment-alternatives, accessed 6 July 2020

Wan, William; and Long, Heather. “‘Cries for help’: Drug overdoses are soaring during the coronavirus pandemic”, The Washington Post, 1 July 2020. https://www.washingtonpost.com/health/2020/07/01/coronavirus-drug-overdose/, accessed 6 July 2020

Noguchi, Yuki. “A New Addiction Crisis: Treatment Centers Face Financial Collapse”, NPR, 15 June 2020, https://www.npr.org/sections/health-shots/2020/06/15/865006675/a-new-addiction-crisis-treatment-centers-face-financial-collapse, accessed 6 July 2020

Grinspoon, Peter MD. “A tale of two epidemics: When COVID-19 and opioid addiction collide”, Harvard Health Publishing, 20 April 2020, https://www.health.harvard.edu/blog/a-tale-of-two-epidemics-when-covid-19-and-opioid-addiction-collide-2020042019569, accessed 6 July 2020

”Obesity Kills More Americans Than Previously Thought”, Columbia Mailman School of Public Health, https://www.publichealth.columbia.edu/public-health-now/news/obesity-kills-more-americans-previously-thought, accessed 6 July 2020

Blumenthal, David MD; and Seervai, Shanoor. “Rising Obesity in the United States Is a Public Health Crisis”, Commonwealth Fund, 24 April 2018, https://www.commonwealthfund.org/blog/2018/rising-obesity-united-states-public-health-crisis, accessed 6 July 2020

Vieira, Cristina Mesa, et al. “COVID-19: The forgotten priorities of the pandemic:, Maturitas, June 2020, https://www.sciencedirect.com/science/article/pii/S0378512220302346, accessed 6 July 2020

Cimons, Marlene. “Covid-19 school closings may spur childhood obesity, experts warn”, Washington Post, 11 May 2020, https://www.washingtonpost.com/health/covid-19-school-closings-may-spur-childhood-obesity-experts-warn/2020/05/08/4bf71326-8e18-11ea-a9c0-73b93422d691_story.html, accessed 6 July 2020

Tan Monique, He Feng J, MacGregor Graham A. “Obesity and covid-19: the role of the food industry”,  BMJ, 10 June 2020, https://www.bmj.com/content/369/bmj.m2237, accessed 6 July 2020

Pearce, Katie. “Obesity A Major Risk Factor For Covid-19 Hospitalization”, HUB – Johns Hopkins University, 1 June 2020, https://hub.jhu.edu/2020/06/01/david-kass-obesity-covid-19/, accessed 6 July 2020

Hartzband, Pamela MD; and Groopman, Jerome MD. “Physician Burnout, Interrupted”, The New England Journal of Medicine, 25 June 2020, https://www.nejm.org/doi/full/10.1056/NEJMp2003149, accessed 6 July 2020

Image Credit

Photo by Frank Eiffert on Unsplash

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