Just the Facts…. Another Inequity Emerges from the COVID Pandemic.

The terms "Long COVID 19" or "Long Haulers" are being batted around among various public health communities as scientists and health providers attempt to define the lingering health impacts that some individuals experience after a positive diagnosis of the COVID virus. While still a very new area of scientific study, places like John's Hopkins, the Mayo Clinic, and the Cleveland Clinic use this terminology to encompass various ongoing symptoms. The Centers for Disease Control (CDC) has stated that "the most common lasting symptoms are fatigue, shortness of breath, cough, joint pain, and chest pain."

This is undoubtedly an area that warrants further investigation and study, particularly as the number of patients continues to rise, as do newer populations such as children and youth. To that end, the National Institute for Health (NIH) recently awarded a $470 million award for building a national study to understand the longer-term health effects of COVID-19 better.*

While I applaud the public and private sectors for pursuing a greater understanding of what a "post-pandemic" world might look like for those with lingering physical health issues, there is a glaring mistake in all of this research and resource allocation; the apparent omission of behavioral and mental health. While I have come across one article in my research that discussed depression, it did so only within the context of patients who had spent time in the ICU. And, while it is about time we begin to study the traumatic effects patients experience accessing and receiving medical care and the impact of managing emotional and physical symptoms of disease, there are so many others for whom the mental health effects of the pandemic will extend for a long period of time.

With 41.8 million cases and 678,220.00 deaths and counting, how can we ignore one of the very core aspects of being human--emotions? And for all of the health science that we conduct, we know that without consideration of a person's mental health status, we are left without a complete understanding of what the science is telling us.

To begin to appreciate the impact of COVID-19 on the emotional health of our nation, all we need to do is multiply the number of deaths with an approximation of the mothers, fathers, siblings, husbands, wives, partners, children, grandchildren, friends, and colleagues, that have been lost to this pandemic. But that is just the tip of the iceberg. What about those who have lost employment, housing, and perhaps access to food for their family? What about the children and youth who have spent a year or more isolated from their peers and without meaningful education opportunities during crucial developmental years?

For some, the grief, anxiety and, depression will dissipate over time as life begins to resume a new sense of normalcy. However, for others, the intensity of their experience will leave lasting, chronic scars that will require care, support, and appropriate treatment. Why then does the definition of "Long COVID-19" not include mental health as part of the list of lingering symptoms? Won't one's mental health, similarly to their physical health, impact their ability to work, care for their family, and return to school? Where are the resources for researching this constellation of post-COVID symptoms?

Sometimes data can better illustrate a point of view so let's turn to some numbers for a moment. The information below reflects children and youth ages 5-21. Why this population, when statistically speaking, they have not contracted COVID-19 nearly to the degree of adults (though the Delta variant is quickly changing that landscape)? Because the stark contrast between the number of children who have tested positive for the virus and the scope and depth of their mental health status should make us terrified of what adult populations are experiencing and what we are overlooking.

· 5.3 million children tested positive for COVID 19 as of September 7, 2021

· 43,000 children have lost a parent to COVID-19 (Just a parent. Not other family or friends)

· Emergency department visits for mental health crises rose 24% over the last year for children ages 5-11 and 31% for youth ages 12-17 as compared to the same time period in 2019.

· The cost of this ED increase is estimated to be $1.2 billion.

· Ninety-six thousand youth ages 12-17 reported having a substance use disorder over the past year, and 25% of the same age range reported starting or increasing substance use.

· From February of 2021-March of 2021, the mean weekly number of ED visits for suspected suicide attempts was 50.6% higher than during the same period in 2020.

And, I could go on. The COVID pandemic has lifted the veil on the gross inequities that remain within our public health system and, frankly, society at large. The fact that an individual's mental health remains in the shadows of their physical health is yet another example of this truth. And, as with the others, it's time for that to change.


Author: Brooke Lehmann

Co-Author-Cara Coleman

*https://www.nih.gov/news-events/news-releases/nih-builds-large-nationwide-study-population-tens-thousands-support-research-long-term-effects-covid-19