What kind of public health problems will the social closure caused by COVID 19 bring?

The COVID-19 pandemic has led to the implementation of an unprecedented isolation strategy. The health problems caused by this are the first to occur in groups such as the elderly.

Social closure increases the health risks of the elderly:

As the epidemic has the greatest impact on seniors over 60 years old, in the UK, it is estimated that nearly half of COVID-19-related deaths now occur in nursing homes. In the United States, about one-fifth of deaths occur in nursing homes, so the elderly have also become key protection targets [1]. The elderly are very dependent on the support of family members or community services in their life functions, so they are more susceptible to social isolation and loneliness. The loneliness and social isolation caused by social isolation are becoming more and more common among the elderly. Loneliness refers to subjective feelings, while social isolation is defined by the degree and frequency of a person’s social interaction. Social isolation describes the objective state of an individual’s social environment and interaction patterns. Studies have shown [2] Although loneliness and social isolation are not the same, both may have adverse effects on health.

Do you think these just affect their psychology? Wrong, this is really manifested in physical and mental health, in other words, it actually exacerbates their own health problems.

Loneliness and social isolation are related to various physical and mental health, including increased systolic blood pressure and increased risk of heart disease [3]. Both loneliness and social isolation increase the risk of death related to coronary heart disease, even if there is no history of myocardial infarction. The same is true among middle-aged adults. Over time, the decline in cognitive ability is to some extent related to loneliness and underlying depressive symptoms. A systematic evaluation concluded that loneliness and social isolation are significantly related to dementia events [4].
In addition, the adverse effects of loneliness on health also focus on physiological stress responses (such as increased cortisol). Abnormal stress responses can lead to adverse health outcomes, such as behavior changes including unhealthy lifestyles (such as smoking, drinking , Reduced physical activity, poor dietary choices and non-compliance with medical prescriptions)

NCD patients and hospitals have been hit

In addition to the elderly, patients with non-communicable diseases (patients with chronic diseases, daily visits, etc.), pregnant women, and hospitals are also affected. Although the pandemic has further developed online diagnosis and treatment, many examinations, prescriptions, and even childbirth need to be performed in medical institutions. Especially in low- and middle-income countries, services for noncommunicable diseases have been partially or completely interrupted. A study showed [5] that the two most common concurrent chronic diseases affected by COVID-19 are diabetes and hypertension, in addition to chronic obstructive pulmonary disease, heart disease, asthma, cancer and depression.

Although the use of Internet applications can support the self-management of chronic diseases, that is, diabetes can be supported by continuous blood glucose monitoring. However, most patients with non-communicable diseases live in low- and middle-income countries, where these technologies may not be widely used. In addition, patients with many chronic diseases may rely heavily on regular checkups or appointments to the hospital to avoid potential risk factors, and therefore have to try to adapt to online management or experience delays in treatment, which may have serious consequences. A large group of patients with chronic diseases also includes pregnant women and newborns. The WHO surveyed 155 countries in three weeks in May, and more than half of the countries postponed screening activities for breast and cervical cancer. Although only 82% of households in high-income countries receive medical care guidance, only half of the respondents in low- and middle-income countries are affected[6]. Globally, 90% of respondents indicate the stress level of fertility Greatly improve. For example, the COVID-19 pandemic has caused severe medical service interruptions in sub-Saharan Africa. In low- and middle-income countries including Kenya, deaths during the perinatal period (from 28 weeks of pregnancy to one week after delivery) are still high[7] The COVID-19 pandemic has disrupted medical services and may lead to increased maternal and neonatal mortality and morbidity. The closure of medical care other than the most urgent COVID has also brought a financial crisis to the hospital. The result is a sharp decline in the number of patients and income, while the cost of dealing with the pandemic remains high. The American Hospital Association estimates that from March 1 to June 30, 2020, the COVID-19 pandemic will cost hospitals and health systems US$202.6 billion, most of which (US$161.4 billion) will come from cancelled surgeries and other services , There are 29 hospitals that have filed for bankruptcy in the first half of 2020[8] and more have filed for bankruptcy throughout 2019. The quarantine has brought unprecedented impact to both the patient and the hospital, and the hospital’s ability to serve the community and financial feasibility is still undetermined.

