Having COVID-19 puts people at a significantly increased chance of developing new mental health conditions, potentially adding to existing crises of suicide and overdoses, according to new research looking at millions of health records in the United States (US) over the course of a year.
The long-term effects of having COVID are still being discovered, and among them is an increased chance of being diagnosed with mental health disorders. They include depression, anxiety, stress and an increased risk of substance use disorders, cognitive decline, and sleep problems – a marked difference from others who also endured the stress of the pandemic but weren’t diagnosed with the virus.
“This is basically telling us that millions and millions of people in the US infected with COVID are developing mental health problems,” said Ziyad Al-Aly, chief of research and development at the VA St Louis Healthcare System and senior author of the paper. “That makes us a nation in distress.”
The higher risk of mental health disorders, including suicidal ideation and opioid use, is particularly concerning, he said.
“This is really almost a perfect storm that is brewing in front of our eyes – for another opioid epidemic two or three years down the road, for another suicide crisis two or three years down the road,” Al-Aly added.
These unfolding crises are “quite a big concern”, said James Jackson, director of behavioural health at Vanderbilt University’s ICU Recovery Center, who was not involved with this study. He is also seeing patients whose previous conditions, including anxiety, depression and opioid use disorder, worsened during the pandemic.
Research like this shows the clear need to follow patients in the weeks and months after even mild COVID diagnoses and to seek quick treatment for any emerging disorders, the experts said. “If we apply attention to it now and nip it in the bud, we could literally save lives,” Al-Aly said.
More than 18 percent of COVID patients developed mental health problems, compared with 12 percent of those who did not have COVID, according to the study published on Wednesday.
The study followed more than 153,000 patients who tested positive for COVID in the Veterans Affairs health system between March 2020 and January 2021, and compared them with other health records: to 5.8 million people who did not test positive in that time, but lived through the same stresses of the pandemic, and with 5.6 million patients seen before the pandemic.
Among all patients who developed new mental health problems during the pandemic, the COVID patients were significantly more likely to develop cognitive problems (80 percent), sleep disorders (41 percent), depression (39 percent), stress (38 percent), anxiety (35 percent) and opioid use disorder (34 percent), compared with those who didn’t have COVID.
The study looked only at patients with no history of mental health diagnoses in the past two years. It compared those hospitalized for COVID versus other illnesses, and compared outcomes to thousands of flu cases. The study also adjusted for factors like demographics, other health conditions and other factors.
The results were all clear: COVID has a marked effect on mental health.
Those with more severe cases of COVID, especially those who need to be hospitalized, tend to be at higher risk. But even those with mild or asymptomatic cases were more likely to receive mental health diagnoses.
“People who were hospitalized had it worse, but the risk in non-hospitalized [patients] is significant and absolutely not trivial – and that represents the majority of people in the US and the world,” Al-Aly said.
The study did have some limitations: most of those analysed were older white men. But controlling for race, gender and age found no changes in risk.
The coronavirus can be found in the brain, other studies have shown. “We can actually see the virus in the amygdala, in the hippocampus – the very centres responsible for regulating our moods, regulating our emotions,” Al-Aly said.
The study adds to other research showing that “mental health issues are a huge concern” after COVID, Jackson said. And the results line up with what he sees among patients.
“We’re learning that COVID may be even more problematic and more impactful than we thought,” Jackson said.
Early treatment of patients facing new or additional mental health challenges after COVID can make a crucial difference, the experts said.
“The idea here is to identify patients’ data early to hopefully reduce this from becoming a much larger problem down the road,” Al-Aly said. “If you leave a disease unattended, it only gets worse.”
But the longer the virus continues circulating, the more long-term problems it may create – adding even greater pressure to health systems.
“The wave of people with mental health disorders is going to be hitting the clinics in the next year or two or three, as a result of COVID and as a result of the pandemic,” Al-Aly said.
And many mental health practitioners don’t accept insurance, creating a large stumbling block for patients, while others have long waiting lists.
“This is a gigantic problem, and I’m not really sure what we’re going to do about it,” Jackson said. “The needs are vastly greater than the resources.”
Jackson has set up peer support groups to offer counselling to patients dealing with long COVID – brain fog, cognitive impairment, memory problems, feelings of inadequacy. The groups are held on Zoom, so patients can join from all over the country.
“We need to pay attention to the long-term consequences of COVID,” Al-Aly said. “If we only pay attention to the short-term consequences, the first 30 days or the first 90 days, we really, really are missing the larger picture.
“The pandemic itself caught the US unprepared, and we’re going to be caught unprepared again for long COVID,” Al-Aly said. “The reality is that COVID is producing long-term consequences, and we cannot just wish it away or sweep it under the rug or not deal with it.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
