May 8, 2020 | Sean McMahon and Sara Harper, LHC Staff
The COVID-19 pandemic seems to have launched us into the great unknown. It’s hard to predict what will change in the world outside the safety of our homes. While news outlets are operating a constant stream of pandemic-related updates, there are other changes going on that don’t make as many headlines. Even in normal times, every policy change leads to unintended consequences, side-effects of the change that are not in line with the goal of the policy. Stay-home orders have certainly slowed the spread of SARS-CoV-2 (the novel coronavirus which causes COVID-19), but what else have those orders done? We’ve rounded up some of the news of the last two months that may be side-effects of staying at home.
Excess Deaths
Excess death data from the CDCUsing data from previous years, the CDC uses statistical modeling to calculate “expected deaths” across the country on a weekly basis. “Excess deaths” is the difference between observed deaths and the expected number. Of course, with over 75,000 COVID-19 deaths in the United States, we would expect roughly that same number in excess deaths. However, in several cities and states the number of excess deaths is larger than their COVID-19 deaths. Death certificates are often submitted without a cause of death with the intention of later completion, so the particular causes can’t be teased out just yet. These deaths stem from a number of possible factors: people may be avoiding healthcare facilities, foregoing medical treatment; people are struggling financially, possibly unable to afford necessities; food insecurity is on the rise. We won’t know exactly what is causing the excess deaths until we have more complete data from death certificates.
Primary Health
On the other end of the healthcare spectrum, a survey of 2,000 primary care physicians reported that approximately 20% predict they will be forced to close within the coming weeks. Privately owned primary care clinics typically operate as small businesses, which have taken a massive blow during the COVID-19 pandemic. Patients aren’t engaging with primary care as we quarantine within our homes, and in consequence, we may see a surge in preventable illnesses in the coming months. Of course, with fewer patients, fewer primary care offices have the resources to remain open. When we emerge from this crisis some families will be left without a primary care physician. Primary care losses can impact treatment access for other deadly diseases like routinely screened cancers, as most treatment referrals come through primary care physicians. Already, lockdowns have resulted in an 86-94% drop in routine cancer screenings and a 60% decrease in chemotherapy attendance.
WHO mental health materialsMental Health
“Are we required to wear masks or not? Are we still seeing 3,000+ deaths a day? All my hometown Facebook friends are posting conspiracy theories. Working from home is not as great as I thought it would be.”
Uncertainty can be hard to deal with. Things are changing so quickly that it’s difficult to keep track of what’s going on. Overall, it seems that mental health and our support systems are taking a hit around the world. Isolation can be a trigger for suicidal ideation, panic attacks, depression, and several other concerns. US alcohol sales spiked at the beginning of the crisis, and “problem drinking” is on the rise in the United Kingdom. Our support systems are also on the rocks. Drug users across Europe cannot access their opioid substitutes and other treatment services. With support groups held online with virtual platforms, participation and accountability may be lower as well. A lack of readily available support services coupled with an economic downturn has led to an increase in deaths from drugs, alcohol and suicide; or what researchers call “deaths of despair”.
Economics
Image of Lucy’s Coffee & Tea. Image from the shop’s Facebook pageOf course, ordering businesses to close has dealt a major blow to the economy. To mitigate this, Congress passed the CARES Act in late March. This $2 trillion stimulus has proven too little, too late in some cases. As of the writing of this blog post, 33.5 million people have filed for unemployment as a result of the pandemic. Over 7 million small businesses are at risk of permanently closing their doors. Several small businesses across the country have already been forced into this. Much to our dismay, Lucy’s Coffee & Tea has shut its doors for good. While some community favorites are forced out of business, other companies find themselves in a position to turn a profit by raising prices on everyday items. Texas Attorney General Ken Paxton, along with a group of individuals in California, has filed a lawsuit against the country’s largest egg producer for price gouging in the midst of a pandemic.
Environment
Not every unintended consequence of stay-home orders has been detrimental. Air quality in the world’s major cities has improved since the lockdowns started. Some cities have seen particulate matter 2.5 (PM 2.5) levels decrease by 60%. This drastic change has increased breathability and visibility in normally crowded cities; quite noticeably in New Delhi. These PM 2.5 declines are beneficial to the environment and human health in general. Lower levels of air pollution also could help fight the novel coronavirus, according to a study from Harvard that found increased susceptibility to COVID-19 in those who have been chronically exposed to high levels of PM 2.5. Air quality will continue to change as countries reopen their economies, hopefully with an increased awareness of sustainability. The National Oceanic and Atmospheric Administration is set to conduct its own studies on the environmental effects of stay-home orders. 
New Delihi’s India Gate war memorial on 17 October 2019 and on 8 April 2020. Photograph: Anushree Fadnavis/Adnan Abidi/Reuters
More Speculations:
Re-opening strategies put communities of color at greater risk
Some domestic violence aid organizations are worried about a drop in reports, a sentiment echoed by the UN Secretary-General.
Some people may be grappling with a “Quarantine 15,” as physical activity decreases and calorie intake increases.
Experts predict a rise in tuberculosis cases as a result of lockdowns’ impact on treatment and mitigation efforts.