COVID-19 changes the median hospital profit margin from positive to negative The Effect of COVID-19 on Hospital Financial Hea

Weight and mental health of young and middle-aged

Large-scale home quarantine orders are rare for many people (especially Europeans and Americans), which will cause people to worry about society. In order to curb and slow down the spread of the virus, people’s movements are restricted, so people’s daily lives have undergone major changes, not only facing the unknown epidemic, but also working at home all at once, facing their children’s homeschooling, Other family members, friends and colleagues lack the new reality of physical contact, and some even lost their jobs directly. Since Internet users actually only use the Internet to maintain communication with existing relationships, that is, to strengthen the intimacy of existing social relationships, it is extremely fatal for people who do not have any friends in reality or who do not love chatting online. The harm.

The psychological and weight effects are mutual

In order to alleviate the tension during that period, people began to stock up some unhealthy foods, such as salty snacks and high-sugar sugar. People stay at home, feel bored, anxious, stressed, and seek relief through eating. In addition, due to the closure of stadiums, casinos and movie theaters, the pressure of isolation has increased and people have begun to eat emotionally. A study involving 568 people showed that slightly more than one-third of the patients after the outbreak, including 73 women (9.54%) and 138 men (20.65%), continued to gain weight [9]. This may be because stress affects weight through biological behaviors and psychological mechanisms, such as the hypothalamic-adrenal-pituitary axis, which releases cortisol, stimulates eating to promote eating, thereby affecting weight, or activating reward centers in the brain, such as Fu The nucleus septum and the dorsal striatum cause behavioral changes.

In addition, as the COVID-19 pandemic continues, people realize that safe food storage and preparation may be restricted, which will also lead to an increase in food storage trends and an increase in the use of canned food and ultra-processed products. This has greatly increased the global burden of obesity, especially the reduction in exercise and measures taken at home. Most of these foods are high in sugar, high in sodium and fat, and high in calories, which may exceed personal calorie consumption. the amount. In particular, the high content of refined carbohydrates in processed foods may lead to changes in the insulin response, resulting in excessive storage of nutrients in adipose tissue, and the resulting obesity may be more difficult for people with chronic diseases. Reduce resistance to COVID-19.

With prolonged isolation, anxiety about obesity will promote other mental illnesses. Some people may experience stress, depression, irritability, insomnia, fear, confusion and other emotions, some of which still exist after the isolation is lifted. Therefore, a review of the psychological sequelae of quarantined people and medical service providers may be instructive. Specific stressors include longer incarceration, insufficient supply, difficulty in obtaining medical care and drugs, and economic losses.

reference:

  • ^National Centers for Health Statistics. Provisional death counts for Coronavirus disease (COVID-19). 2020; https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm. Accessed 18 Apr 2020
  • ^Kobayashi, L. C. and Steptoe, A. (2018). Social isolation, loneliness, and health behaviors at older age: longitudinal cohort study. Annals of Behavioral Medicine, 52, 582–593. doi: 10.1093/abm/kax033.
  • ^Heffner, K. L., Waring, M. E., Roberts, M. B., Eaton, C. B. and Gramling, R. (2011). Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults. Social Science & Medicine, 72, 1482–1488. doi: 10.1016/j.socscimed.2011.03.016.
  • ^Kuiper, J. S. et al. (2015). Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews, 22, 39–57. doi: 10.1016/j.arr.2015.04.006.
  • ^Yogini V. Chudasama, Clare L. Gillies, Francesco Zaccardi, et al.Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals.Diabetes Metab Syndr. 2020 September-October; 14(5): 965–967. Published online 2020 Jun
  • ^ Semaan A, Audet , Huysmans , Afolabi ,et al.. Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Glob Health. 2020 Jun;5(6):e002967. doi: 10.1136/bmjgh-2020–002967. PMID: 32586891; PMCID: PMC7335688.
  • ^United Nations Population Fund. Reproductive, maternal, newborn and adolescent health during pandemics. United Nations Population Fund; 2020. https://reliefweb.int/sites/reliefweb.int/files/resources/en-rmnah-web_2.pdf
  • ^https://www.aha.org/system/files/media/file/2020/05/aha-covid19-financial-impact-0520-FINAL.pdf
  • ^The impact of social distancing and self-isolation in the last corona COVID-19 outbreak on the body weight a prospective case series study. Annals of Medicine and Surgery Volume 59, November 2020, Pages 110–117 doi: https://doi.org/10.1016/j.amsu.2020.09.024

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