As we continue conversations about how individual stakeholders, organisations and policymakers can address the COVID-19 crisis, we must understand the interconnected and essential challenges it poses. Below we take a look at social trends in healthcare during the era of COVID-19.
Healthcare is a basic human need
Equal access to healthcare is a basic promise of democracy. Healthcare is part of the social fabric that binds us all as a society. It is an essential service and not discretionary like retail goods such as clothing and dining. Unfortunately, COVID-19 will acutely exasperate prior challenges to our universal needs.
The opioid and substance use disorder problems will get worse
With the economic and social damage occurring across the U.S., it will take some time to recover. This will lead to increased opioid and substance use disorder for many.
“Rising unemployment and reduced opportunities caused by the pandemic are also likely to disproportionately affect the poorest, making them more vulnerable to drug use and also to drug trafficking and cultivation in order to earn money,” according to a report published by the United Nations Office on Drugs and Crime. We clearly have seen this in prior economic downturns, including the Great Recession in 2008.
Moreover, the circumstances of the pandemic itself are not causing just increased use but increased overdosing. Monthly overdoses are up as much as 42 per cent compared to the same time last year. Disrupted supply chains have caused people to turn to new substances they are unfamiliar with, leading to a higher risk of fatal overdose.
In addition, the isolation of lockdown means other people are not around to make lifesaving interventions. These interventions are not only important during this phase, but more so during the aftermath of an economic crisis. As the economy improves, there is a chance that many people will be left out of it, making the situation worse.
Behavioural health needs are soaring
The impacts of mental health during the pandemic include, but are not limited to, negative effects of social distancing, the psychological toll of a humanitarian crisis, the fear surrounding a healthcare crisis (particularly for those who already have obsessive-compulsive disorder or other forms of anxiety), the well-documented link between economic downturn and mental health, and the multi-directional causal link between substance use disorder and mental health.
Domestic abuse issues are on the rise as well
Domestic abuse also has a documented relationship with economic downturns. Workforce gender composition shifts, which are going to be at play in the U.S., have been known to cause an uptick in domestic violence as the role of “breadwinner” is transitioned from the male to the female.
In particular, during this crisis, social distancing is, quite literally, locking victims in with their abusers and isolating them from their support system. Technology can help here, but it also poses risks of its own.
This could be the demise of the skilled nursing facility model
The U.S. has hundreds of independent retirement homes and skilled nursing facilities. These care models have been mostly one-size-fits-all with little individualisation. Even before the COVID-19 pandemic, 82 per cent of all skilled nursing facilities had infection prevention and control deficiencies cited in one or more years from 2013-2017, according to the Government Accountability Office, and 48 per cent had such a deficiency in multiple years.
With the advancement in remote patient monitoring, it is becoming increasingly possible to realistically take care of more patients in their homes, or even in much smaller groups of four to eight people who live in home-like facilities with full-time caregivers. A smaller number of people living together lessen the chance of the next pandemic ravaging skilled nursing facilities where hundreds of residents reside.
Healthcare disparities are widening
COVID-19 will, unfortunately, make housing, food, transportation, job and healthcare insecurities much worse. Minority and immigrant communities will be disproportionately affected. Without equitable healthcare to all, there will be no upward economic mobility.
As conversations around racial equity remain at the forefront of the collective consciousness right now, we must take healthcare and health outcomes into account.
Many will be affected by the stigma of COVID-19 and guilt of having had the disease
Unfortunately, as we have seen, some ethnic groups are unfairly targeted as having COVID-19 and even implicated in being complicit to it. This is intolerable and completely unacceptable. As a society, we must categorically reject the stigmatisation of anyone with COVID-19. This virus knows no boundaries.
People who survive the ordeal will most likely be ridden with guilt, especially if they have loved ones pass away. They will need social and emotional support for many years to come. Moreover, others in their community may react to them with fear or distrust.
Dr. Eric Eskioglu
Having been in healthcare for over 21 years, including being on the frontlines as a Neurosurgeon and partaking in roles as a Physician Executive, the discussion here reflects the author’s personal opinions.