COVID-19 has contributed significantly to decline in physical and mental health.

River Walk in Lisbon, Portugal. (Dr. Noorali Bharwani)
River Walk in Lisbon, Portugal. (Dr. Noorali Bharwani)

Alberta Medical Association (AMA), as part of advocacy and engagement with the public has a website (albertapatients.ca) which is Canada’s largest online community for patients to share their thoughts.

AMA engages in dialogue with approximately 13,500 Albertans about health care issues. AMA’s latest survey, fielded May 19 to 27, 2021 asked about people’s worries and priorities regarding their health care. AMA received more than 4,700 responses.

AMA recently shared their findings with the members of the association. AMA says, “The results are sobering: lifestyle and livelihoods (for many) have shifted dramatically, contributing to a significant decline in physical and mental health.”

Here are the important points:

  • More than half of respondents (52 per cent) report that their physical health has declined since the start of the pandemic (15 per cent say their health is now much worse). This is up eight per cent since November 2020 and tends to be more prominent in those under the age of 54 years, and those who have a chronic medical condition. The top reasons cited for the decline in physical health are: harder to exercise, fear of going to a health care provider, and not socializing.
  • The impact COVID-19 has had on the mental health of Albertans is troubling. Sixty-four per cent of respondents report a decline in their own mental health since the start of the pandemic.
  • Twenty-three per cent say their mental health is much worse now. This is more common response among women than men, those under the age of 55, and those with a chronic medical condition.
  • Forty-seven per cent struggle with social isolation, while others cite concerns about finances and the security of their jobs, along with concerns for their own or their family’s health.
  • Only seven per cent of respondents say their mental health has improved since the pandemic began.
  • There is anxiety and depression due to care deficit on individuals who are waiting for treatment. Especially patients who are waiting for cancer surgery, chemotherapy, and radiotherapy.

The deterioration in mental and physical wellness that Albertans are reporting may be a prelude of what is to come. With significant financial deficit the government will have to find more money to play catch-up. As COVID-19 retreats, there will be no automatic reset to what was before the pandemic.

An article in the Canadian Medical Association Journal (CMAJ June 7, 2021 – Postpartum mental illness during the COVID-19 pandemic) highlights the difficulties faced by women after child birth. In Ontario, visits for mental health conditions in the postpartum period increased markedly from March 2020.

The authors of the article observed increased use of nonacute care services for postpartum mental health in Ontario during the first few months of the pandemic, suggesting that self-reported mental distress has translated into increased help-seeking for postpartum people.

The authors of the article suggest health systems should focus proactively on patients from high-risk groups, monitor waiting lists for care, and explore creative solutions to expand system capacity, with special attention to postpartum patients who may be experiencing barriers to care. With the extensive use of virtual care, further evidence regarding the safety and effectiveness of virtual treatment for postpartum mental illness should be sought.

As we can see the health care delivery has changed dramatically in the last year and a half. I doubt whether things will return to the old ways. Doctors will have to find creative ways to assess and treat patients.

Take care. Be safe. Don’t take unnecessary chances. The highly contagious Delta COVID-19 is likely to become dominant in Alberta. So, we have to be careful.

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What are the long-term effects of COVID-19?

Capilano Suspension Bridge in Vancouver, BC. (Dr. Noorali Bharwani)
Capilano Suspension Bridge in Vancouver, BC. (Dr. Noorali Bharwani)

With mass vaccination in progress, we look forward to post-COVID days. While we look forward to post-COVID era, we should not forget people who have been sick with COVID-19. Do we know how they are doing? What are the long-term effects of COVID-19?

What about all the people who have died because of COVID-19?

Here are the Canadian statistics as of June 3, 2021: total number of cases of COVID-19 1.4 million, total number of deaths 25,000.

Good news is Alberta is steadily climbing towards its vaccination goal for lifting COVID-19 restrictions, with nearly 65 per cent of eligible Albertans having received their first dose.

The province expects to lift all COVID-19 restrictions by the end of June or early July, two weeks after 70 per cent of Albertans aged 12 and older have received one dose of the vaccine.

What about those who have been diagnosed with COVID-19?

Recommendations are that people be vaccinated regardless of whether they already had COVID-19. If you are fully vaccinated, after two weeks you can resume activities that you did prior to the pandemic keeping in mind the guidelines set by your province.

What about people that have recovered from COVID-19? Are there any long-term effects?

Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions, says an article in the Centre for Disease Control and Prevention (CDC) website dated April 8, 2021.

CDC continues to work to identify how common these longer-term effects are, who is most likely to get them, and whether symptoms eventually resolve. Multi-year studies are underway to further investigate post-COVID conditions. These studies will help us better understand post-COVID conditions and understand how to treat patients with these longer-term effects.

Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus.

Even people who did not have symptoms when they were infected can have post-COVID conditions. These conditions can have different types and combinations of health problems for different lengths of time.

Types of Post-COVID conditions:

1. Long COVID
Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms.

2. Multiorgan Effects of COVID-19
Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.

3. Other effects
Effects of COVID-19 treatment and hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that remain after a critical illness. These effects can include severe weakness and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.

The best way to prevent these long-term complications is to prevent COVID-19. In general, people are considered fully vaccinated two weeks after their second dose in a two-dose series. If you were diagnosed with COVID-19 and are experiencing long-term complications then you should contact post-COVID care clinics. These clinics are opening at medical centers across Alberta and Canada. Your family doctor can help you with that.

As the saying goes, prevention is better than cure: wear a mask that covers your nose and mouth, stay two meters apart, get vaccinated, avoid crowded areas, and wash your hands frequently.

Enjoy the camping and BBQ season safely.

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Understanding the risk of COVID-19 for individuals with underlying medical conditions.

