The Impact of Our COVID-19 Response

This document puts into perspective a few aspects of the danger of COVID-19 and the dangers of the response. This does not directly discuss the overall economic impact but rather focuses on the impact on health. Judge for yourself which is worse. All points are cited, I have reviewed all of the articles, and all are credible. 1. The mortality rate of COVID-19 is difficult to determine. Initial estimates of up to 15% were wildly exaggerated and have continued to drop dramatically. The difficulty in determining the actual mortality rate (which is used interchangeably with the phrase case fatality rate) stems from the fact that a tremendous number of infected individuals never have any symptoms and a substantial number beyond that have symptoms so mild they do not realize they have the disease.

One rare example of an opportunity to observe the mortality rate for COVID-19 occurred on the Diamond Princess Cruise Line. Because that ship was quarantined and had an outbreak it provided a legitimate population to study. The mortality rate of those 3711 passengers and crew was 0.99%. This is likely quite artificially high compared to the greater United States because most people on board were older and treatment options were not the same as elsewhere in the USA.

Important to note is that, as a comparison, the original SARS had a mortality rate of 9.5% (nearly 10 times higher) and MERS had a mortality rate of 34.4% (over 34 times higher). (Rajgor, Lee, Archuleta, Bagdasarian, & Quek, 2020)

While another recent article by David Baud in the Lancet suggested a possibly higher mortality rate this was very credibly disputed by a number of other authors (one of the articles can be found at doi: 10.1016/S1473-3099(20)30246-2). Frankly that article was debunked in peer review and is essentially garbage as opposed to science.

Based on my overall research I believe the final true mortality rate for COVID-19 amongst the general population of the USA will likely be below 0.5%.

2. The shutdown that has occurred as a response to COVID-19 has created a crisis in overdoses. According to the Overdose Detection Mapping Application Program (“ODMAP” – a partnership between the University of Baltimore and HIDTA), there was a 17.59% increase in overdoses after March 19, when the lockdowns began (Alter & Yeager, 2020).

I have not seen data on the suspected increase in opioid or amphetamine addiction but the numbers from this study would seem to indicate a substantial increase which will result in associated increases in crime, deaths, and long-term costs of treatment.

3. The Robert Graham Center performs research on something they term as “Deaths of Despair” (DoD). DoDs are defined as “deaths to drug, alcohol, and suicide, and often associated with socioeconomic factors.” This report examines the potential increases of DoDs moving forward. It takes a conservative approach but notes that projections would inherently be imprecise at this point. That said, the report runs 9 scenarios and bases them on economic recovery rates, unemployment, and geography. The result is that they are estimating an additional 27,644 – 154,037 deaths due to what is essentially the economic impact of COVID-19 which is largely due to the shutdowns. The impact may also be disproportionate on minorities (Petterson, Westfall, & Miller, 2020).

Given the extent to which the current death reporting is being exaggerated (see my presentation) it would be interesting to know whether deaths will occur in the United States from economic despair than from COVID-19.

4. Domestic violence has seen a dramatic increase globally due to the lockdowns. While international domestic violence rate increases have been alarming, these notes focus on the USA which has also seen a dramatic increase. While overall numbers for domestic violence rate increases due to the lockdown are difficult to find a number of law enforcement agencies have reported alarming data. They include:

  • Portland, Oregon – 22% increase in DV (domestic violence) arrests compared to pre-lockdown;
  • San Antonio, Texas – 18% increase in calls pertaining to family violence;
  • Jefferson County, Alabama – 27% increase in calls compared to the same time period from the year prior;
  • New York, New York – 10% increase in DV reports in March compared to March of 2019; and
  • Philadelphia, Pennsylvania – 7% increase in shooting victims compared to the same period last year.

The article goes on to state, “This cursory analysis illustrates that stay-at-home orders may create a worst-case scenario for individuals suffering from DV and demonstrates a need for further research” (Boserup, McKenney, & Elkbuli, 2020)

5. A JAMA article discusses the potential for severe mental health consequences due to COVID-19 and social distancing. A key pull quote for the article states:

  • In the context of the COVID-19 pandemic, it appears likely that there will be substantial increases in anxiety and depression, substance use, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse. This concern is so significant that the UK has issued psychological first aid guidance from Mental Health UK. (Galea, Merchant, & Lurie, 2020).

The article discusses past disasters and their impact on mental health and is clear that the fear and governmental reactions to COVID-19 will have a substantial and widespread impact on mental health.

6. Elder abuse is difficult to detect and underreported at any time. A number of articles have been published related to the increased risks of elder abuse due to the measures being promoted by state and federal officials to combat COVID-19. The article being used here notes that:

  • Social distancing, school closures, and the shuttering of nonessential businesses have already led to significant personal, social, and economic hardship. While it has been well publicized that older adults are at highest risk of serious illness and death from COVID-19, they may also be at high risk for negative consequences from the measures being enacted to protect them from the viral threat (Makaroun, Bachrach, & Rosland, 2020).

This article discusses a myriad of issues that may or are occurring due to the COVID-19 response that include more neglect, less contact, more opportunities for financial abuse, etc. It also states, “In addition to increased risks for new abusive situations arising, this pandemic may be worsening the severity or lethality of existing abusive relationships” (Makaroun, Bachrach, & Rosland, 2020).

While I have not yet seen data, it would be very interesting to see the impacts COVID-19 is having on nursing home patients that are not affected by the virus.

References

Alter, A., & Yeager, C. (2020). COVID-19 Impact on US National Overdose Crisis. University of Baltimore. Baltimore: ODMAP. Retrieved July 12, 2020, from http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf

Boserup, B., McKenney, M., & Elkbuli, A. (2020). Alarming Trends in US Domestic Violence During the COVID-19 Pandemic. The American Journal of Emergency Medicine. doi:https://doi.org/10.1016/j.ajem.2020.04.077

Galea, S., Merchant, R., & Lurie, N. (2020). The Mental Health Consequences of COVID-19 and Physical Distancing. JAMA Internal Medicine, 180(6), 817-818. doi:10.1001/jamainternmed.2020.1562

Makaroun, L., Bachrach, R., & Rosland, A. (2020). Elder Abuse in the Time of COVID-19—Increased Risks for Older Adults and Their Caregivers. American Journal of Geriatrich Psychiatry. doi:10.1016/j.jagp.2020.05.017

Petterson, S., Westfall, J., & Miller, B. (2020). Projected Deaths of Despair During the Coronavirus Recession. Robert Graham Center. Well Being Trust. Retrieved July 11, 2020, from https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/Projected-Deaths-Despair-COVID-19.pdf

Rajgor, D., Lee, M., Archuleta, S., Bagdasarian, M., & Quek, S. (2020, July). The Many Estimates of the COVID-19 Fatality Rate. The Lancet, 20, 776-777. Retrieved from https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30244-9.pdf?fbclid=IwAR0X5ZxmhzdVUC5Uas_GYlAtpQlX7K0BVg39h3EcnnRh46MBRGjHoyxw3WY