Mitigating Second-Order Impacts of the COVID-19 Pandemic

The devastating consequences of the COVID-19 pandemic have no doubt left a lasting impact on the world as COVID-related deaths continue to climb with each day. The U.S. continues to combat the spread of COVID-19 as we experience a rapid rise in Delta variant cases among the unvaccinated, even as much of the general public embraces vaccination as a means for protection against COVID-19 infection. However, while COVID-19-related deaths and hospitalizations continue to be the most notable immediate effect of the pandemic, second-order impacts — i.e. situational health consequences resulting from pandemic-era restrictions — also are plaguing individuals around the world, both worsening many health conditions and creating new ones. Even as practices must continue to handle COVID-19 infections, it’s important that practices also begin preparing to mitigate the downstream effects of the global crisis.

Recognizing and understanding many of the most common second-order impacts will help practices and healthcare professionals better care for current and future patients. Below we will explore six common health-related consequences of pandemic restrictions and provide actionable advice for how practices can address these issues.

1. Delayed screenings

   Medical professionals know that delayed diagnosis of many ailments can lead to adverse outcomes—that fact is nothing new. Unfortunately, with pandemic restrictions, screenings for many common medical issues were put on hold, directly affecting physicians’ ability to detect diseases for early intervention.

2. Delayed “elective” surgeries and procedures
   “Elective” surgery does not always mean “optional” surgery, and while many of these surgeries and procedures may have been considered nonurgent at the time, leaving these issues unaddressed can lead to worsening issues. Progression is a key feature of many surgical procedures, and the burden of disease continues to accumulate while patients await surgery, sometimes leading to advanced issues and even death.
3. New and worsening mental health disorders
   According to a U.S. Census Bureau Household Pulse Survey, more than 40% of adults have reported symptoms of anxiety or depressive disorder during the pandemic, up from 11% in 2019. A KFF Health Tracking Poll from July 2020 also revealed an uptick in specific negative mental health and well-being impacts, including difficulty sleeping or eating, increase in alcohol or substance abuse, and worsening chronic conditions due to worry and stress over the pandemic.
4. Delayed childhood vaccination
   Restrictions and risks associated with the COVID-19 pandemic have adversely affected routine childhood immunization as many parents found it increasingly difficult to maintain scheduled wellness checks for their children. According to a study conducted by the National Center for Biotechnology Information (NCBI), nearly one-quarter of parents surveyed reported a delay of more than one month in the immunization of their child, 60% citing fear of COVID-19 infection as the most common reason. This delay in childhood vaccination leaves children vulnerable to many vaccine-preventable diseases, potentially leading to community outbreaks.
5. Increased instances of downstream health impacts associated with food insecurity
   Stress and poor nutrition can make disease management particularly challenging. During the pandemic, many Americans suffered from financial hardship and/or an inability to access nutritional food. According to Feeding America, in 2019 the overall food insecurity rate was the lowest it had been in more than 20 years, but those improvements were upended by the pandemic and recent projections predict a continued trend of elevated levels of food insecurity across the nation.
6. Care interruption for patients with chronic diseases
   As a result of pandemic-related restrictions, most practices saw a reduction of chronic care activities, and this care disruption left many patients vulnerable to new and worsening issues and ailments associated with their chronic conditions. Resources in practices and hospitals shifted toward an effort to contain the pandemic and minimize direct consequences, translating into reduced access to necessary chronic disease management.

How Doctors and Medical Practices Can Address Second-Order Impacts

To effectively address many of the above concerns, it’s critical for practices to reengage their patients and follow up with missed and cancelled appointments. In particular, documentation will play a key role in this engagement. EHR and EMR patient management systems can help practices track cancellations and no-shows while monitoring the conditions each of these patients were being seen for. Additional suggestions and resources can be found in our recent article, “Reengaging Patients During the COVID-19 Pandemic.”

Telemedicine also remains an effective tool for physicians to meet with patients with greater ease as compared to an in-office visit. However, it’s important for practices and healthcare providers to keep in mind that licensure requirements, waivers, and payment parity may be affected in days to come. More information on that topic is available in our recent article “COVID-19 Public Health Emergency is Now Ending: What Does This Mean for Telehealth?”

With necessary follow-up and greater accessibility, it’s possible for physicians and practices to address second-order impacts and ensure patients remain healthy in the post-pandemic era. If you have any questions on this topic, please call 800-662-7917 to speak with one of our risk management experts.