Public health interventions entail non‐economic as well as economic trade‐offs. Some trade‐offs can involve other aspects of public health.
I have written about how blanket bans on elective medical procedures combine with the fear already infused in the public to cause crucial delays in necessary health care. This adds to human suffering from causes other than the COVID-19 virus. Many people with chronic conditions, particularly chronic pain patients, are disproportionately affected by reduced access to routine care. Then there’s the dramatic drop‐off in the number of young children receiving crucial scheduled immunizations against much more dangerous pathogens, because parents, afraid of their children contracting COVID-19, have shied away from pediatricians’ offices. Yet often overlooked are the great number of people with anxiety and other mental health disorders whose conditions are also made worse–by fear along with lockdown‐induced isolation and economic hardship.
A Kaiser Family Foundation poll early last month found nearly half of Americans stated the public health crisis is harming their mental health. A Disaster Distress Helpline run by the Substance Abuse and Mental Health Services Administration has seen a huge spike in calls since the crisis began. According to the Household Pulse Survey, jointly conducted by the National Center for Health Statistics and the Census Bureau, roughly 30 percent of Americans reported symptoms of anxiety disorder and 25 percent reported symptoms of depression disorder since mid‐April. The pharmacy benefit management organization Express Scripts saw a spike of 34.1 percent in prescriptions filled for anti‐anxiety medications between February and March, and reported “More than three quarters (78%) of all antidepressant, antianxiety and anti‐insomnia prescriptions filled during the week ending March 15th (the peak week) were for new prescriptions.”
Substance use disorder, anxiety, depression, and other mental health problems are usually characterized by feelings of isolation and loneliness. “Shelter in place” orders can only exacerbate these feelings. Human interaction and a feeling of connection are integral to their recovery. While Zoom and other forms of remote meeting can help to a degree, they lack the intimacy and behavioral cues required for genuine connectedness.
Add to the effects of quarantine the anxiety and depression that result from loss of a business, loss of a job, and loss of savings and one can expect a spike in “deaths of despair” as a direct result of the public health crisis. The Centers for Disease Control and Prevention defines “deaths of despair” as “suicide, drug overdose, and alcohol‐related deaths.” The Well Being Trust earlier this month released a study that examined the toxic combination of isolation with economic hardship and projected increases in deaths of despair using nine different scenarios. The study projected an increase of 27,644 deaths of despair with a quick economic recovery (smallest impact of unemployment), 154,037 with a slow recovery (greatest impact of unemployment), and an increase of 68,000 deaths with a mid‐range scenario.
Government interventions to address a public health emergency might sometimes require blanket “one‐size‐fits‐all” directives. When exercising this authority, consideration must be given to the trade‐offs such policies entail. These trade‐offs are often economic and can indirectly affect the social determinants of health. But policymakers must not lose sight of the fact that many of these trade‐offs more directly concern crucial non‐coronavirus components of public health.
Former Cato intern Jimmy Schmitz assisted with the research for this blog post.