Alcatraz, San Francisco. (Dr. Noorali Bharwani)
Alcatraz, San Francisco. (Dr. Noorali Bharwani)

On Tuesday May 18, Canada reported 25,000 COVID-19 deaths. Unfortunately, this is not the end. There are many hot spots in the country.

Although we are making progress in terms of immunization and controlling the spread of the disease, the worst is not over yet. I feel we need to keep talking about this until we are in full control of the situation. Otherwise, nobody will be able to enjoy the summer or Christmas.

If you do get sick with severe COVID-19 then one or all of the four things will happen. You will be hospitalized, you may end up in intensive care unit, you may end up on a ventilator to help you breathe or you may even die. Nobody wants to be in this situation.

Who is at most risk?

We are learning more about the risk factors for severe COVID-19 outcomes.

Older adults are more likely to get severely ill from COVID-19. More than 80 per cent of COVID-19 deaths occur in people over age 65, and more than 95 per cent of COVID-19 deaths occur in people older than 45. Unfortunately, misinformation, isolation and fear are among the reasons why about 17 per cent of Albertans over 70 haven’t gotten first dose of COVID-19 vaccine.

Residents of long-term care facilities make up less than one per cent of the population but account for more than 35 per cent of all COVID-19 deaths.

Studies have shown COVID-19 does not affect all population groups equally. Your risk of getting sick and dying from COVID-19 goes up if you have long-standing disabilities and systemic health issues and/or belong to a racial and ethnic group. The risk increases as the number of underlying medical conditions increases in an individual.

A study published in Infectious Disease (December 10, 2020) titled Risk Factors Associated with In-hospital Mortality in a US National Sample of Patients with COVID-19 drew the following conclusions:

  1. Thirty per cent of inpatients and 70 per cent of outpatients diagnosed with COVID-19 had no comorbidities. That means these were all healthy individuals.
  2. Most common comorbidities were hypertension 46.7 per cent, hyperlipidemia 28.9 per cent, diabetes 27.9 per cent, and chronic pulmonary disease 16.1 per cent.
  3. Twenty per cent of inpatients with COVID-19 died in the hospital.
  4. Very old age (80 years) was the risk factor most strongly associated with death.
  5. Pre-existing medical conditions significantly are associated with increased odds of in-hospital deaths. Examples are: metastatic cancer, history of heart attack, heart failure, anemia, stroke, dementia, diabetes and COPD.

What can we do?

Take this pandemic seriously. For yourself, your family and the general public. Most people do take this seriously and follow the rules: get vaccinated, wear a mask, practice social distancing, and hand hygiene.

In general, older you are, more health conditions you have, and more severe the conditions, higher the risk of dying. It is very important to take preventive measures.

We are all in this together. One for all and all for one. Stay safe and stay healthy. Follow the rules.

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Psychological Effects of COVID-19 on Healthcare Workers

Columbia Icefield (Dr. Noorali Bharwani)
Columbia Icefield (Dr. Noorali Bharwani)

Statistics show as of January 15, 2021, there were 695,704 COVID-19 cases in Canada. Of those, 65,920 (9.5 per cent) were healthcare workers. Twenty-four healthcare workers had died from COVID-19 by that date. Since then, more doctors and other healthcare workers have contracted the disease or have died.

In Alberta, there were 7,986 COVID-19 cases in healthcare workers, which made up 6.9 per cent of the total cases. There were four COVID-19 – related healthcare worker deaths.

That raises the question: How can healthcare workers practice the best possible medicine under extraordinary circumstances?

Every Alberta healthcare worker is exposed through work in in-patient units that are likely to admit Covid-19 patients together with healthcare workers working in family medicine, emergency medicine, ambulatory care or in walk-in clinics.

Besides being exposed to COVID-19 there is psychological burden. Overall wellness of healthcare workers has received increasing awareness, with research continuing to show high rates of burnout, psychological stress, and suicide.

With this kind of burden, health care workers experience emotional exhaustion, which may lead to medical errors, lack of empathy in treating patients, lower productivity, and higher turnover rates. This has been seen not only in Alberta or Canada but all over the world. How is this going to affect them down the road is not known.

What can we do to help healthcare workers?

We should make sure we provide uninterrupted, quality care to healthcare workers when they are sick. They should be encouraged to take care of themselves.

We should understand that when we take care of ourselves, we are helping the doctors and other healthcare workers to take care of people who are sick.

We should follow the principles laid down by our government and healthcare professionals to prevent the spread of the virus: maintain social distance, wear a mask, wash our hands frequently, avoid parties and social gatherings and take care of our family and friends.

We should mitigate the impacts of COVID-19 on mental health by protecting and promoting the psychological wellbeing of healthcare workers during and after the outbreak. We should not forget them after the pandemic is over.

Following are key points mentioned in an article published in the Canadian Medical Association Journal (CMAJ April 27, 2020) titled “Mitigating the psychological effects of COVID-19 on healthcare workers”:

  1. Combating fears and uncertainties by strong leadership with clear, honest and open communication.
  2. Bolster individual self-efficacy and confidence by providing adequate resources (e.g., medical supplies) and mental health support.
  3. Provide psychosocial support while preserving physical distancing.
  4. Healthcare workers should be complimented for serving for greater good in times of crisis.

Doctors, other healthcare workers and the general public is stressed for several reasons: uncertainty about the duration of the crisis, social misinformation, lack of proven therapies, and shortages of healthcare resources, including personal protective equipment. Add to that are the effects of social distancing balanced against the desire to be present for their families, and the possibility of personal and family illness.

We cannot overlook the impact of COVID-19 on healthcare workers. Since there are no easy solutions to the current problems, mitigation strategies for all scenarios are vital to ensure psychological wellness and in turn ensure a healthy and robust clinical workforce. We are all in this together.

One for all, all for one. Take care.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!